In March 21, 2023, Rajasthan became the first state to pass the Right to Health Bill in the state assembly. The Bill entitles every resident of the state to avail free of cost Out Patient Department (OPD) and In Patient Department (IPD) services in all public health facilities. Along with this, similar health services will be provided free of cost at selected private hospitals.
Responding to a debate on the Bill, state health minister Parsadi Lal Meena said the government is committed to provide health facilities to the people of the state and the Bill is in public interest. The minister said that complaints have been received that despite having the Chiranjeevi card, some private hospitals do not treat patients under the Chiranjeevi Health Insurance Scheme, and hence the Bill is being brought.
The Bill was introduced in the assembly in September last year, but was sent to a select committee. The committee gave its report, and accordingly the Bill was amended and passed on March 21.
The law states that a patient during emergency treatment such as accidents, or any other emergency decided by the state health authority, will be treated without prepayment of requisite fee. Any person who knowingly contravenes any provision of the law, or any rule made thereunder, shall be punishable with a fine of up to Rs 10,000 for the first contravention and Rs 25,000 for subsequent contraventions.
In this law, the state aims to provide protection and fulfil rights and equity in health and well-being under Article 47 of the Constitution as well as secure the right to health as per the expanded definition of Article 21 in the Constitution. The law also ensures free access to as well as equality in healthcare for all residents of the state, with a gradual reduction in expenditure incurred in seeking, accessing or receiving healthcare.
The Rajasthan model of public health may push the state into an era of improved public health, as every resident of the state is entitled to enjoy the highest attainable standards of physical, mental, intellectual and social wellbeing, which is conducive to living a life of dignity. The right to health is an inclusive right, extending not only to timely healthcare, but also to the underlying socio-economic, cultural and environmental wellbeing.
According to the law, every person in Rajasthan shall have the following rights:
(a) to have adequate, relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs.
(b) to avail free OPD services, IPD services consultation, drugs, diagnostics, emergency transport, procedure and emergency care provided by all public health institutions according to their level of healthcare as may be prescribed by rules made under this law.
(c) to have emergency treatment and care under any emergent circumstances, without prepayment of requisite fee or charges, including prompt and necessary emergency medical treatment and critical care, emergency obstetric treatment and care by any healthcare provider, establishment or facility, including private provider, establishment or facility, qualified to provide such care or treatment without delay, and in a case of medico-legal nature, no healthcare provider or healthcare establishment shall delay treatment merely on the grounds of receiving police clearance or a police report.
As per the law, the State Health Authority shall carry out the following functions:
(a) to advise the government on any matter concerning public health, including preventive, promotive, curative and rehabilitative aspects of health and occupational, environmental, and socio-economic determinants of health;
(b) to formulate state health goals and get these included in the mandate of Panchayati Raj Institutions and urban local bodies;
(c) to formulate state level strategic plans for implementation of right to health as provided under this law, including action on the determinants of healthy food, water and sanitation.
The law also deals with meetings of the State Health Authority. It says:
(1) The State Health Authority shall meet at least once in six months, by giving such reasonable advance notice to its members and shall observe such rules of procedure regarding the transaction of business at its meetings as may be prescribed by rules made under this law—provided that if, in the opinion of the chairperson, any business of an urgent nature is to be transacted, he may convene a meeting of the Authority at such time as he thinks fit.
(2) The meetings of the Authority and the mode of transaction of business at such meetings, including quorum, etc., shall be governed by such regulations as may be prescribed by rules made under this law.
The state government shall constitute an independent body such as District Health Authority, within one month from the date of constitution of the State Health Authority. The District Health Authority shall carry out the following functions:
(a) ensure implementation of the policies, recommendations and directions of the State Health Authority;
(b) formulate and implement strategies and plans of action for the determinants of health, especially food, water, sanitation, and environment;
(c) formulate a comprehensive written plan for prevention, tracking, mitigation, and control of a “public health emergency”, as well as situations of “outbreak” or “potential outbreak” in the district based on state’s plan;
(d) coordinate with the relevant government departments and agencies to ensure availability and access to adequate and safe food, water and sanitation throughout the district;
(e) organize hearing of the beneficiaries coming to the hospital once in three months with a view to improve the healthcare services.
The law also says that the state government shall prescribe a Grievances Redressal Mechanism, within six months from the date of commencement of this law. The powers of the State Health Authority and District Health Authority are:
(1) For purposes of carrying out the inquiry under this law, the State Health Authority or District Health Authority, as the case may be, may nominate one or more persons or committees, in the prescribed manner, for the efficient discharge of its functions.
(2) The State Health Authority or District Health Authority, as the case may be, shall have the power to require any person to furnish information on such matters as may the subject matter of the inquiry and any person so required shall be legally bound to furnish such information.
(3) The State Health Authority or District Health Authority, as the case may be, or any other officer authorized in this behalf by the State Health Authority or District Health Authority, as the case may be, enter in any building or place where the State Health Authority or District Health Authority, as the case may be, has reason to believe that any document relating to the subject matter of an inquiry may be found in such building or place and may seize any such document or take extracts or copies thereof:
Provided that the State Health Authority, District Health Authority or any officers authorized by it, as the case may be, shall follow the provisions of Section 100 of the Code of Criminal Procedure, 1973, while acting under this subsection.
Regarding appeal, any person aggrieved by an order of the District Health Authority passed under the provisions of this law may file an appeal in the prescribed manner to the State Health Authority within 30 days from the date of the order.
As regards jurisdiction, no civil court shall have the jurisdiction to entertain any suit or proceeding in respect of any matter which the State Health Authority or District Health Authority, as the case may be, constituted under this law is empowered by or under this law to determine.
The law also deals with the power of state government to make rules. It says:
(1) The State Government may, by notification in the Official Gazette, make rules to carry out the provisions of this law.
(2) Every rule made under this law shall be laid, as soon as may be after it is so made, before the House of the State Legislature, while it is in session, for a period of not less than fourteen days which may be comprised in one session or in two or more successive sessions and if before the expiry of the session in which it is so laid or of the sessions immediately following, the House of the State Legislature makes any modification in the rule or resolves that the rule should not be made, the rule shall thereafter have effect only in such modified form or be of no effect, as the case may be, so, however, that any such modification or annulment shall be without prejudice to the validity of anything previously done thereunder.
Health is defined as a condition of complete physical, mental and social prosperity and not only the occurrence of disease. In several cases, courts have accentuated health inside the ambit of life and freedom under Article 21 of the Constitution. The Constitution expects states to make every possible effort, within available resources, to realize the right to health. Human rights are interdependent, indivisible and interrelated and thus, violating the right to health may often impair the enjoyment of other human rights, such as the rights to education or work.
Although, Rajasthan is running popular schemes like Mukhyamantri Chiranjeevi Swasthya Bima Yojana, Rajasthan Government Health Scheme, apart from regular budget allocated to run medical colleges, associate hospitals, district and sub-district hospital, community health centres, primary health centres and sub-centres, the government desires to establish legal rights of citizens of the state to avail best of health services.
Therefore, to enhance effectiveness and implementation of the Rajasthan model of public health, the state government proactively decided to bring a legislation to safeguard the right to health. The law ensures duties of residents and also provides for a strong grievance redressal mechanism.
—By Adarsh Kumar and India Legal Bureau