"LEGAL DIMENSION OF PUBLIC HEALTH LAWS IN INDIA"
Noore Saba
B.A. LL.B. 1st Year, S & S Law College, Indore
Abstract - Society and public policy have remained interwoven since the inception of the modern state. Public health policy has been one of the important elements of the public administration of the Government of India (GOI). In order to universalize healthcare facilities for all, the GOI has formulated and implemented the national health policy (NHP).
The latest NHP (2017) has been focused on the "Health in All" approach. On the other hand, the ongoing pandemic COVID-19 had left critical impacts on India's health, healthcare system, and human security. The paper's main focus is to critically examine the existing healthcare facilities and the GOI's response to combat the COVID-19 apropos the NHP 2017. The paper suggests policy options that can be adopted to prevent the further expansion of the pandemic and prepare the country for future health emergency-like situations.
Keywords: COVID-19; Government of India, National health policy, National Health laws in India.
1 INTRODUCTION
COVID-19 has raised many questions on Indian public health policy in the backdrop of a large number of cases of infection and death. COVID-19 can be seen as a global health crisis, which has had multilateral effects on countries including the health system. It is caused by severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2).
The WHO first became aware of this new virus on 31 December 2019, following the report of a cluster of cases of "viral pneumonia" in Wuhan (China). China declared it a new type of novel coronavirus (nCoV) on 7 January 2020, and the World Health Organization (WHO) changed its name to COVID 19 on 11 February 2020. As of December 25, the WHO has reported 77,920,564 confirmed cases and 1,731,901 deaths worldwide. COVID-19 is not the first outbreak of the coronavirus; Rather, the world had experienced some other coronavirus outbreaks, such as the Coronavirus with Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Coronavirus Respiratory Syndrome (MERS-CoV), and India is no exception Epidemics and civilizations have run side by side since recorded history.
It had already resulted in several endemics and epidemics, such as measles, cholera, dengue, smallpox, including the ongoing COVID-19. A Brief History of Epidemics and Epidemics in India includes the Cholera Epidemic (1817–1899); Bombay Plague Pandemic (1896), Influenza Pandemic (1918), Polio Pandemic (1970–1990), Smallpox Epidemic (1974), Surat Plague Pandemic (1994), Northern India Plague (2002), Dengue Pandemic (2003), SARS Epidemic (2003), Meningococcal meningitis epidemic (2005), Chikungunya outbreak (2006), Dengue outbreak (2006), Gujarat Jaundice Epidemic (2009), H1N1 Flu Epidemic (2009), Odisha Jaundice Epidemic (2014), Indian Swine Flu ( 2015), Nipah (2018) and the ongoing COVID-19 (2020) pandemic, as well.
Therefore, to take care of the health issues and concerns of its citizens, the Government of India has formulated and implemented several public health policies (1983, 2002 and 2017). The main goal of the latest National Health Policy (NHP) 2017 is to provide universalization of healthcare with a “health in all” approach, but COVID-19 has worsened the health situation, leading to a large number of infected cases and deaths.
2 DEFINITION
Public health law is a field that focuses legal practice, scholarship, and advocacy on issues involving the legal authorities and duties of government "to ensure the health of people".
public good and how to balance these officers and duties with "individual rights to autonomy, privacy, liberty, property and other legally protected interests."
According to Laurence Gostin, "Public health law is the study of the legal powers and duties of the state, in cooperation with its partners, to assure the limits of the state's power to constrain the healthy living conditions and autonomy of the people, the privacy, liberty, ownership, or other legally protected interests of individuals for the common good."
Public health law refers to a statute or rule or local ordinance intended to promote or protect public health.
3 PUBLIC HEALTH LAW
Public health law includes legislative (passed by parliament) and judicial (a court decision) statements of rules or norms governing health interventions or health behaviours. Law by its nature is in the public domain.
Legislation consists of written documents setting out the rules of behavior of individuals, private and public bodies; powers of public bodies; limits on powers; and the rights of persons subject to those powers. Such a written document would be called a statute, an Act of Parliament, or an ordinance in some legal systems, and a code in other systems. There can be 'secondary' law with statute or act or ordinance or code, which has fewer powers and which explains in more detail how the legislation is to be implemented.
This secondary legislation may be called a regulation, but may also be called a code of practice or a decree or circular. What makes these written documents law rather than policy is the process by which they are prepared and the author of the state to enforce the provisions of the document.
Legislation in a democratic state is determined by a parliamentary process that enables parliamentary representatives of the public to contribute to the shaping of legislation. The procedure by which a law is made shall be clearly defined, so that any defect in the procedure would render the law invalid and unenforceable. The authority to make laws derives from public recognition of the legitimacy of the law-making body, as well as the public's belief that the law has been prescribed in accordance with the legislative process. In a non-democratic context, laws can be made by state rulers without public representation and without compliance with rules of procedure, and in such a case the law- enforcement ability derives from the power of military support rather than the rule of law. it occurs.
In some legal systems, notably those based on the Napoleonic Code, the total body of law is contained in the written documents that make up the law. Other countries such as Canada, Australia, New Zealand, India and the United States have a similar legal system.
For example, the Hong Kong Legislative Council began its approach to harm prevention from smoking by establishing the Hong Kong Council on Smoking and Health.
3.1 Importance of Public Health Laws
The main objective of international health laws is to improve the health situation at the international level.
Eliminating or reducing health risks to the global environment.
Legal intervention by creating health policies and laws
To prevent non-communicable disease, diabetes.
Introduction and management of new technologies in the field of health like biotechnology, information etc.
To prevent health risks caused by international travel.
Useful health system for proper solution.
Appropriate economic policies.
3.2 Constraints of Public Health Laws
Health laws face many obstacles at the local level,
Regional, National and International level.
It includes constraints caused by social, political, administrative and economic spheres.
In addition to these barriers, such problems related to trade and commerce, communication, technology and globalization also hinder the proper implementation of health laws.
3.3 Major Acts in India
The Pharmacy Act, 1948
The Transplantation of Human Organs Act and Rules1994
Environmental Acts and Rules
Consumer Protection Act and Medical Profession
Mental Health Act, 1987
Food Safety and Standards Regulations
The Protection of Women From Domestic Violence Act, 2005
The Marriage Laws (Amendment) Bill, 2010
The Prohibition of Sexual Harassment Of Women At Workplace Bill 2010
Food Safety and Standards (Prohibition and Restrictions on Sales). Regulations, 2011
Food Safety and Standards (Contaminants, Toxins and Residues) Regulations, 2011 4 RESULT
4.1 India's national health policies: lofty dreams
Public health has been given an important place in Indian public policy. Health policies were instrumental in deciding how health issues and concerns would be taken care of. The health policies of the Government of India began soon after independence and more precisely with the establishment of the Bhore Committee Report in 1946. In order to provide preventive and curative health systems in rural and urban areas, Bhore committee made three important recommendations in three. -level models, such as the public health system, health workers on government payrolls, and an emphasis on limiting the need for private physicians.
India's first NHP was created in 1983 to provide primary healthcare for all Indian citizens by 2000. It is mainly based on the suggestions given by the Bhore Committee. It has given priority to the establishment of a primary healthcare network using health volunteers and technology that has created a referral network and an integrated network of specialist facilities. However, since the mid-nineties, the private health sector has expanded rapidly. In the other scenario, the public health system has been reformed to conform to the private model by implementing user fees and outsourcing of services.
The second NHP, created in 2002, was developed on the basis of NHP 1983, with the goal of providing health services to the general population through decentralization, private sector access, and an overall increase in public health care spending. It has also emphasized the use of non-allopathic medicines like Ayurveda, Unani, Siddha and strengthened the decentralized decision-making processes by giving more autonomy to the states. Previous health policies have prioritized health care in the Five Year Plans, but after the implementation of the NHP 2002 for a considerable period, the health issues and concerns of the people have changed. Despite the rapid decline in maternal and child mortality rates, non-communicable diseases and some infectious diseases continue to plague the society. There are massive spending issues due to the costly healthcare system, which is currently projected as one of the major contributors to poverty in India. In addition, the improved health of the Indian economy has increased the financial capacity of the Government of India to increase its expenditure on the health sector. In this background, there is a dire need for a new health policy to fit in with the emerging health problems and challenges. Therefore, considering the prevailing internal and external scenarios, the Government of India had restructured and conceptualized its health policy NHP-2017.
4.2 National Health Policy 2017: "Health in All" Approach
The latest NHP 2017 is based on the principles of Universality, Affordability, Equity, Patient-Centered and Quality Care, Inclusive Partnership, Pluralism, Decentralization and Mobility, based on the World Health Organization's "Health in All Policies". The main objectives of this policy included strengthening people's confidence in the public health system, aligning the development of the private health sector with public health goals and quantitative targets, and progressively achieving universal health coverage (UHC). To check the successful implementation of the policy, the set targets are to be achieved in a time bound manner, such as increasing the life expectancy at birth from 67.5 to 70 by 2025, the under-five mortality rate by 2025 reduce to 23; Reducing infant mortality rate to 28 by 2019. Under the NHP 2017, it has been decided to achieve the global target of 2020, also
known as the 90:9090 target; Ensuring availability of paramedics and doctors in high priority districts by 2020; Increase in population ratio of community health volunteers in high priority districts by 2025. The most important highlight of the policy is the Healthy Citizens Campaign or "Health in All" approach which provides "Assured Healthcare for All at an Affordable Cost". The NHP 2017 reflects India's commitment to achieving the United Nations' third Sustainable Development Goals (SDGs), ensuring healthy living and promoting well-being for all. Therefore, the primary goal of NHP 2017 is to achieve the highest possible level of health and well-being for all through the promotion of preventive and health care systems; and universalizing high quality healthcare for all, despite financial constraints. The policy recommends a time-bound increase in public health spending to 25 percent of GDP. According to JP Nadda, the former health minister of India, 2.5 percent of the GDP spending target for the health sector will be met by 2025. The articulation of the goals, key policy principles and objectives of NHP 2017 is in line with India's commitment to Universal Health Coverage (UHC).
5 DISCUSSION
5.1 National Health Policy-2017: Its Contradictions
Health protection is a fundamental right in India under Article 21 of the Constitution which deals with the "right to life"; However, healthcare expenditure in India is one of the lowest in the world. The gravity of the situation is best understood by the fact that, according to the WHO Expenditure Database 2016, India ranks 170 out of 188 countries in household general government spending on health as a percentage of GDP. Although the post- liberalisation Indian economy is growing rapidly, healthcare investment is hovering around 1.6 percent of GDP in FY20162]. Although the NHP-17 is primarily associated with the United Nations SDGs, due to low spending on the health budget. India still cannot meet the SDG targets set, which ensure "healthy living and well-being for all".
India's health expenditure includes salaries, gross budgetary support to various institutions and hospitals, and transfers to states under centrally sponsored schemes such as "Ayushman Bharat'' established under the NHP 2017 1631. The health policy of 2017 has set its objective. "To improve health conditions through concerted policy action in all sectors and to expand the preventive, promotive, curative, palliative and rehabilitation services provided through the public health sector with a focus on quality". Now the question is how will the government spend 2.5 percent of GDP to achieve these lofty objectives and even without additional funding methods, the preferred method of funding health care is still general taxation. Furthermore, the policy paves the way for undermining public health systems, thus, reducing the role of government in the delivery of health services and promoting the dominance of the private sector in palliative care . Similarly, Ayushman Bharat scheme is also providing public funding for private benefit as this policy ensures publicly funded and privately managed health insurance schemes. However, the objective of the scheme is universal health coverage as recommended by the NHP-2017. Yet, it does not cover the entire population and does not cover all health expenditures resulting in different morbidity rates, mostly communicable type Under PM JAY, the states that have reported the highest hospitalization are Rajasthan. , Gujarat, Jharkhand, Chhattisgarh, and Kerala. However, the irony is that admissions in private hospitals were higher than those in government hospitals. The number of hospitals registered/listed under the private sector scheme is also higher than that of the public sector . The main argument against the PMJDY model is that government funds are being used to subsidize the private health sector, where health care spending in public hospitals is nearly double or triple. Therefore, cases of fraudulent expenditure claims in private hospitals are on the rise [66,67]
Furthermore, since poor people in India are mostly illiterate/uneducated, it is extremely difficult for them to understand the government's related insurance claims process. Due to which fraud took place in private hospitals.
While terms such as cooperative federalism are often used in policy documents, the scheme makes it almost mandatory for state governments to "cover" eligible beneficiaries as specified/identified in the Socio Economic Caste Census (SECC 2011), which naturally divert the allocated funds. To build health infrastructure/policy within the state. However, in the times of COVID-19 pandemic, 41,000 Ayushman Bharat centers are providing health services to 8.8 crore people. However, Ayushman Bharat Ben officials chose private
hospitals for their COVID-19 treatment due to low trust in government healthcare facilities [68]. During the lockdown, the number of active hospitals in both the public and private sectors dropped by about 40 per cent. According to the report submitted by NHA (2020), which assessed the impact of COVID-19 on PM JAY, the decline in hospital operations in private hospitals has led to stigmatization among hospital owners and staff due to the possibility of contracting COVID-19 infection. is afraid of. And will lose business if they want to treat patients with COVID-19. At the same time, because of the oversight of most COVID-19 treatments, shortages in public hospitals may be due to a lack of staff and resources. In this context, health facilities have proved to be inadequate to meet the requirement of cases infected with the coronavirus. Most of the government hospitals in India are Overloaded, underemployed, and unskilled.
5.2 Health Policy Options for India
Under NHP 2017, several steps have been taken by the Government of India for universalization of health facilities. However, the outbreak of COVID-19 proved that the healthcare system is not adequate/suitable for emergency situations like COVID-19. The healthcare system is still haunted by the inadequacy of medical professionals like doctors, nurses, paramedics especially in the public sector. The availability of health facilities is still not commensurate with the size of the population.
India is a developing country where the financial position to deal with the COVID-19 outbreak is not very good as compared to the US, China, UK, Russia and other developed countries. Therefore, India needs to focus on efficient development of strong health infrastructure to counter any health crisis in the times to come. This type of corona---- attributable macroeconomic vulnerability has recently been exposed in prosperous OECD countries, with high per capita health spending. Health is undoubtedly one of the most important dimensions of human life. Therefore, the Indian government needs to increase its health expenditure by at least 5-10 percent of GDP. Like other developing countries in Africa the stakes remain high given India's heavy double burden of acute infectious and chronic non-communicable diseases. Moreover, the COVID-19 pandemic has shown that privatization of healthcare is not the right solution for India. The government should regulate the functioning and expenditure charged by private hospitals. NHP 2017 may be redesigned to focus more on public healthcare rather than relying on the private healthcare sector. During the COVID-19 times, private hospitals have not performed as per the requirements of the situation. In addition, the NHP-2017 and Ayushman Bharat scheme laid emphasis on curative care, while preventive and promotive services should be given more attention. India needs to spend more on R&D to provide world class healthcare facilities to its citizens
As of now, there is no community-based strategy to deal with COVID-19.
Community-based resources such as volunteer groups and elected local officials can be used to create mass testing, isolation, and public awareness. Panchayats in Kerala and Odisha are the best examples of community-based response or organisers. Also, Andhra Pradesh has deployed village and ward volunteers for symptom-based rural and urban household syndrome surveillance and contact tracing. In addition, local authorities are involved in mental health awareness campaigns through the mass media, community leaders, and community leaders. Some states in India effectively contained clusters of infected people in their territories and showed some unique regional models, such as the Agra model (Uttar Pradesh), the Bhilwara model (Rajasthan), and the Pathanamthitta model (Kerala), each was the representative of Sending Indian states from north, west and south respectively.
Common measures across all three models include imposition of curfew in districts, barring essential services, door-to-door surveys and outdoor screening for possible cases, daily through the app for those under home quarantine. Monitor the conditions. Along with tracking them through Geographical Information System (GIS), detailed contact tracing of each of the positive cases as well as all those with whom the infected people came in contact, necessary to ensure strict lockdown rules Door-to-door delivery of services.
6 CONCLUSION
COVID-19 can be described as a global health crisis, which leaves a multifaceted impact on all aspects of life including health, economy, education etc for the entire world including India. Realizing the gravity of the situation, the Government of India had taken several remedial measures like lockdown, quarantine, social distancing etc. to deal with the inefficiency of 2021.
COVID-19. However, the COVID-19 outbreak has emerged as an eye-opener and reality check of the healthcare system created under NHP 2017. Inadequate availability of medical professionals, Le., doctors, nurses, and paramedics is still one of the critical ones.
Issues for the public health system in general and for the public health system in particular. Adequate availability of public health facilities, especially in hospitals, primary and community health centres, beds, ICUs, ventilators, etc., is still not commensurate with the size of the country's population. The expenditure percentage of GDP on public health has not reached the target set under the NHP 2017. The most important observation during COVID-19 was the inaction of the private health sectors towards COVID-19 patients, which is one of the important concerns. For NHP 2017.
NHP 2017 still has a lot to do to meet the doctor-patient ratio as per the prescribed limit. Current challenges are considerable shortage of medical professionals, low health budgets, SDG health care goals such as "healthy living and wellness for all; universal health coverage, not covering the entire population. During the pandemic, there have been higher admissions than in public hospitals."
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