An Open appeal to Doctors Opposing Right to Health Bill of Rajasthan

Dear Healers:

We would still use healers for the fraternity of doctors, as that is your prime occupation, to heal people, bodily and mentally. You continue to be member of a most respected community. A famous member of your fraternity, Dr Rudolf Virchow had said that doctors are attorneys of the poor. We know that those less fortunate among us suffer a disproportionate burden of disease and disability. Ironically, they have also the least means to access good quality healthcare. That has led to a situation where poor citizens of the country have much higher burden of diseases, and deaths. Their children are much more malnourished and sicker.

We believe that society and the state (government) has the responsibility to do all it can to reduce these disparities, to stand with our own brethren, and to heal them. Doctors, Nurses, paramedics, pharmacists, technicians, community health workers and other healthcare providers have a huge responsibility here. Dr Bidhan Chandra Roy, who is founder of your Association, was once jailed in Alipore Jail as a first class prisoner. However, he demanded a rigorous imprisonment so that he could be with other less fortunate inmates. He started treating them in jail, and even bought medicines from his own money, as some of these drugs were not available there! Such was his selfless commitment to healthcare for those who could not seek it!

All civilized societies ensure that when a person meets with a medical emergency, he should not be worried whether he has the money to access healthcare. This extends to a woman facing an emergency that may be fatal for her or her unborn child. You know it better than we do, that many women continue to lose their lives when faced with such an emergency, especially amongst those who have the least means. Making health care a right is in line with the Constitution’s fundamental right to life, directive principles on health and international human rights conventions to which India is a signatory. It is a legal and policy mechanism to ensure that the state bears responsibility for ensuring health care access.

The Right to Health Act, by committing that everyone will have the right to access free and quality healthcare, irrespective of their ability to pay is therefore a step in the direction of ensuring Universal Health Coverage (UHC), which also is part of India’s national and international commitments. It has the potential to ensure that people are able to manage their healthcare needs, especially when faced with an emergency, with dignity and without falling into a debt trap. You are aware that expenditure on healthcare is one of the most common reasons for people falling in poverty in India and in Rajasthan

We know that having an act does not ensure that it would change things on the ground. However, they are signals that we care for those who have less means. They also provide a constitutional framework which allows citizens to question, to appeal, and to ensure that the government keeps it promises.

We know that you are opposing the bill because you fear that you may be forced to provide free health care, putting you under financial stress. We have thoroughly reviewed the act. The Act is applicable to only government health facilities for all provisions of the act, except for emergency clinical care. Hence government facilities will need to be upgraded to provide the care that the government commits in this act. The private sector is not bound to provide routine clinical, preventive, promotive or rehabilitative care as per this Act. Only in case of defined medical emergencies is the private sector expected to provide care and not deny the same in case the patient is unable to pay. This is also in line with an earlier Supreme Court order (in the Parmanad Katara versus Union of India AIR 1989, SC 2039), and subsequent Law Commission Report (201St report titled, Emergency Medical Care to Victims of Accidents and during emergency medical condition and women under Labour, August 2006).

For providing such cashless emergency care, the Act provides for reimbursement to private facilities. How would this be carried out is something that the Rules will clarify further. As of now, existing provisions such as Chiranjeevi Yojana (which covers more than 80% of the state’s population), and Chief Minister’s Accidental Insurance Scheme do cover most of the emergencies.

We are at a historic crossroads, where through the Act, we are saying that disparities in healthcare are not acceptable. That it is unfair that many people in the state, our own brethren, continue to suffer from avoidable deaths and disability. That through the Act, we are committing as a society to end this, and do all we can do. Or we may oppose it for our own petty interests. The choice is ours.

We, the concerned doctors, and civil society representatives from Rajasthan and across the country are writing to appeal you to rise above our interests and affiliations, and constructively engage with the Act and formulation of its rules, so that we can proudly contribute to health and well-being of all. We would end with this hymn ” Sarve Bhavantu Sukhinah, Sarve Santu Niramaya” – May all be well, may all be free of disease. Let us put our sincere effort towards achieving this goal.

Dated: 27 March 2023

Signatories:

1. Akash Dongre, Final Year Medical Student, UCMS
2. Akhila Vasan, Karnataka Janaarogya Chaluvali
3. Aleena Rodrigues- St. John’s Bangalore
4. Alisha Kalyanpur- PGI Chandigarh
5. Dr. Ally Malar I.
6. Dr. Amar Jesani, Independent consultant and teacher, Bioethics/Public Health
7. Dr Anand Bharathan, Surgeon,Tamilandu
8. Dr Anand Zachariah, Christian Medical College, Vellore
9. Dr Anusha Agrawal, Resident doctor
10. Amita Pitre, Public Health Practitioner, Mumbai
11. Bijoya Roy, Public Health Researcher, Delhi
12. Dr Badakere Rao, Family Physician, Bengaluru
13. Chhaya Pachauli, Jan Swasthya Abhiyan
14. Dr Deepak Badhani, Surgeon, Uttarakhand
15. Dr Devendra Tayade, doctoral student, Kozhikode
16. Prof DVR Seshadri, ISB Hyderabad & Equitable Access to Healthcare Consortium
17. Evelina Jane- CMC Vellore
18. Dr Evita Fernandez, Obstetrician, Hyderabad
19. Dr Harsh, CMC Vellore
20. Dr Gargi Goel, Primary care Physician, Rajasthan
21. Dr Gayathri Anand, Primary Care Physician- Tamilnadu
22. Jagdish Patel, Peoples Training & Research Centre, VADODARA
23. Kavita Srivastava, Social activist, Rajasthan
24. Dr K Sujatha Rao, ex-Union Secretary, Health and Family Welfare
25. Karuna M., MNI, Chennai
26. Lekha Rattanani, Editor, Foundation of the Billion Press
27. Dr.Mahtab S. Bamji, INSA Emeritus  Scientist, Dangoria Charitable Trust,Hyderabad
28. Dr. Mohan Rao, former professor at the Centre of Social Medicine and Community Health, JNU, New Delhi.
29. Dr. Mohit P. Gandhi – Faculty, Azim Premji University, Rajasthan
30. Dr Mira Shiva, New Delhi
31. Dr Narendra Gupta, Jan Swasthya Abhiyan, Rajasthan
32. Nikhil Dey, social activist, Rajasthan
33. Nirupama Vijaykumar- Manipal Hospitals Bangalore
34. Dr Nandkumar, Gudalur Adivasi Hospital
35. Dr. Nidhin Joseph, Mumbai
36. Dr Pankaj Tiwari, Physician, Chattisgarh
37. Dr Parth Sharma, Delhi
38. Dr Pavitra Mohan, Physician, Rajasthan
39. Dr Prabir Chatterjee, Physician, Bankura, WB
40. Dr Prakash Tyagi, Physician, Rajasthan
41. Dr Rajalakshmi RamPrakash, Chennai
42. Dr. Rakesh Biswas, Independent Researcher
43. Dr Ramakrishna Prasad, Family Physician, Bengaluru
44. Dr Ramani Atkuri, Independent public health professional, Bengaluru
45. Dr Ravi Narayan, Community Health Adviser, SOCHARA,
46. Dr Regi George, Tribal Health Initiative, Sittilingi
47. Ronel Joseph- Gudalur Adivasi Hospital
48. Royson Dsouza- CMC Vellore
49. Sana Contractor, Public Health Researcher
50. Dr Sanjana Brahmawar Mohan, Rajasthan
51. Sayyed Ali, Ujjain, MP
52. Sayan Roy, Program Associate, SHRC Raipur.
53. Dr Shilpa Khanna, Anaesthtist
54. Dr Sharad Iyengar, Public health physician, Rajasthan
55. Shramna – Communications and Documentation lead, Kolkata
56. Shriyuta Abhishek, Public Health Researcher and Practitioner
57. Dr Shyamsundar Raithatha, Community Physician, Gujarat.
58. Siddhartha Das, Hyderabad
59. Dr Sonali Vaid, co-founder, Inclusive labs
60. Dr Srimathi, Vellore
61. Dr Sunil Kaul, Founder, The ANT, Assam
62. Dr Sunita Sheel Bandewar, Founding Trustee, Vidhayak Trust, Pune.
63. Dr Vidit Panchal, Madhya Pradesh
64. Dr Thelma Narayan, SOCHARA
65. T. Ramakrishnan, Sathyamangalam, Erode Dt., TN
66. Dr Vasundhara Rangasamy, Public Health Physician, Vadodara
67. Dr Yogesh Jain, Public health physician, Chattisgarh