Health Regime In India With Special Reference to Study of The Impact Of

Covid-19 On Health Care System

Kulraj Kumari*

Abstract : The current global pandemic of Covid-19 needs a public health strategy that
places a great importance on epidemiology, Particularly in terms of understanding the cause
as well as identifying appropriate population based behaviour. It is essential to realise that the
covid-19 pandemic has initially spread in well developed countries that have achieved so
called health transition. The virus on the other hand makes no distinction between rich and
poor.it is a big threat to a country like India, where 65 to 68 % of the population lives in rural
area and the country has the highest overall disease burden in the world.

Keyword. Covid-19 , Health care System, Right to health, ,Pandemic, Right, Treatment.

Introduction

In the midst of delving into one of the most contentious topics that has changed over time and
has profound implications for basic ethical principles and, most crucially, the sanctity of life,
Thomas Jefferson1's wise remark::

“The care of human life and happiness and not their destruction is the first and only
legitimate object of good governance.”

A right to life is the right to have or strive for whatever one needs to live, as long as doing so
does not infringe on the rights of others. Each of us has a right to health, privacy, food,
livelihood, and education in a free, democratic society. But have we ever considered what it
is that guarantees us of these rights? All of this is guaranteed by the Indian Constitution under
Article 211

These eighteen words safeguard our right to life, implying that no one can harm us and get
away with it, and that we cannot be deprived of our personal liberty without our consent. This
indicates that a person's life and liberty can only be contested if he or she has committed a
crime. This article aims to examine the elements of Article 21 in the context of the current
circumstances, taking a broad view of the right to life, health, education, food, and privacy.
Citizens' fundamental rights have been entailed since the start of the lockdown. Despite some

*Research scholar, Panjab University, Chandigarh.

1

“No person shall be deprived of his life or personal liberty except according to procedure established by law.”
sensible initiatives from state governments, enforcing them has been tough.

The following are some of the aspects of Article 21 that are relevant to the current pandemic:

Right to Health

In 2017, a private member's bill was proposed to add a new article 21B to the Constitution,
making the right to health a fundamental right. It says that, “the state shall provide a system
of health protection to all citizens, including prevention, treatment and control of diseases and
access to essential medicines.”2 financial statement has not attached with the bill. It is not
wise to proceed with the Bill without any homework on financial liability.

In the current situation, our nation's health and welfare are in jeopardy, bringing the
Fundamental Right of "Right to Health" into sharp focus. Those infected with Covid-19, as
well as those working in the medical field, are all entitled to health and medical care in the
same way..

While fundamental rights cannot be denied due to a lack of funds, it is an unfortunate reality
that public health demand huge expenditure. The Supreme Court refused to make all Covid-
19 tests free of charge within the first month of the lockdown in 2020, in the case of
Shashank Deo Sudhi v. Union of India3The Court appeared to be influenced by two factors,
namely —(a) making health scheme a policy matter, (b) the financial constraints cannot be
ignored, (c) poor and needy persons are given Covid-19 treatment and tests free of cost under
Aayush and other government schemes. Many news articles claim that Covid-19 sufferers are
rushing from one hospital to the next. For various reasons, many hospitals refused to admit
Covid-19 patients. Recently, in the case of In Re Contagion of Covid-19 Virus In Children
Protection Homes4 the supreme court given the direction to the central Govt. for proper
2
*Research Scholar, Panjab University, Chandigarh.
Art. 21 B - (1) The State shall provide health protection to all citizens which shall include; (a) prevention,
treatment and control of diseases; (b) access to essential medicines; (c) maternal, child and reproductive health;
(d) access to basic health services; (e) access to emergency medical treatment; and (f ) access to mental
healthcare.
Provided that the State in such manner as deemed fit, shall provide the above objectives for every citizen by
earmarking not less than eight per cent of the annual estimated receipts of the State for healthcare, available at:
http://164.100.47.4/billstexts/rsbilltexts/AsIntroduced/21B-E-151217.pdf (last visited on june 19, 2021).

3
2020 SCC OnLine SC 358
4
June 11, 2020. Prior to this a detailed order was passed on April 3, 2020, 2020 SCC OnLine SC 354,
treatment of children and Covid-19 patients in protection homes.

However, the government lacks the medical equipment needed to contain a pandemic of this
magnitude. The state is unable to provide for both, from the lack of testing kits required to
assess patients with Covid-19 to the lack of proper Personal Protective Equipment required
for the safety of healthcare staff. Right to live with human dignity under procedure
established by law enshrined in Article 21 of the constitution which includes right to health.
The Supreme Court in M.C. Mehta vs. Union of India 5 has recognised right to healthy
environment as a fundamental right in the first instance and right to health and health care are
derived from that. Right to medical facilities and right to health is collateral of the right to
health as a part of the right to life under Article 21 of Indian Constitution .Article 21 does not
provide any special rights to the patients but the patient’s rights are arising from the relevant
provision of Indian constitution. Medical treatment of patients and right to health are the
Human rights as well as fundamental rights of citizens. The Supreme court in case of Balram
Prasad vs. Kunal saha6 has observed nursing homes, hospital, clinic are liable to provide
treatment to best of their capacities to all patients. Doctors are to dealt strictly in case of
negligence.. Every human has the fundamental right to enjoy attainable standard of health.
The exceptional health crisis aroused because of covid-19 which proved the Indian Health
care infrastructure and scientific offerings exist in abroad and India insufficient.

Health Care System in India

The Indian health care system is divided between the state government and central
government, according to Indian federal system (1) The Union Ministry of Health and Family
Welfare heads the programs to be implemented, which can be eventually adopted by the state
government, while the state government overlook and concerns the public health system
within the state. The state and central governments have worked together to maintain a high
level of health at the national level. India's health-care infrastructure is separated into three
levels: primary, secondary, and tertiary health-care centre. Sub-centre for marginalized
communities, rural, and urban areas are included in primary-level health centre for disease
prevention and health promotion. Primary health centre are a major priority of the 2017,
National Health Policy, with two-thirds of resources allocated to their construction, building

5
1987 AIR 1086, 1987 SCR (1) 819
6
CIVIL APPEAL NO.2867 OF 2012
and maintenance as the initial point of contact with individuals7.

Community health centre for medical specializations, surgeries, and radiological equipment
are examples of secondary-level health centres. University and district hospitals make up
tertiary-level health centres, which provide specialist medical services. In India, private
health facilities are mostly secondary and tertiary level centres. Ayurveda, Yoga and
Naturopathy, Unani, Siddha, and Homeopathy, commonly known as AYUSH, are part of
Indian healthcare system8.Certified practitioners of AYUSH are recognized as authorized
healthcare professionals and deal with herbal, ergonomic, and traditional medicine-based
therapies for diseases9.

India obtained a “CCC” overall rating and was ranked ninth out of nine countries in the Laura
Miller ranking system, indicating that its health system requires significant improvement.
Furthermore, since 2006, the Indian government has consistently spent only 3.5 % of its
overall gross domestic product (GDP) on health.10 This percentage is roughly half of WHO
member states' overall global GDP spent on health systems, as well as the average current
health spending by BRICS nations, both of which are 6.3 per cent. According to the National
Sample Survey, Ministry of Statistics and Program Implementation 2013–2014, OOP
accounts for about 65 % of overall health expenditure in India. However, according to the
Central Bureau of Health Intelligence's National Health Profile, the government's public
expenditure (GPE) for health is only 1.28 % of total government revenue, implying that
private health expenditure and out-of-pocket payment (OOP) are extremely high11.

Universal Health Coverage Global Monitoring Report by WHO12 summarized that Indians
were spending nearly 80 per cent of their household income on medications. Long-term
7
WHO. Primary Health Care. Available online: https://www.who.int/india/health-topics/primary-health-care

8
Ministry of AYUSH. 2020. Available online : https://main.ayush.gov.in

9
Ministry of Health and Family Welfare. National Health Profile of India—2019; Central Bureau of Health
Intelligence, Ed.; Government of India: New Delhi, India, 2019.
10
Global Health Observatory Data Repository. Current Health Expenditure (CHE) as Percentage of Gross
Domestic Product (GDP) (%) Data by Country.
11
Ministry of Health and Family Welfare. National Health Profile of India—2019; Central Bureau of Health
Intelligence, Ed.; Government of India: New Delhi, India, 2019
12
WHO. Primary Health Care on the Road to Universal Health Coverage, 2019 Monitoring Report; WHO:
Geneva, Switzerland, 2019.
hospitalization necessitates the borrowing of assets and/or the use of income savings to cover
treatment costs, resulting in the patient's impoverishment. Ashman Bharat Pradhan Mantri
Jan Arogya Yojana (AB PM-JAY) was launched in 2018, covering 40%t of the poorest
population in India has one of the world's biggest health-care insurance systems, with the
goal of reaching universal health coverage13. The lack of health-care providers is a big worry,
as there are only 35 doctors, nurses per 10,000 people, and just one allopathic public doctor..
Patients are more likely to visit private health facilities than governmental health facilities
because private health facility14. give better health care and quality. Furthermore, private
health facilities create a monopoly in rural areas, where people pay more for services than
they do in metropolitan areas15.Gender parity is important, as male patients pay about more
than female patients due to demographic, socioeconomic, and discriminatory factors16.
According to OECD data, India has 0.5 beds per 1000 person, compared to China's 4.3 beds
per 1000 person17.

Impact of Covid -19 on health care system

The World Health Organization declared COVID-19 to be a pandemic on March 11, 2020 ,
after it spread from China to the rest of the world in December 2019. The asymptomatic
transmission of COVID-19 has made it difficult to pinpoint the exact source of viral
dissemination. India's rigorous point-of-entry screening may be ineffective in preventing the
epidemic from spreading because the authorities only used thermal scanning for symptomatic
travelers, ignoring asymptomatic passengers as disease carriers.

COVID-19 research is primarily coordinated by the Indian Council of Medical Research

13
National Health Authority. Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana. Available online:
https://pmjay.gov.in/

14
Ministry of Statistics and Programme Implementation. Sustainable Development Goals National Indicator
Framework Baseline Report, 2015–2016; Ministry of Statistics and Programme Implementation, Ed.;
Government of India: New Delhi, India, 2019.
15
Thakur, R.; Sangar, S.; Ram, B.; Faizan, M. Quantifying the burden of out-of-pocket health expenditure in
India. Public Health 2018, 159, 4–7.
16
Saikia, N.M.; Bora, J.K. Gender difference in health-care expenditure: Evidence from India human
development survey. PLoS ONE 2016, 11, e0158332
17
OECD. Hospital Beds (Indicator). Available online: https://data.oecd.org/healtheqt/hospital-beds.htm
(ICMR), which is at the forefront of medical research in India. The ICMR is looking into test-
kit production and distribution, pharmaceutical use, daily case counts, and virus-fighting
procedures 18.

All stages of the research and guidelines have been made public and kept up to date. COVID-
19 is now tested using an RT-PCR nasal and/or throat swab, with testing probes imported
from the United States by ICMR-NIV. Non-US FDA EUA/CE IVD kits have also been
validated by the ICMR for fast commercial use in India [24].Registered physicians, medical
officers, and AYUSH practitioners should report any suspected COVID-19 cases to the
district surveillance unit. COVID-19 rapid antibody kits, on the other hand, test positive for
SARS-CoV-2 infection r. Despite the fact that the COVID-19 test can cost around INR 4500,
the ICMR has called for the tests to be made free or significantly subsidized, particularly for
private laboratories [25,26].With the covid-19 pandemic putting even the world's most
developed healthcare systems to the test, India's health-care system has been affected as well.
Both the private and public sector collaborated in the overall response to the Covid-19
pandemic. Isolation beds for treatment and all the support that the Government needs e.g.
medical staff have been provided by the private Indian health care system.so the private
sector has a key role in the battle of Covid- 19. This pandemic has a huge impact on national
economy and livelihood of poor and rich .it is a responsibility of major private sector to
contribute to the meeting of challenge of immunise Indians so as to mitigate the burden off
the govt. shoulder for it to better focus on the unprivileged, poor and those at high risk. Indian
private health care system has made a considerable contribution, accounting for over 60% of
inpatient care. Most private hospitals began their plans in reaction to the Covid-19 pandemic
which includes considerable investment in infrastructure for quarantine and treatment (the
pandemic is speculated to trim private hospitals operational profit by nearly 40 % this fiscal
year.19

India's healthcare system is inadequate, with a major emphasis on primary health care. The
country's healthcare spending accounts for 3.5 % of GDP. However, health care expenditures
account for only 1.28 % of overall government revenue, showing a substantial OOP burden.
In addition, despite rapidly growing laboratory facilities, India performs fewer tests than
other countries. The substantial disparity between modelled trajectories and existing case

18
Indian Council of Medical Research. Information of Testing Strategies. 2020. Available online:
https://www.icmr.gov.in/cteststrat.htm
19
According to Government advisory, OPDs(outpatient department) had also been closed for the whole year.
numbers could suggest the magnitude of cases that have gone undiscovered20

Shortage of oxygen and Second Wave:

In India, the second wave of COVID-19 is generating a significant rise in cases and deaths. In
every state of India, there is a shortage of oxygen in hospitals. Since March 2021, the corona
has spread quickly and been detected average of 3.5 lakh cases every day. As India struggles
to cope with a fatal second wave of the virus, medical oxygen has been in limited supply.

However, bureaucratic hurdles are preventing the critical resource from reaching people who
need it the most. It is obvious that there are two facts that have been established.

Oxygen is necessary for life, and the state cannot deprive anyone of it until a procedure has
been established to do so. It is the state's responsibility to protect its citizens' health and their
lives.With these considerations in mind, it's worth looking into legislative laws relating to
oxygen and the right to life. The government announced on April 15, 2021, that oxygen usage
was only 54% of daily production capacity. The statement went on to mention the country's
official production capacity, as well as the fact that it had excess oxygen and the methods
taken to provide it to people who needed it. Because oxygen is a drug under the Drugs and
Cosmetics Act, it is legal to produce it. The Drug Controller General of India issued a
directive in April 2020, allowing makers of industrial oxygen to apply for a license to
manufacture oxygen within 24 hours. The act's section 3(b)(i) would categorize oxygen as a
substance intended for or utilized in the diagnosis, treatment, mitigation, or prevention of any
disease or disorder in humans, in other words, to improve people's health. Section 26B of the
act also allows the government to limit or restrict the manufacture, sale, or distribution of a
drug if it considers it is necessary to satisfy the needs of an emergency emerging from an
epidemic or natural disaster, by publishing a notice in the Official Gazette. According to the
National List of Essential Medicines, 2011, oxygen is likewise an essential medicine, and its
price may be regulated by the Drugs (Prices Control) Order, 2013, meaning that its sale is
also permitted

Article 25(1) of the UDHR21 , Article 6 of International Covenant on civil and political rights

20
46.Narayanan, K.; Frost, I.; Heidarzadeh, A.; Tseng, K.K.; Banerjee, S.; John, J.; Laxminarayan, R. Pooling
RT-PCR or NGS samples has the potential to cost-effectively generate estimates of COVID-19 prevalence in
resource limited environments. medRxiv 2020.

21
Article 25(1) of the UDHR that everyone has the right to a standard of living adequate for the health and well-
being of himself and of his family, including food, clothing, housing and medical care and necessary social
196622, Article 12 of International Covenants On economic, social and cultural rights, 1966
provides right to life and medical care23.

There appears to be no legal system in place that might deprive people of their right to life
by shutting off their oxygen supply.

The preamble of the WHO states that of complete physical, mental and social wellbeing
and not merely the absence if disease or infirmity. The Organisation promotes public health
and also focus to keep the world safe from any kind of disease.

Conclusion

Governments, the courts, and, most importantly, the people of the polity must work together
to confront disasters, epidemics, and pandemics. Dr. D.Y. Chandrachud, J. rightly observed
that “Our Constitution places the individual at the forefront of its focus, guaranteeing civil
and political rights in Part III and embodying an aspiration for achieving socio-economic
rights in Part IV.”24. It's high time to add public health to the concurrent list, declare the right
to health a fundamental right, and establish a central enactment to enforce it. With India's 1.3
billion people, limited public health spending, and various COVID-19 development
estimates, the disease's influence on India's health infrastructure and economy may be
difficult to predict with precise data, but it is likely to make a dent in the current health and
financial system.

services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond his control.
22
, Article 6 of International Covenant on civil and political rights 1966 : the covenant provides that every
human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily
deprived of his life. it is a duty of the state to provide access to medical services and to give primacy to public
health. So this article provides legal protection against any malpractices and negligence.
23
Article 12 of the Covenant States that everyone who is a party to this covenant has the right to enjoyment of
the highest attainable standard of physical and mental health. Article 12(2)(c) includes prevention, treatment and
control of epidemic, endemic, occupational and other diseases. Article 12(2)(d) ensures the creation of condition
which would assure to all medical service and medical attention in the event of sickness. Therefore, this
covenant urges the member state to provide all medical access and in case of any negligence state will be held
liable to compensate victims.
24
(2017) 10 SCC 1 at para 266.