Research Proposal

The Struggle for Right to Health in India: Movement, Strategy and Challenges

Module: 710 M9 Research Design

Term: Spring 2020

Word Count: 2582

Research Question and Gap
The puzzle this study looks at is the lack of a right to health legislation in India despite there
being a nationally coordinated campaign for it since 2000. This is a puzzle because in the last
two decades, particularly between 2004 and 2014, under United Progressive Alliance-I & II
(UPA-I, UPA-II), several national campaigns resulted in rights-based legislations. Right to
Health campaign (RTHC) remains an exception.
The string of rights-based legislations have been studied (Chopra 2014; Nielsen and Nilsen
2016; Ruparelia 2013). The rights-based legislations were Right to Information Act (RTI)
2005, Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) 2005, Right
to Forest Act (RTF) 2006, Right to Education Act (RTE) 2009, and Right to Food Security Act
(RFS) 2013. These legislations were at least partially the result of nationally coordinated social
movements advocating for legislations (Nielsen and Nilsen 2016; Ruparelia 2013). RTI had
National Campaign for People’s Right to Information (NCPRI), RTF had Campaign for
Survival and Dignity (CSD), MGNREGA had CSD and People’s Action for Right to Work
(PARW), RTE had National Alliance for Fundamental Right to Education (NAFRE), and RFS
had Right to Food Campaign (RTFC). However, despite Right to Health Campaign being
launched in 2000 by Jan Swastha Abhiyan (JSA), the Indian chapter of People’s Health
Movement, there has been no legislation of a Right to Health Act in any states of India. This
study attempts to find out why the campaign has not led to an Act.
The main research question of this project is ‘Why has the right to health campaign in India
not led to a Right to Health Act?’

There are three sub-questions under the main research question. They are-
1) What are the perceptions of key actors on the characteristics, strategies and challenges
of RTHC in India?
2) What are the characteristics of successful rights-based campaigns in India?, and
3) What are the characteristics of successful health rights campaigns internationally?
It is important to note that in sub-question 1, ‘key actors’ include leaders of RTHC, bureaucrats,
journalists, and leaders of philanthropic groups investing in health. In sub-questions 2 and 3,
the word ‘successful’ denotes the ability of the movement to legislate a constitutional right. It
is also important note that in all three sub-questions, the word ‘characteristics’ refers to both
contextual and inherent characteristics. Inherent characteristics include strategies adopted by
the campaign and framing of issues among others. Contextual characteristics include political
opportunities, international pressure, and political ideology of the government among others.
Using the answers of all three sub-questions, the common characteristics among successful
movements will be compared with the characteristics of RTHC in India. This analysis would
allow us to infer which contextual and inherent characteristics of the RTHC in India shares
with other successful rights movements and which characteristics are missing. Through such a
comparative analysis, the study can arrive at a possible explanation for India not legislating a
right to health act.
The hypotheses for the research question are-
1) The inherent characteristics of successful campaigns inferred from the analysis of other
campaigns were not present in RTHC
2) The contextual characteristics of successful campaigns inferred from analysis of other
campaigns were not present in RTHC
3) Both, necessary inherent and contextual characteristics of successful campaigns
inferred from analysis of other campaigns were not present in RTHC
Currently, there is very limited literature on RTHC in India (Abhiyan 2006; Nandi 2018;
Shukla 2008). The available literature does not detail the strategies of the national level
campaign but speaks more about the national goals and state-level experience with policy
advocacy. There has been no study of the campaign strategies, drafting of right to health bills
at state-level and reasons for the lack of a right to health legislation so far.
Literature on RTI and RTE suggest that creating alternative public spheres at the state-level,
support from eminent activists, international pressure and public interest litigations play an
important role among other factors (Baviskar 2010; Pande 2014; Rosser and Joshi 2018).
Literature on health reforms in South Africa and Brazil strongly suggest the importance of
public litigations and broad networks in engendering constitutional amendment for right to
health (Heywood 2009; Shankland and Cornwall 2007; Weyland 1995).
This study is crucial for three reasons: to help trace the trajectory of RTHC, understand how
the strategies and framing of demands changed over regimes, third to understand what could
explain the lack a right to health legislation in India. Right to health is a part of the Constitution
as a Directive Principle of State Policy, a policy that the state must work towards achieving,
but it has not yet been legislated. Ensuring the legislation of right to health can give legal
legitimacy to claims for equity in access to health.
Currently, the Indian government is increasingly privatizing healthcare, particularly curative
health, which is increasingly putting the burden on the private sector to achieve public goods
(Lahariya 2018). RTHC demands the strengthening of the government’s role in public health
service delivery and is against expanding privatization (Abhiyan 2006; Nandi 2018). In the
analysis of the subject, I will also attempt to find out where other actors such as private
hospitals, bureaucrats and donors position themselves in the struggle for right to health.

Conceptual Framework
I will be primarily using the analysis of Right to Information and Right to Education
legislations to analyze rights-based legislations in India. Using the literature on social
movements and looking at the ‘long arc of activism’ I will explore the initial phases of the
movements leading up to the legislation. In the international case studies I will study the right
to health movements in South Africa and Brazil.
In order to understand the state, I will use Migdal’s conception of the ‘anthropology of the
state’ which recognizes the fragmented form of the Indian state and the contradiction between
different levels of the state, creating opportunities for the social movement (Migdal 1994).
Given that India is a federal state and the framing could be different in each state. I will look
into cases of successful movements at the sub-national level, such as the states of Madhya
Pradesh and Rajasthan. In order to understand the strategies adopted by the right to health
campaign I look at Hung’s concepts of state resisting and state engaging strategies (Hung 2013;
Pande 2014).
To understand when the state was receptive to the rights based social movements, I will use
the concept of political opportunities (Marks and McAdam 1996). Political opportunity
structures which explain the success and failure of social movements. The concept of political
opportunities will help me understand how rights-based legislations were enacted between
2004 and 2014, how political opportunities changed post-2014. Additionally, the concept will
be used to understand how the Madhya Pradesh and Rajasthan members of JSA were able to
draft Right to Health Bills in their states in 2019.
In order to understand how the right to health movement changed the framing of its demands
under different government I will use Leach and Scoone’s theories of framing (Leach and
Scoones 2007). I will be using the ‘theories of framing’ approach to understand if the goal of
‘health for all’ was framed differently during regime changes in 2004 and 2014. At the
beginning of the movement, a conservative- NDA was in power, until 2004, when the centrist-
UPA came to power, and 2014 when NDA-2 came to power. The framing of the problem might
have changed during these regime changes and this theory will help analyze that.
I will additionally look at law as an ‘arena of struggle’ between actors from society and State
who debate over the ‘construction, use and experience’ of law when discussing the drafting of
the bill in Rajasthan and Madhya Pradesh (Hunt, Harrington and Brigham 1993). I believe
these frameworks will help me understand the nature of the movements, the strategies adopted
to engage with different levels of the state, political opportunities the movement used, how it
framed its concerns with changing regimes and worked on legislating an act.
In order to compare the cases of India, South Africa and Brazil, I will use Heller’s ‘Moving
States’ since the article compares social movements in Brazil, South Africa and India(Heller
2001). It provides a framework to compare the three countries in the context of social
movements.

Research Strategy
In order to answer the research question and the sub questions, the study will involve Key
Informant Interviews (KIIs) and analysis of literature. The KIIs will be used to answer the first
sub-question: the right to health movement in India. The leaders of the right to health
movement will be interviewed including leaders from Rajasthan and Madhya Pradesh who
have drafted bills for the right in the states. This will provide information on the perspective of
the activists regarding their understanding of right to health, history of the movement, strategies
adopted, political opportunities perceived, challenges faced, conflicts related to drafted the bill
and reasons for right to health not being legislated with other rights based legislatives during
UPA-1 and UPA-II.
Additionally, heads of prominent donor agencies, former bureaucrats from the health ministry,
lawyers, and health journalists who have tracked the movement will be interviewed. Heads of
donor agencies will give insights on international funding for right to health, donor concerns
about right to health, government’s health policies and about their approach to right to health.
Bureaucrats will inform the study about how the government perceives the right to health and
why it did not get legislated between under any of the regimes since 2000, particularly between
2004 and 2014.
The interviews of the lawyers will inform the study about the interpretation of the right to
health by the Indian judiciary and the Indian state. It will also inform about the way the
judiciary and legal fraternity has participated in extending or denying the right to health. The
interviews of journalists will give the media’s perception of the movement, right to health and
its role in the movement. These interviews will provide key insights from actors who have
information on how the state perceives the claims of the movement for health and will allow
this study to understand what are the forces driving the interests of the government regarding
health policy making.
In order to answer the sub question on what are the characteristics of successful rights based
movements in India, I will explore literature analyzing the long arc of activism in RTI and
RTE, strategies adopted, nature of the movements, framing of the demands, forming of the
national level coalitions, role of eminent activists. I will also refer to literature from other rights
based movements in India (Baviskar 2010; Nielsen and Nilsen 2016; Pande 2014; Rosser and
Joshi 2018).
In order to answer the second question, I will use secondary literature to understand what
characteristics made the right to health movements successful in all those cases. This will
involve looking at literature analyzing the history of the movements, the networks formed, the
nature of the movement, the strategies involved, external actors, and the nature of the regimes
under which right to health became constitutional, political opportunities the movement
utilized. I will particularly refer to Patrick Heller’s ‘Moving States’ to study the right to health
movements in South Africa and Brazil(Heller 2001; Heywood 2009; Shankland and Cornwall
2007; Weyland 1995).
After finding answers for both the sub questions, I will compare the essential characteristics
drawn from the first sub question and compare them to the characteristics of the right to health
movement in India. This will help me understand which characteristics the right to health
movement shares with the RTI and RTE movements and which characteristics are missing.
Secondly, I will compare the essential characteristics found in right to health movements in
South Africa and Brazil to the characteristics found in the right to health movement in India to
see the missing characteristics. By assimilating all the characteristics I will be able to answer
the question of why did the right to health movement not translate to a right to health act in
India
In case, I am unable to collect primary data for this analysis, I change the scope of the first sub-
question to limit the exploration of strategies, drafting of bills and perception of other key
actors on the campaign. I will go through the annual publications of the JSA to understand the
goals, campaigns, press releases, networking, strategies adopted to work towards right to
health. And I will use secondary literature to understand how the framing of the demands
changed under different regimes. The second and the third sub-questions are solely dependent
on secondary literature, so they will not be affected by the possible unavailability of primary
data in the form of KIIs.
My positionality as a researcher previously involved in the RTHC is beneficial and detrimental
to the study. My previous association with the campaign is beneficial since it gives me better
access to the leaders of the movement and insights into the movement, but this association
might also bias my findings towards not allowing for harsh criticisms to be made about the
movement, particularly with regards to finding shortcomings in the inherent characteristics of
the campaign. By including interviews of journalists, bureaucrats and other key actors, I will
be able to position the campaign more objectively. My findings will be generalizable to other
rights based movements in India, however due to my analysis of right to health movements
being limited to two countries, the generalizability of findings regarding right to health
movements might be limited.
With regard to timeline and ethics, I have already submitted my ethical review application. I
will begin the interviews in the third week of June and complete them by the first week of July.
I will get the consent of each interviewee before conducting the interviews and before I submit
my dissertation. The interviewees will have access to the final draft with their quotes and inputs
for them to state if they believe they have been misquoted.

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