Context: Terming the right to health as a fundamental right which includes affordable treatment, the Supreme Court on Friday said it is the duty of the state to make provisions for affordable treatment during this unprecedented pandemic. "Right to health is a fundamental right guaranteed under Article 21 of the Constitution of India. Right to Health includes affordable treatment. Therefore, it is the duty upon the State to make provisions for affordable treatment," the court said. A three-judge bench of Justices Ashok Bhushan, R Subhash Reddy and MR Shah had taken up the issue of healthcare during the time of the pandemic on its own and also looked at instances where bodies of coronavirus casualties were not handled with dignity. The top court asked the government to devise a mechanism to give rotational break to doctors and healthcare professionals working continuously since April. On behalf of the Centre, Solicitor General Tushar Mehta assured the court that the government would take a decision in a day or two. The court also directed the authorities to conduct more testing and to declare correct facts and figures. In this edition of The Big Picture we will analyse the observation of the Supreme Court on affordable healthcare.
COVID-19 triggered an introspection of India’s Healthcare System

• Treatment and Viewing of Healthcare System: The headlines of the tragic loss of lives, the exponential increase in cases, economic morass and social disruptions have emerged a deeper subtext on how the healthcare sector is viewed and treated.
• Emergence of Reports on Healthcare’s Problem: The pandemic has raised reports on longstanding problem of healthcare workers protesting the shortage of equipment, patients charging doctors and hospitals for profiteering, policy makers issuing edicts against providers and reported cases of hoarding of essential medicines.
• Increasing lack of interest between stakeholders of the Healthcare System: The growing lack of trust between patients and their doctors and providers and the wider mistrust between policy makers and the industry found fresh ground during the pandemic.

Is India’s Public Healthcare systems prepared to handle community transmission?
India would struggle to deal with a situation similar to that in Italy or the other European countries. There are three primary concerns which would prove to be a roadblock:

• The diversity and variance in needs of every region, would not allow India impose a unitary set of rules. Each region would have to be assessed and given a separate set of exemptions under lockdown, depending on the needs.
• The partnering of the Indian Government with the private stakeholders is very crucial as 70% of the medical care provision in India is through the private sector and the rest 30% through the Government.
• High-end tertiary medical care is the real challenge. High-end tertiary medical care is quite expensive and would prove to be a long drawn process for patients. It is doubtful as to which extent the Government would be able to rely on schemes such as Aayushman Bharath. 
• The urban areas would be at a slight advantage than the rural areas in terms of surveillance and containment of the infection. 

Status of India’s Healthcare Sector

• The general perception behind the inadequate provision and availability of healthcare services is attributed to the country’s developing nation status.
• India lags behind its BRICS peers on the health and quality index (HAQ index).
• As per the National Health Profile 2018, India’s public health spending is less than 1 per cent of the country’s GDP, which is lower than some of its neighbours, countries such as Bhutan (2.5 per cent), Sri Lanka (1.6 per cent) and Nepal (1.1 per cent).
• According to the World Health Organisation, India finishes second from the bottom amongst the 10 countries of its region for its percentage spending of GDP on public health.
• As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh, 2.11 in Chile, 1.38 in Mexico, 4.34 in China and 8.05 in Russia.

Doctor Patient Ratio

• Studies and Survey reveal that in India, there is one government doctor for every 10,189 people (the World Health Organisation recommends a ratio of 1:1,000) implying a deficit of 6,00,000 doctors.
• The nurse:patient ratio is 1:483, implying a shortage of two million nurses.
• India today needs twice as many doctors as are available, three times as many nurses and four times as many paramedics.

What is the status of the Public Health System in the Country?

• India has a strong surveillance system in the country. It is called the Integrated Disease Surveillance Programme. It is already active in all the districts of the country and would aid in quick detection of cases and providing accurate information regarding the spread of the infection. 
• India has also deployed a rapid response team in all the districts.
• Thus, currently, India is doing its responsibility of early detection and response, however, the availability of infrastructure such as ventilators and isolation beds might prove to be a problem in India.

What measures has India taken to strengthen its Public Health System?

• India’s PHS in the face of epidemics is quite strong as India has repeatedly faced a number of such infections. Eg. Swine flu epidemic, Polio etc.
• India has improved with every challenge it has faced. The Integrated Disease Surveillance Network has strengthened over the years and has now been put to use in all districts providing for 100% coverage.
• Indian Council of Medical Research (ICMR) is the apex medical research council in India, has created a testing capacity in India without waiting for the caseloads to increase before enhancing the testing process, demonstrating preparedness.
• The testing laboratories were initially localized to ICMR labs and the National Institute of Virology, but are now expanding. 49 additional laboratories would be constructed and established within the Government system in non-ICMR facilities, thereby involving DRDO, DBT and CSIR.
• All the systems have come together to prevent India from transitioning to the third stage of infection- Community Transmission.
• Social media advisories are a very important pillar of the public health response to COVID-19.
• The Indian Government has started the India Epidemic Intelligence Service Training Programme, in 2012. This training programme trains epidemiologists in epidemiology skills.  

How can the front-line healthcare workers be supported?

• The Government has come up with a plan to support the healthcare workers who would need protection against the infection while working.
• As it is estimated that about 20 percent of the frontline healthcare workers contract the infection themselves while being on the frontline of treatment.
• The regulatory arm of the Government has to come into work and ensure that the individual institutions, and the field workers are able to get access to proper protective equipment.

The initiatives to further strengthen the Healthcare system 

• Increase the overall expenditure on the public healthcare system in India.
• Build an epidemiological skill base in the country.
• Ensure the availability of enough public health manpower in the country.
• Enhance the public healthcare infrastructure whilst ensuring that the price of the services offered doesn’t increase, which is a possibility when the private sector is involved.

The PHS is composed of communities, individuals and the government. It has three levels of response:

• The Government level
• The Individual level
• The Public-Health workers
• The public has to step up and recognize their responsibilities, and ensure that India does not transition into stage three of the infection. The entire social distancing advisory has to be taken seriously by the public. 
• The initiatives have to be enhanced from Government preparedness to Community preparedness.  

Road Ahead

• Social responsibility is one of the key factors in containment of the infection. India would also have to be better prepared and work on improving its PHS infrastructure and the overall healthcare budget. India should also adopt evidence-based decision making.
• The Government is doing its part to ensure that everyone has access to quality healthcare. The Ayushman Bharat scheme covers the poorest of the poor and the government is looking to widen the scope of coverage to ensure that all vulnerable sections are covered, we need to improve infrastructure in government hospitals and rebuild faith of the people in public run healthcare system also we need to have a creative solutions inplace and work towards ensuring that people don't need to go to hospitals in the first place i.e. ensure that we improve public healthcare as a whole and we need to invest in public health and ensure that we invest in human resources as well going forward and hopefully the pandemic has taught us to do just that.