Merely eight months from the Rajasthan Assembly polls, scheduled to be held in December this year, Chief Minister Ashok Gehlot is leaving no stone unturned to retain his seat. The Gehlot-led Congress government is banking on social security policies to fight anti-incumbency.
The latest in his flagship schemes is the landmark Right to Health law, which Governor Kalraj Mishra cleared on Wednesday (April 12), three weeks after the bill was passed in the Assembly on March 22.
The law guarantees better healthcare to 80 million people in Rajasthan. According to the state government, it is spending Rs 22,000 crore, which is 7.4% of the state Budget, on the health sector, whereas other states spend an average of 6%. The challenge before Rajasthan’s policymakers will now be to enforce patients’ rights while also ensuring that healthcare providers’ concerns are not neglected. If the RTH law helps Congress retain power, the 72-year-old Gehlot will be the first to break anti-incumbency in the state.
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This is not the first time Gehlot has introduced a populist healthcare welfare scheme in the state. In his previous tenure as chief minister, he introduced a free medicine scheme in the state in 2012. In his present tenure, he has launched the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, which provides free indoor patient care in all state and affiliated private hospitals. Recently, the insurance cover was increased to up to Rs 25 lakh per family. The government will pay a premium to insurance companies. The National Insurance Agency has been shortlisted for the tender.
Protests against the Act
The RTH Act is the first of its kind in India, but the road to implementing it has been quite rocky for the Rajasthan government. What sparked protests against the RTH Bill was a provision in the law that made it mandatory for public and private hospitals to offer emergency treatment to people, the cost of which the government would later reimburse. The doctors said there was no clarity on how and where this money would come from.
Around 50,000 doctors went on a state-wide protest demanding the complete rollback of the law, resulting in the crippling of private and public healthcare services. However, two weeks after the protest, on Tuesday (April 11), the state government reached an agreement with the doctors, prompting them to call off the strike. The state agreed to the major demands put forth by the doctors’ bodies, and the state Medical Education Department principal secretary T Ravikanth and the representatives of the Indian Medical Association (IMA), United Private Clinics’ & Hospitals’ Association of Rajasthan (UPCHAR), and Private Hospitals and Nursing Homes Society (PHNS) signed an MoU.
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Commenting on the way forward, Dr Sunil Chugh, president of IMA Rajasthan and one of the signatories, told The Federal that the doctors’ associations would now ensure that the rules are formed according to the MoU. “This is a huge victory for around 55,000 doctors protesting across the state. After signing the agreement, it has now become clear that at least 98% of private hospitals do not fall under RTH Act. The agreement mentions only those hospitals that have taken help from the government will come under RTH,” said Dr Chugh.
“These were the two major demands raised by us. Moreover, the regularisation of hospitals built across Rajasthan will be done based on the Kota model. The agreement also assures that police cases registered against the doctors during the protest shall be withdrawn,” added Dr Vijay Kapoor, president, PHNHS, a signatory of the MoU.
The RTH Act will cover private medical college hospitals, hospitals established on a PPP mode, those run by trusts, and those established on land allotted by the government at subsidized rates.
Govt buckles under pressure
On being asked how the Act will be implemented smoothly if 98% of private hospitals are out of its ambit, a senior government official told The Federal, “It is much early to predict the numbers. But most of the big private hospitals will come under its ambit. Also, once the rules are formed, we will try to make it more attractive so that they opt to come under the RTH Act.”
Considering the demands raised by doctors, a recent statement on RTH issued by the CM’s office reads, “The changes in the rules in the Right to Health law would be made in consultation with the representative of IMA. Also, police cases and other cases registered during the agitation will be withdrawn.”
It was also agreed that the government would consider regularising hospitals across the state following the Kota Model. As part of this model, relaxation in building rules may be given to hospitals functioning out of residential premises. The model was first launched by Rajasthan UDH Minister and Kota MLA Shanti Kumar Dhariwal.
Basic healthcare needs improvement
However, citizens and rights activists point out that even before RTH can be implemented, basic healthcare in the state needs to be improved. Suresh Vyas, a resident of Phalodi district, shared his plight during the COVID-19 pandemic.
“During COVID, we had a health emergency, and the primary health centre and sub-centre in Phalodi were not functional. We were forced to take my wife to a district hospital, which, too, lacked a ventilator and other facilities. So, I was forced to admit her to a private multi-speciality hospital in Phalodi town. By the end of two weeks, I was handed a bill for Rs 2 lakh, which I am still repaying the relatives from whom I borrowed money,” narrated Vyas.
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“If the government wants to keep hospitals with fewer than 50 beds out of the laws’ ambit, then it should improve infrastructure in the hinterlands so that people, especially in the desert districts where distances are huge, do not need to travel,” added 45-year-old Vyas. The government has agreed to exclude private multi-speciality hospitals with fewer than 50 beds from the RTH Act.
Healthcare rights activists in Rajasthan, while welcoming the end of the impasse arising out of the private hospitals’ protest against the RTH Act, also expressed concern about the smooth implementation of the law across the state.
A lot to be done
“Though some private hospitals are now out of the purview of the law, there should be no compromise with the core commitment of the Act, which is to strengthen the public healthcare system,” said Dr Narendra Gupta of Jan Swasthya Abhiyan (JSA) Rajasthan. He also pointed out that the state government should make adequate budgetary allocation for the implementation of the law.
Chhaya Pachauli, another healthcare rights activist with JSA, said: “The government must make basic primary health services available within a half an hour’s walking distance for everybody, comprehensive primary health services not requiring hospitalization for more than 24 hours within 12 km, all emergency medical care, including blood transfusion facility, that can be covered by any motorized vehicle within an hour, and all kinds of speciality and medical services within 150 km.”
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Ahead of the 2018 Assembly polls, Congress had promised the Right to Health Act in its manifesto. The government introduced the Rajasthan Right to Health Bill, 2022, on September 22. It was sent to a 16-member committee headed by state Health Minister Prasadi Lal Meena. On March 22, the amended Bill, approved by the committee, was passed by the state Assembly. On Wednesday, the Act finally got the Governor’s nod.
(The author is a senior journalist based in Rajasthan reporting on politics, gender, human rights, and issues impacting marginalised communities. She tweets @tabeenahanjum.)