Rajasthan Right to Health Act, 2022

Chhaya Pachauli*

JSA Rajasthan played a crucial role as a pressure group advocating for the Act right from persuading political parties to committing to bringing such an Act in their 2018 state election manifestos, to consistently advocating for it and engaging with the government post elections in the drafting of the Bill.

All this was done while also countering the anti-Act rhetoric publicised by the groups opposing such an initiative. It was JSA Rajasthan which provided the first blueprint of the Bill to the newly formed government by the Congress Party in 2019. The party had committed to bring the Act in their election manifesto.

While health is a state subject in India and the states have the power to legislate laws guaranteeing the right to health, no state came forward to do so until Rajasthan passed an Act on the right to health, titled ‘Rajasthan Right to Health Act, 2022’ on March 21, 2023.

The Act is thus a significant development in the sphere of health in the country and is being hailed as a pivotal step towards ensuring universal healthcare. However, the rules of the Act are yet to be framed and with the change in the government in the state after the recent elections, the future of the Act remains uncertain.

The Journey

The Rajasthan Right to Health Act 2022 which happened as a result of a long-standing demand and sustained advocacy efforts by civil society groups, particularly Jan Swasthya Abhiyan Rajasthan (JSA Rajasthan), along with the political will exhibited by the then government, had a tumultuous journey of its own marked by two years of severe pandemic and massive protests by doctors against the Act.

“The private sector hostility to the Act had begun to build up in the state”

Followed by the JSA blueprint and a series of deliberations, the government put up the first draft of the Bill in March 2022 in the public domain for suggestions. The draft though was a much diluted version of what JSA had proposed. The private sector hostility to the Act had begun to build up in the state right since then which later transformed into a nationwide Anti Right to Health Act movement. The Bill was first tabled in the state legislative assembly on September 21, 2022. Followed by vehement protests by various groups of private medical practitioners including the Indian Medical Association (IMA), the Bill was referred to a Select Committee for reconsideration the next day. The Committee took into account the concerns raised by the agitating doctors and made multiple amendments in the Bill in their favour, which also led to more dilution in the provisions of the Bill.

The amended Bill was then tabled in the Assembly on March 21, 2023 for discussion and was passed the same day. The agitating doctors though were still not convinced and called to escalate their protest until the Bill had to be withdrawn. The initial protests by the private doctors which were marked by rallies and temporary suspension of the government’s Chiranjeevi and Rajasthan Government Health Scheme (RGHS) soon turned more vigorous. A complete shutdown of private hospitals and laboratories across the state was announced, thus systematically paralysing health care services in the state. The government, however, stood its ground. Following negotiations with the agitating doctors, compromises were made and an agreement was reached on April 4, 2023 bringing things back to normal after over two weeks of vehement protests and a complete shutdown of private health services across the state.

Salient Features

The Rajasthan Right to Health Act 2022 in its preamble refers to

“Treatment for medical emergencies (comprising accidental emergency and snake or animal bite cases) cannot be delayed or denied by any health institution on the grounds that the patient wasn’t able to make an advance payment.”

Article 47 and Article 21 of the constitution and aims to protect and fulfill rights and equity in health and also to provide for free accessible and equal healthcare for all residents of the State with “progressive reduction in out-of-pocket expenditure in seeking, accessing or receiving healthcare.” It must be noted here that although titled ‘Right to Health Act’, the provisions in the Act largely cater to enhancing access to healthcare and safeguarding patients’ rights rather than addressing the various determinants of health. So the Act is more appropriately a Right to ‘healthcare’ Act rather than a ‘right to health’ Act.

The Act is also majorly focused on strengthening the public healthcare system and hardly talks of regulating rates or standards in healthcare under the private sector. This is contrary to what was being falsely propagated by the agitating doctors. The only section in the Act which could have had some financial implication on the private healthcare sector, and which had also been a major reason of contention among the private doctors, is section 3(c) of the Act which mandates that treatment for medical emergencies (comprising accidental emergency and snake or animal bite cases) cannot be delayed or denied by any health institution on the grounds that the patient wasn’t able to make an advance payment. The section was later expanded by the Select Committee to also include that if the patient is unable to pay for the emergency care so received from a private healthcare provider, the government would reimburse the payment on the patient’s behalf. Apart from this, most of the other sections in the Act are directed towards revamping the public healthcare system, and others cater to safeguarding patients’ rights in both public and private health institutions as also laid down in the ‘Patients’ Rights Charter’ of the National Human Rights Commission (NHRC). Thus, the narrative publicised by the agitating doctors that the Act would financially drain private healthcare providers and sabotage private healthcare in the state was baseless.

One of the most important provisions in the Act is the right to receive all OPD and IPD services including drugs, diagnostics and emergency transport free from all public health facilities. This provision is crucial in terms of realising

“Some of these loopholes were inherent in the draft of the Bill, the others ensued from the amendments made by the Select Committee under pressure from the agitating doctors.”

the aim of enhancing access to treatment and reducing out-of-pocket expenditure on healthcare which the preamble of the Act outlines. The other crucial provision is the right to receive emergency treatment and care for accidental emergency and emergencies due to snake bite/animal bite without prepayment of requisite fee or police clearance (in case of a medico-legal case). This applies on both public and private health institutions. However, following the agreement between the government and the agitating doctors, this provision may now apply only on select private hospitals as discussed later.

The Act also obligates the government to set standards for healthcare delivery and make adequate budgetary allocations for health. It lays down the rights of the patients to have access to their medical records and itemised bills; to have the company of a female person if a female patient is being examined by a male practitioner; to have information about the rates and charges of the services; to be able to choose the source of obtaining medicines or tests; to be able to seek second opinion and not be denied treatment summary in case the patient leaves the medical establishment against medical advice etc.

The Act further states that the rules of the Act would specify the responsibilities and duties of the patients and the rights and responsibilities of the healthcare providers. It also obligates the government to develop and institutionalise human resource policy, set up quality audit and grievance redressal mechanisms and ensure that there is no direct or indirect denial of guaranteed public healthcare services.

The Act stipulates the constitution of two State Health Authorities (One for logistical grievances and the other for treatment protocols) and one District Health Authority at each district. These Authorities are meant to advise the government, monitor the implementation of the act, policies and programs and to also function as appellate authorities to adjudicate on the patients’ grievances.

The Act also has the provision of penalty of up to twenty-five thousand rupees if anyone knowingly contravenes any provision of the Act.

Main Weaknesses

While the Act is quite comprehensive and holds some significant provisions directed towards revamping the public healthcare system, protecting patients’ rights and augmenting transparency and accountability in the health systems, it leaves certain loopholes which are quite concerning. While some of these loopholes were inherent in the draft of the Bill, the others ensued from the amendments made by the Select Committee under pressure from the agitating doctors.

A major drawback in the Act is that it applies only to the residents of Rajasthan. This would mean that a large section of the vulnerable population including migrant laborers, refugees, nomads, homeless etc. who do not have proof of residence would be out of its ambit. This amounts to discrimination and violates the spirit of equity emphasised in the Act’s preamble.

The other area of concern is the composition of the State and District Health Authorities listed in the Act. The members of these Authorities are solely government officials and representatives of government medical colleges and IMA. Civil society, public health experts, people’s representatives, patients’ groups and even the paramedics whose representation is extremely crucial to ensure that these Authorities function in a fair and impartial manner have all been kept out of it. While public health experts and public representatives were included as members of these authorities in the initial draft of the Bill, they were eliminated by the Select Committee in the amended version succumbing to the demand of the agitating doctors to not have any non-medicos or ‘outsiders’ in these Authorities.

The Select Committee in its amendments also eliminated the provision of patients being able to file complaints through web portal and helpline. As per the Act, the complaints can now only be filed in writing to the concerned health facility in-charge. This would certainly deter a lot of patients from raising grievances.

Also, the Act leaves a lot to be specified in the rules and doesn’t provide any clarity on the budgetary allocation, the standards of care which would be adopted and the timelines for fulfilling various obligations, thus making it seem vague and ambiguous in many places.

The Act has further been compromised by the settlement between the government and the agitating doctors. Based on the agreement, the Act would now apply only on private hospitals with more than 50 beds, private medical college hospitals, hospitals being run on PPP

“While it has generally been observed that there’s a serious undermining and neglect of schemes, programmes and laws introduced by the outgoing government as the new government takes over”

model and those which have availed free or subsidized land or buildings from the government. This would mean that a large number of private hospitals in the state would not fall under the ambit of the Act.

Challenges and the Way Forward

It’s disappointing that even after over eight months of the passage of the Act, its rules haven’t been framed as yet without which the Act only remains on paper and its implementation stays in limbo. With the change in the government in Rajasthan after the recent legislative assembly polls with BJP taking over Congress it would be interesting to see how the new government

responds to the Act. While it has generally been observed that there’s a serious undermining and neglect of schemes, programmes and laws introduced by the outgoing government as the new government takes over, one can only hope that this Act would be given the attention it deserves and that the rules would be framed at the earliest.

How the rules are framed would be crucial for the future of the Act. The process must widely engage experts and representatives beyond the bureaucratic and medical realm to make it more patient-centric and to align it effectively with the ground realities and practical challenges that inhibit access to healthcare and curtail patients’ rights. Civil society, public health experts, people’s representatives and patient groups must therefore be taken on board. A fair implementation of the Act would also require gradual but adequate enhancements in budgetary allocations and adequate deployment of human resources. It would also be crucial to generate wide awareness about the Act and its various provisions both among the health care providers and the people at large.

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