Oxfam India

Oxfam India

Section-wise comments on the proposed draft of Right to Health Act of Rajasthan State

We welcome the introduction of the Right to Health Bill by the Government of Rajasthan. This

holds the potential for protecting the lives of millions of people in the State, particularly those from

marginalized communities.

Oxfam India would like to leverage the space provided for making suggestions for the text to make

a few recommendations. The lens for the submission is from the perspective of the experience of

marginalized communities. It draws on Oxfam India‘s over a decade of experience of working on

healthcare in India from a rights-based lens. Through our recommendations, we seek to make the

Act more comprehensive, legally viable, and people-centred.

We recommend the addition of the following clauses in-

Rights of Residents

Chapter II under the „Right of Residents‟ section could be expanded to include additional

clauses that are part of the patient‟s rights charter1

Right to get basic emergency medical care irrespective of paying capacity of patient or

attendant in all health care establishments be it public or private

Right to receive treatment in public or private without any discrimination based on his or her

illnesses or conditions, including HIV status or other health condition, religion, caste,

ethnicity, gender, age, sexual orientation, linguistic or geographical /social origins.

Right to choose between alternative treatment/management options, if these are available,

after considering all aspects of the situation.

Right to affordable surgeries could be rephrased to right to care according to prescribed rates

as a whole. At the same time, the right to choose a source of obtaining medicines or tests

could be recognized.

Clause (h) in chapter II under the „Right of Residents‟ section - Right to confidentiality,

human dignity and privacy at all health care establishments as may be defined by rules made

under this act

Right of Health Care Provider

clause (c) given in chapter II under Right of Health Care Provider- decent

remuneration, working condition and training.

Duties of Health Care Provider

Chapter II under the „Duties of Health Care provider‟ section needs to be expanded

to include- Providing protection to participants involved in Clinical Trials, biomedical and

health research

Obligations of the Government

Chapter III- Obligation of the Government needs to be broken down to spell out the roles of

individual tiers of the government – viz state, district, block and Panchayati raj levels. This would

be critical to fix the responsibility and accountability of these individual structures who have

different roles with respect to the delivery of the right to health.

It would also be important to define the role of the existing structures and bodies with a role

for the delivery of healthcare in the state such as PRIs, VHNSCs, district and state Authority

Body under CEA, etc. which are constituted under the constitution, health policy or part of existing

health programme interventions. The proposed structures/bodies under this act would need to be

linked to existing constitutional structures/bodies.

The RtH would need to eventually help to identify the accountabilities of the concerned

officials with a role in public health including frontline health workers, medical staff, and health

1 http://www.clinicalestablishments.gov.in/WriteReadData/3181.pdf

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officials working at each level i.e. from village to state. Defining the responsibility of each service

provider will help to fix accountability and improve the implementation of the proposed act.

Hence, more specifically, the RtH Act needs to not only spell out the broad responsibilities of the

Rajasthan government and the rights of its citizens but also help to fix appropriate accountability

and delineate the mechanisms/processes to be taken to ensure the same.

Clause (c) given chapter III- Obligation of the Government. We recommend the following

change in the text “Within one year, lay down and notify standards for quality (IPHS standards)

and safety of all levels of health care as notified under the rules‖. It would be desirable to notify a

set of existing public health standards as the standards of quality. The IPHS standards could form

the basis for the laying down of the standards for the state.

It would be critical to add the following clause in chapter III- Obligation of the Government.

Within one year, set up the mechanism for regulation of private health care establishment as

notified in the rules under the Act.

In order to not only provide more clarity but also avoid misinterpretation of the following key

terms, there is need to specify or elaborate on the following terms used in the given draft-

- Appropriate state budget

- Notify standard for quality and safety of all levels of health care

- Co-ordination mechanisms among the relevant government departments

Chapter- VI Penalties and Procedures- The suggested punishable fine in Rupees needs to be

linked with inflation.

We are looking forward to considering and including the above recommendations in the act by the

state government of Rajasthan. Along with asking for recommendations, the state government

should conduct a consultation with various stakeholders including CSOs working on Health Rights

at pan India. The proposed consultation/meeting will provide space for dialogue for sharing the

views on the drafted act and will enable the state government in finalizing the drafted act in

consultation with various stakeholders.

For further communication -

Dr. Nitin Jadhav, Program Coordinator-Health, Oxfam India, New Delhi

Contact details- [email protected]; 9923107623

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AMITY INSTITUTE OF BIOTECHNOLOGY 1. Till date treatment of rare diseases are not covered by Govt of Rajasthan like Wilson's Disease. The disease is rare, earlier patients were dying undetected but now health care professionals are sensitive/intelligent enough to detect the disease. Even medicines for patients of Wilson are not available in Govt supply, how is this Act going to protect the rights of the residents of the state? The treatment of rare disease being costly, the Act must clearly state that the cost of such treatment will be taken care of by the state. 2. Treatment for rare diseases are not covered under the CM Chiranjeevi Scheme. The scheme (CM Chiranjeevi Scheme) should also be mentioned in the act as a financial source to support health care of the residents of the state. 3. Similar to this Celiac disease patients are also increasing in the state, the state should promote gluten free products and provide gluten free food material at subsidised rates. 4. Grievance redressal system is literally poor. Rajsampark portal is useless. If you make a complaint, you will receive irrelevant responses. If twice you are not satisfied the complaint file will be closed. It seems by providing such a portal the Government wants to complete formalities. There must be a separate online complaint system for health care related issues and responsibilities may be fixed for certain officers to respond. 5. Hygiene and cleanliness maintenance in Govt Hospitals may also be ascertained by this Act. The penalty provisions may be added if there is any negligence in maintenance of hygiene or cleanliness in any Govt or Private hospital. (Till date public toilets are in horrible situations) 6. To facilitate the patients in overloaded hospitals proper provisions may be mentioned. Otherwise you will find long queues in hospitals at various windows of OPD/ Labs etc.

Lt. idrees khan bagaria

1. ऩहऱा सुझाव यह है कि राजस्थान िे प्रत्येि जजऱे में स्थापऩत RTPCR Lab में ऱगे सभी ऱैब technician िार्मििों िो स्थायी किया जाए और RTPCR Lab िो ऩूर्ित् जजऱा अस्ऩताऱ से पवऱय िर सुचारू रूऩ से संचाऱन किया जाए ताकि भपवष्य में आने वाऱी अनेि महामारी से असानी से ननऩटा जा सिे। और राजस्थान िे प्रत्येि नागररि िो RTPCR से संबंधधत सभी जांचों (Covid

gene detect , TB, HIV, HBV, HCV, Leprosy gene Real time pcr, VDRL Gene detection, etc) िा ऱाभ तुरंत प्रभाव से मुफ्त र्मऱ सिे।

2. दसूरा सुझाव यह है कि आऩिो पवददत है कि किसी ना किसी ददन प्राय यह देखने िो र्मऱता है कि िोई ना िोई संघठन वेतन पवसंगनत िो ऱेिर हड़ताऱ िरते रहत ेहैं जजसिे चऱते आम जनता िो ऩरेशानी िा सामना िरना ऩड़ता है और एि गंभीर यथाजस्थनत िा खर्मयाजा भी जानता िो भुगतना ऩड़ता है तो आऩसे अनुरोध िरते हैं कि RTPCR में िायिरत सभी Lab

Technicians िार्मििों िा मानदेय NRHM िे तहत हुई घोषर्ा िे अनुरूऩ मानदेय में 20% िी वदृ्धध िर 20350 से बढािर 24420 ₹ किया जाए।

3. तीसरा सुझाव यह है कि जजस प्रिार RTPCR िार्मििों िा अनुमोदन सीधा NRHM directorate

से होता है उसी प्रिार हमारा वेतन सीधे खाते में Transfer किया जाए ताकि हमारे मानदेय िी ऩारदर्शिता यथावत बनी रहे और हमारे वेतन में से िोई भी किसी भी प्रिार िी िटौती नहीं िर ऩाएगा।



Section-wise comments on the proposed draft of Right to Health Act of Rajasthan State

We welcome the introduction of the Right to Health Bill by the Government of Rajasthan. This

holds the potential for protecting the lives of millions of people in the State, particularly those from

marginalized communities.

Oxfam India would like to leverage the space provided for making suggestions for the text to make

a few recommendations. The lens for the submission is from the perspective of the experience of

marginalized communities. It draws on Oxfam India‘s over a decade of experience of working on

healthcare in India from a rights-based lens. Through our recommendations, we seek to make the

Act more comprehensive, legally viable, and people-centred.

We recommend the addition of the following clauses in-

Rights of Residents

Chapter II under the „Right of Residents‟ section could be expanded to include additional

clauses that are part of the patient‟s rights charter2

Right to get basic emergency medical care irrespective of paying capacity of patient or

attendant in all health care establishments be it public or private

Right to receive treatment in public or private without any discrimination based on his or her

illnesses or conditions, including HIV status or other health condition, religion, caste,

ethnicity, gender, age, sexual orientation, linguistic or geographical /social origins.

Right to choose between alternative treatment/management options, if these are available,

after considering all aspects of the situation.

Right to affordable surgeries could be rephrased to right to care according to prescribed rates

as a whole. At the same time, the right to choose a source of obtaining medicines or tests

could be recognized.

Clause (h) in chapter II under the „Right of Residents‟ section - Right to confidentiality,

human dignity and privacy at all health care establishments as may be defined by rules made

under this act

Right of Health Care Provider

clause (c) given in chapter II under Right of Health Care Provider- decent

remuneration, working condition and training.

Duties of Health Care Provider

Chapter II under the „Duties of Health Care provider‟ section needs to be expanded

to include- Providing protection to participants involved in Clinical Trials, biomedical and

health research

Obligations of the Government

Chapter III- Obligation of the Government needs to be broken down to spell out the roles of

individual tiers of the government – viz state, district, block and Panchayati raj levels. This would

be critical to fix the responsibility and accountability of these individual structures who have

different roles with respect to the delivery of the right to health.

It would also be important to define the role of the existing structures and bodies with a role

for the delivery of healthcare in the state such as PRIs, VHNSCs, district and state Authority

Body under CEA, etc. which are constituted under the constitution, health policy or part of existing

2 http://www.clinicalestablishments.gov.in/WriteReadData/3181.pdf

about:blank

about:blank

about:blank

health programme interventions. The proposed structures/bodies under this act would need to be

linked to existing constitutional structures/bodies.

The RtH would need to eventually help to identify the accountabilities of the concerned

officials with a role in public health including frontline health workers, medical staff, and health

officials working at each level i.e. from village to state. Defining the responsibility of each service

provider will help to fix accountability and improve the implementation of the proposed act.

Hence, more specifically, the RtH Act needs to not only spell out the broad responsibilities of the

Rajasthan government and the rights of its citizens but also help to fix appropriate accountability

and delineate the mechanisms/processes to be taken to ensure the same.

Clause (c) given chapter III- Obligation of the Government. We recommend the following

change in the text “Within one year, lay down and notify standards for quality (IPHS standards)

and safety of all levels of health care as notified under the rules‖. It would be desirable to notify a

set of existing public health standards as the standards of quality. The IPHS standards could form

the basis for the laying down of the standards for the state.

It would be critical to add the following clause in chapter III- Obligation of the Government.

Within one year, set up the mechanism for regulation of private health care establishment as

notified in the rules under the Act.

In order to not only provide more clarity but also avoid misinterpretation of the following key

terms, there is need to specify or elaborate on the following terms used in the given draft-

- Appropriate state budget

- Notify standard for quality and safety of all levels of health care

- Co-ordination mechanisms among the relevant government departments

Chapter- VI Penalties and Procedures- The suggested punishable fine in Rupees needs to be

linked with inflation.

We are looking forward to considering and including the above recommendations in the act by the

state government of Rajasthan. Along with asking for recommendations, the state government

should conduct a consultation with various stakeholders including CSOs working on Health Rights

at pan India. The proposed consultation/meeting will provide space for dialogue for sharing the

views on the drafted act and will enable the state government in finalizing the drafted act in

consultation with various stakeholders.

For further communication -



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1. Edify Group 2. Arun Soni 390207 3. Dr Naresh Somani 4. vishnu bhutia 5.Marudhar Hospital 5. Dr. Bharat Rajpurohit HCG Hospital Mansrovar 6. Asopa Hospital, 7. Indus Jaipur Hospital, 8. Jain ENT Hospital lalkothi, 9. Dr Shivraj Sigh Rathor AHPI 10. Dr. Ashok Sharda IMA

Grievances and Suggestions for Rajasthan Right to

Health Care Act 2022

CHAPTER-I

Section 2(t)- The definition of Healthcare provider is not exhaustive. Must include the

qualifications and relevant licenses required to be obtained by them.

Section 2- Define ―Quackery‖

CHAPTER-II Section 3(c)- Replace all public hospitals to public health institutions as defined.

Section 3(j)- Proper referral transport includes the cost incurred in acquiring the vehicle, equipment, medicines, trained staff etc., which should be clearly mentioned. Healthcare facilities, especially private hospitals, cannot bear the cost of such services by themselves.

Section 3(l)- Define Redressal Mechanism

Section 3(m)- Unfavorable for the Private Healthcare Facilities as the Provision allows patients to not pay their dues for an indefinite period. Should only be allowed to take the body

of the deceased after providing an assurance/bond to pay the dues within a specific period of time and within the limits of capping of dues on total bill.

Section 4- Should include duty of patients to pay the all the bills and dues for services rendenered before discharge to private healthcare establishments.

Section 4(f)- Include punishment under The Rajasthan Medicare Service Persons

and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008.

Section 4(h)- Specify the Prescribed Authority to which such acts should be reported.

Section 5- Include right to:

- practice profession without undue pressure, distress and harassment - refuse treatment to patients indulging in disruptive and violent behavior - refuse treatment to patients if required services are not available - report unruly patients and attendants - receive timely payments for services

Section 5(a)- no criminal proceedings against healthcare providers such as FIR/arrest

should be initiated without obtaining a report from district level committee of

subject specialists

Section 5(d)- Right to have physical safety and security at the workplace , through proper safety

measures by government. CHAPTER-III

Section 7- Include:

- Ensure proper safety and prevention of violence against health care workers and

establishments. Enact proper rules and stringent laws against physical violence, verbal abuse, mob lynching harassment etc. for the same and direct all concerned

authorities to implement them.

- Make provisions to prevent quackery and crosspathy by unqualified persons in health care. Respective authorities like CMHO, District Collector or SDM of the

concerned territory must be made liable and accountable to prevent quackery. CHAPTER-IV

Section 8 (b) VII 2. - Specify representatives of health associations: must be from office bearers of

Indian Medical Association and Private Hospital association. Chairperson should

not appoint any representative by ―Pick & Choose‖ method. Exclusive power to the Chairperson to appoint the representatives can create a bias.

Section 9(b)VI2. - Specify representatives of health associations: must be from office bearers of

Indian Medical Association and Private Hospital association. Chairperson should not appoint any representative by ―Pick & Choose‖ method. Exclusive power to the

Chairperson to appoint the representatives can create a bias.

Section 11(b)(VI)- Representatives of health associations should be their concerned executives or

office bearers. Should also include President/Secretary of Indian Medical Association (IMA),

representatives of Private Hospital associations. Exclusive power to the Chairperson to appoint the

representatives can create a bias. Section 12(b) – IPC section 176 and 177 should not be applicable. Required information must be

defined properly.

Section 12 (c) – Totally unconstitutional provisions. Any authority or officer should not be given rights for a search and seize operation. Only related documents and records can be asked to produce according to section 91 of CrPC.

Section 12 (d) – Unconstitutional provision of fixing responsibility and accountability of private institutions for services. Clear Contraventions of Article 19 1(g) of constitution of India. State Health Authority and District Health Authority can have only supervision and advisory rights. Not acceptable to extent of deciding the prices for private hospitals as the services provided at each establishment are diverse.

The government shall have powers to regulate prices for the packages of

government schemes only. Private institutions should not have any bindings for

participation and empanelment of such government schemes. State Health Authority

and District Health Authority committee may have powers to send

recommendations to revise the rates of packages of government schemes to

concerned departments to encourage participation of more and more private

institutions.

CHAPTER-V

Section 13 (a) – Complaint forums and Grievance redressal must be at three levels:

1. Institutional Level 2. District Level: Must have members from representative of local

medical association, subject medical specialist and CMHO

3. State Level: Must have members from representative of state medical association, subject medical specialist from Medical College

Section 13 (b) – No grievance, complaint and investigation summary should not be shared on public domain. Goodwill and reputation of health care providers and institutions must be properly preserved and maintained.

Section 13 – Include following provisions:

- Burden of proof must be on complainant

- Must have penalty provisions for frivolous and misleading complaints. - Health care providers and institutions should be allowed to lodge complaints

against any person, groups and authorities against infringement of their rights.

CHAPTER-VI

Section 16 – Totally unconstitutional provision, legal remedies and appeals are constitutional

rights and principal of natural justice. Should be deleted. We believe that the said act should be beneficial to public and health care providers. No

adverse relationship between public and health care providers] should develop in the society

due to vague provisions of the act.

Nitin Pandey

Humble submission for Grievances and Suggestions for Rajasthan Right to Health Care

Act 2022

CHAPTER-I


qualifications and relevant licenses required to be obtained by them. Section 2- Define

“Quackery”

CHAPTER-II

Section 3(c)- Replace all public hospitals to public health institutions as defined.

Section 3(j)- Proper referral transport includes the cost incurred in acquiring the vehicle,

equipment, medicines, trained staff etc., which should be clearly mentioned. Healthcare

facilities, especially private hospitals, cannot bear the cost of such services by

themselves.


Section 3(m)- Unfavorable for the Private Healthcare Facilities as the Provision allows

patients to not pay their dues for an indefinite period. Should only be allowed to take the

body of the deceased after providing an assurance/bond to pay the dues within a specific

period of time and within the limits of capping of dues on total bill.

Section 4- Should include duty of patients to pay the all the bills and dues for services

rendenered before discharge to private healthcare establishments.



and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act,

2008.

Section 5-

Include right to:

- practice profession without undue pressure, distress and harassment

- refuse treatment to patients indulging in disruptive and violent behavior

- refuse treatment to patients if required services are not available

- report unruly patients and attendants

- receive timely payments for services

Section 5(a)- no criminal proceedings against healthcare providers such as FIR/arrest

should be initiated without obtaining a report from district level committee of subject

specialists

Section 5(d)- Right to have physical safety and security at the workplace , through proper

safety measures by government.

CHAPTER-III Section 7- Include:

- Ensure proper safety and prevention of violence against health care workers and

establishments. Enact proper rules and stringent laws against physical violence, verbal

abuse, mob lynching harassment etc. for the same and direct all concerned authorities to

implement them.

- Make provisions to prevent quackery and crosspathy by unqualified persons in health

care. Respective authorities like CMHO, District Collector or SDM of the concerned

territory must be made liable and accountable to prevent quackery.

CHAPTER-IV

Section 8 (b) VII 2. - Specify representatives of health associations: must be from office

bearers of Indian Medical Association and Private Hospital association. Chairperson

should not appoint any representative by “Pick & Choose” method. Exclusive power to the


Section 9(b)VI2. - Specify representatives of health associations: must be from office

bearers of Indian Medical Association and Private Hospital association. Chairperson

should not appoint any representative by “Pick & Choose” method. Exclusive power to the


Section 11(b)(VI)- Representatives of health associations should be their concerned

executives or office bearers. Should also include President/Secretary of Indian Medical

Association (IMA), representatives of Private Hospital associations. Exclusive power to

the Chairperson to appoint

the representatives can create a bias.

Section 12(b) – IPC section 176 and 177 should not be applicable. Required information

must be defined properly.

Section 12 (c) – Totally unconstitutional provisions. Any authority or officer should not be

given rights for a search and seize operation. Only related documents and records can be

asked to produce according to section 91 of CrPC.

Section 12 (d) – Unconstitutional provision of fixing responsibility and accountability of

private institutions for services. Clear Contraventions of Article 19 1(g) of

constitution of India. State Health Authority and District Health Authority can have only

supervision and advisory rights. Not acceptable to extent of deciding the prices for private

hospitals as the services provided at each establishment are diverse.

The government shall have powers to regulate prices for the packages of government

schemes only. Private institutions should not have any bindings for participation and

empanelment of such government schemes. State Health Authority and District Health

Authority committee may have powers to send recommendations to revise the rates of

packages of government schemes to concerned departments to encourage participation

of more and more private institutions.

CHAPTER-V


1. Institutional Level

2. District Level: Must have members from representative of local medical association,

subject medical specialist and CMHO

3. State Level: Must have members from representative of state medical association,

subject medical specialist from Medical College

Section 13 (b) – No grievance, complaint and investigation summary should not be

shared on public domain. Goodwill and reputation of health care providers and

institutions must be properly preserved and maintained. Section 13 – Include following

provisions:


- Must have penalty provisions for frivolous and misleading complaints.

- Health care providers and institutions should be allowed to lodge

complaints against any person, groups and authorities against infringement of their rights.

CHAPTER-VI

Section 16 – Totally unconstitutional provision, legal remedies and appeals are

constitutional

rights and principal of natural justice. Should be deleted.

We believe that the said act should be beneficial to public and health care providers. No

adverse relationship between public and health care providers] should develop in the

society due to vague provisions of the act.

Pallavi Gupta

Comments on the draft Rajasthan Right to Health Care Bill, 2022

Submitted by: Health Systems Transformation Platform*, New Delhi on 24 March 2022

We would like to congratulate the Government of Rajasthan for recognising health care as a right and being the first state in the country to introduce a legislation in this regard. It is commendable that the draft Bill lays down the rights and duties of the care users and the care providers (both in the public and in the private sectors), along with the obligations of the state government. However, there are certain issues which we would like to bring to your kind attention and suggest ways to further strengthen the Bill. Hope you will find our suggestions useful and consider them while finalising the draft. Chapter, Section,

Clause of the draft

Bill

Problem/issue

with the

concerned clause Proposed change

Reason for proposing

the change

Chapter I, Section 2 Definitions e) "capacity to consent" means ability of an individual, including a minor or mentally

challenged person, assessed by the relevant health service provider on an objective basis…”

It is incorrect to use the term “mentally challenged person” in the present context.

Replace, “mentally challenged person” with “a person with mental illness/ disability”.

The proposed change is in accordance with the terminology used in Central legislations, i.e., Mental Healthcare Act, 2017 and Rights of Persons with Disabilities Act, 2016.

Chapter I, Section 2 Definitions (v) Health impact assessment

The draft Bill defines health impact assessment but there is no further mention of how it would be put into practice.

Consider adding a clause in Chapter III- Obligation of the Government that health impact assessment of new projects, programmes, technology etc. would be conducted.

As a preventive measure, it is important to ensure that no harm is done to people’s health, even if unintended, in undertaking any new initiative.

Chapter I, Section 2 Definitions (tt) “Resident”: Person who is a bonafide resident of the state or is currently residing in the state.

The definition of ‘resident’ as given in the draft Bill does not cover persons who may be visiting or travelling through the state.

Replace ‘Resident’ with ‘People’, defined as “all those persons who may need health care while they are in the state of Rajasthan”.

Since need for health care may arise at any moment, the term ‘resident’ may be replaced with ‘people’ to provide a more comprehensive coverage under the legislation.

Chapter II, Section 3 Right of Residents

Certain crucial Rights are excluded in Section 3.

May please include the following Rights: Right to seek services such as laboratory investigations, purchase of medicines and other

There are several instances when patients suffer because service providers do not follow these practices. Enshrining these in the

consumables from vendors of their choice. Right to be given an estimate of cost of health care before initiating treatment. Right to be provided itemised bill with break up of costs before making the payment. Right to be provided emergency health care in case of a serious/life threatening situation irrespective of the ability to pay. Right to be provided health care without having to necessarily make advance payment. Right against discrimination: No person shall be subject to any discrimination in any form or manner, by the Government or any other person or body of persons, whether public or private, in access to health care services and health care establishments, on one or more of the grounds of sex, class, monetary or other economic status, place of birth, age, marital status, actual or perceived health status, sexual orientation, physical or mental disability, occupation, religion, language, political or other opinions, caste, civil, political, social or other status or affiliation, race, or any

legislation would help in more ethical delivery of health care services. An example: https://timesofindia.indi atimes.com/india/private -hospitals-making-over- 1700-profit-on-drugs consumables-and diagnostics study/articleshow/62997 879.cms In accordance with Article 14 of the Constitution of India, it is important to ensure people’s right to equality in accessing health care without any discrimination

other ground. Right to be treated with dignity and to be free from any inhuman, cruel or degrading treatment, at the hands of Government or any other person or body of persons, whether public or private, in the matter of health rights.

Chapter IV Section 9: Constitution and Duties of State Executive Committee Section 11: Constitution and Duties of District Health Authority.

While the composition of the State Health Authority includes representatives of patients’ groups, the same are missing from the other two bodies that the Bill proposes.

Representatives of patients’ groups may be included in the State Executive Committee and District Health Authority as they are the implementing bodies.

Patients’/Users’ voices need to be heard both in policy formulation and implementation as they are the ones who are directly impacted by such measures. Therefore, their inclusion in the implementing bodies is equally important.

Chapter IV, Section 12 (d)

With respect to fixing the cost of health care at private health care facilities and displaying rates in public domain, reference may be given to the Clinical Establishments Act, 2010 which has similar provisions and has been adopted by the state of Rajasthan.

To Section 12, clause (d) add “as also prescribed under the Clinical Establishments (Registration and Regulation) Act, 2010 which has been adopted by the Government of Rajasthan”.

This would help in laying emphasis on the importance of fixing costs and displaying them publicly.

Chapter VI, Section 16: Bar of jurisdiction.

This Section restricts people’s access to judicial recourse.

The Section may be deleted.

It would be unconstitutional to hamper people’s right to seek legal remedy if the grievance redressal mechanism provided for in the legislation does not resolve a dispute satisfactorily.

Note: We would be happy to provide any further information/clarification.

Contact Person: Ms. Pallavi Gupta, Specialist, Health Systems Governance, Health Systems

Transformation Platform, New Delhi. [email protected]; 9560080907.

* About Health Systems Transformation Platform (HSTP) (hstp.org.in)

Health Systems Transformation Platform (HSTP) was conceptualised as a Centre of Excellence under

the guidance of Prof. (Late) Maharaj Kishan Bhan, renowned scientist and visionary in 2017 with a

grant from Sir Ratan Tata Trusts. In May 2018, HSTP was incubated within the Tata Trusts family and

registered as Forum for Health Systems Design and Transformation, a not for profit company (section

8) under the Indian Companies Act 2013. Our mission is to enable Indian health systems to respond

to people’s needs. We do this in collaboration with Indian and Global expertise through research for

health systems design, enhancing stakeholders’ capabilities and fostering policy dialogue. Our

multidisciplinary team with expertise in health financing, service delivery, governance and health policy

and

systems research works under the able guidance of the Chief Executive Officer, Mr. Rajeev

Sadanandan, former Additional Chief Secretary, Government of Kerala.

As part of the Health Systems Governance work, we conducted a study, ‘Regulation of Health Care

Delivery in India – A Landscape Study’ to review health legislations with a focus on health care delivery

in India and document the strengths, gaps, and challenges. The study report is available here.

Dr. Dhavani Mehta 1 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

2. Introduction

o On 8 March, 2022, the Rajasthan State Government released a draft of the Rajasthan Right to Healthcare

Bill, 2022 (―Bill‖) and invited public comments on the same.

o The Vidhi Centre for Legal Policy (―Vidhi‖) is submitting this Note in response to this call.

o This Note is divided into two parts: I.

II. Comments on Drafting and Definitions

Comments on Substantive Aspects of the Bill A. The Need for a distinction between Public Health & Healthcare, and addition of a separate

chapter on Public Health Emergencies

B. Interface of the Bill with existing laws

C. Rights & Duties of stakeholders

D. Obligations of the State Government

E. Regulatory Architecture and Administration

F. Grievance Redressal Mechanisms

III. Details that Require Clarity through Rules 3

PART I: COMMENTS ON DRAFTING AND DEFINITIONS This Part examines whether the language of the Bill lends itself to clear and unambiguous implementation and

enforceability. Specific instances of drafting errors have been enlisted and explained below.

o Preliminarily, it may be noted that the section on definitions is traditionally not seen as a substantive

provision of a law. Unless the defined term has been used in a substantive provision, it has no

enforceability. This is the case with several terms defined in Clause 2 of this Bill.

o As such, these terms may be linked to substantive provisions to ensure that they can be enforced.

o For example, the term ‗capacity to consent‘ has been defined in Clause 2(e) of the Bill, but has not been

employed anywhere else in the Bill. To ensure that its intended implication is realised and its significance is

clearly understood, this term may be linked to the provision which gives persons the right to informed

consent (Clause 3 of the Bill).

A. Drafting errors Provision Error Long title Long title of the Bill is absent. Enacting formula Enacting formula of the Bill is absent.

Preamble

The Preamble seems incomplete and ends abruptly. The

last sentence is ―The

Constitution of India incorporates provisions Article 21 of

the constitution

guarantees protection of life and personal liberty to every

citizen‖ – This is

incomplete.

Clause 1(c) - Short Title,

extent and

commencement

This clause states that the Act ―shall come into force on

such date as the

government may, by notification in the official Gazette.‖

There seems to be a

missing word here, leading to the lack of clarity. As per

the general norm, this

clause should read as follows: ―It shall come into force on

such date as the

government may, by notification in the official Gazette

appoint.‖

Clause 2 - Definitions

The numbering format (alphabets) used for the sub-

clauses under this clause

hampers the readability of the text. Instead, a numerical

pattern should be used. Clauses 2(o)(I) and 2(o)(II) A mistaken repetition of the same clause.

Clause 8(b)(VI) -

Constitution and Duties

of State Health Authority

The clause does not mention the procedure for the

appointment of the three

persons from the Government Medical Teachers of the

state. Adding the phrase

―nominated by the state government‖ or any other

qualification would address

this.

Clause 11(c)(III) -

Constitution and Duties

of District Health

Authority

There is no clarity with respect to the way in which the

quotation marks have

been placed when mentioning a potential outbreak. It

seems as though the

intention was to put the phrase ‗potential outbreak‘ in

quotes, which suggests

that the drafters meant to use it in a specific sense. If this

is the case, ‗potential

outbreak‘ should be explicitly defined in Clause 2 of the

Bill. B. Ambiguous Drafting Provision Issue

Clause 2(a) - Definition of

„affordable‟

This clause defines ‗catastrophic household healthcare

expenditure‘ as

health expenditure exceeding 10% of its total monthly

consumption

expenditure or 40% of its monthly non-food consumption

expenditure.

This may be reconsidered as the WHO defines

expenditure as being

catastrophic if a household‘s financial contributions to the

health system 4 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan Provision Issue exceed 40% of income remaining after subsistence needs

(not just food)

have been met.

Clauses 2(b) and 2(d) – Definition

of „basic primary healthcare

services‟ and „comprehensive

primary healthcare services‟

These clauses provide the definitions for the phrases

‗Basic Primary

Healthcare Services‘ and ‗Comprehensive Primary

Healthcare Services‘.

In defining these terms, the wording used is ‗as defined

from time to

time‘. However, the Bill does not state how specific

services that fall

under either of these definitions will be defined or who

will define them.

Clause 2(e) - Definition of

„capacity to consent‟

Uses archaic language such as the phrase ―mentally

challenged‖. Instead,

it is advised to either try and list out the specific

disabilities that are

intended to be covered, or provide a more acceptable

phrasing. For

guidance, the UK government‘s guide on inclusive

language (here) can

be referred to.

This term should be linked to the right to informed

consent in Clause 3

of the Bill.

Clause 2(jj) - Definition of „public

health‟

The draft defines public health as the health of the

population, as a

whole, specially as monitored, regulated and promoted by

the

Government.

This definition is at odds with the generally accepted,

more

comprehensive definition of public health - Public health

is defined as

―the art and science of preventing disease, prolonging life

and promoting

health through the organized efforts of society‖ (Acheson,

1988; WHO). Clause 2(k) - Definition of primary The word ‗disaster‘ is loosely defined, and seems to be an

healthcare services‟ incomplete

version of the definition provided in Clause 2(d) of the

National Disaster

Management Act.

The complete definition from the National Disaster

Management Act

should be adopted.

Clauses 2(i), (j), and 2(l) -

Definition of „decontamination‟,

„deratting‟, and „disinfection‟

These terms do not find further mention in the Bill,

although these are

important public health functions.

In defining ‗Decontamination‘ and ‗Disinfection‘‘, the

Bill mentions

‗health measures‘ without defining the same. Considering

the broad

scope of this phrase, a clear outline of what such measures

can include

should be provided.

Clause 2(o) - Definition of

„essential public health functions‟

This clause specifies that monitoring and evaluating health

status to

identify community health problems and taking measures

to solve them

are one of the essential public health functions. However,

the procedure

for this should be outlined in the chapter which lays out

the obligations

of the relevant authorities under the Bill.

The various sub-clauses under this provision seem to use

the phrases

‗health problems‘ and ‗health issues‘ interchangeably,

without outlining

the scope of either of these.

Clause 2(t) - Definition of

„healthcare provider‟

The definition of ‗healthcare provider‘ is vague. In the

interest of clarity,

an illustrative and inclusive list of healthcare providers

should be set out

in this provision (for e.g., registered medical practitioners,

nurses, ANMs,

ASHA workers etc.).

Clauses 2(w) - Identifiable health

information; and 2(dd) - non

identifiable health information

While the intent behind this provision is commendable,

the terms have

not been employed in any of the substantive provisions of

the Bill.

Clause 2(y) - Definition of

„Informed consent‟

Suggestion to use gender-neutral language instead of

phrases like

‗himself/herself‘.

Clause 2(kk) - Definition of „public

health institution‟

The term ‗health services‘ should be defined with

reference to the

definition of ‗health care‘ set out in Clause 2(r) of the Bill.

Clause 2(ll)(II) – Definition of

„public health emergency‟

Given that the definition uses broad phrases like ‗large

number‘ and

‗widespread exposure‘ which are subjective, the

substantive provisions

of the Bill must provide a more detailed method for

determining these

thresholds.

5 Provision Issue

Clause 2(oo) – Definition of

„public health surveillance‟

Surveillance powers granted in respect of collecting

‗health-related‘

data. To ensure that the broad phrasing carries does not

give rise to the

possibility of potential misuse, reasonable safeguards

should be

introduced in the substantive provision, i.e., Clause

8(d)(IX). Clause 2(ww) - Definition of

„Secondary Health Care Services‟

and 2(xx) - Definition of „Tertiary

Health Care Services‟

Including some examples or illustrations may be useful

here, to make the

definitions more holistic/ comprehensive.

Clause 3 (Rights of Residents) and

Clause 5 (Rights of Health Care

provider)

There should be a uniformity in the drafting language. For

instance, some

of the sub-clauses of Clause 3, relating to rights of

residents start with

‗Residents will have a Right to‘, whereas some start with

‗Right to—‘

Clause 3(a)

‗Residents have the right to collect information to make

themselves

healthy‘ - This is drafted in a vague manner and would be

difficult to

operationalise.

Clauses 3(g), 3(h), 3(j) and 3(m)

These clauses use the term ‗health care establishment‘ in

different ways.

For instance, while in some sub-clauses it is used in

conjunction with the

terms like ‗be it public or private‘, in other ones it is used

broadly (‗every

health care establishment‘). This creates an unexplained

inconsistency.

The terms ‗be it public or private‘ need not be used if

health care

establishment itself has been defined in the Definitions

section to

include both public and private establishments.

Clause 3(k)

‗Right to take treatment summary in case of patient,

leaving against the

medical advice‘ - The language used to draft this is

unclear and the

meaning, responsibility, and implication are vague.

Instead, this should be broadened to provide a general

right of patients

to access medical records at all times, irrespective of

whether they are

discharged against medical advice.

Clause 2 (e) - Capacity to consent,

Clause 3 (dd) - non-identifiable

health information

The terms defined here do not find specific references in

the act. The

act does not utilize the terms defined in these clauses later

in the draft,

making the implications of such definitions ambiguous.

Clause 7(a) under Obligations of

the government

Vague mention of ‗appropriate state budget‘ without

outlining what is

intended by the use of the word ‗appropriate‘ or which

body will

determine whether it is appropriate or not.

Clause 7(i)

It should be made clear that the standard to be followed in

determining

the threshold of ‗nutritionally adequate and safe food‘

should be clarified

in the rules framed under the Bill. Clause 7(j) Broad phrasing like ‗effective measures‘ used which can

potentially vest

excess power in the government to impose restrictions in

this regard. A

clearer outline of the kind of measures that can be taken

under the

mandate of the Bill should be provided.

The Bill should contain a distinct chapter on public health

emergencies,

given that they will require special measures over and

above the

performance of essential public health functions and the

delivery of

health care services.

Clause 9(d)(V) under Constitution

and Duties of State Executive

Committee

The acceptable procedures that can be used to monitor

health status

should be outlined to avoid the risk of legitimizing

excessive surveillance.

Moreover, a definition of what parameters fall within the

umbrella of

‗health status‘ should be provided.

Clause 11(b)(IV) under

Constitution and Duties of

District Health Authority

The number of senior-most officers that the Bill seeks to

include in the

District Health Authority from each of the 7 departments

mentioned

must be clarified.

Clause 11(c)(VI)

This clause discusses the creation of tools for monitoring

as one of the

functions of the District Health Authority. It also

discusses the collection

of data. It must be clarified what the extent and scope of

the usage of

these tools would be. Additionally, clear rules must be

laid down for

what kind of data will be collected, whether it will be

stored or not, etc.

6 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan Provision Issue

Clause 12 - Powers of the State

Health Authority and District

Health Authority

In this clause, there is an absence of proportionality

requirements that

would be in keeping with the rights-based nature of the

Bill. For

instance, the references to carrying out inquiries (Clause

12(a)), entering

a building (Clause 12(c)), etc. should all reflect the

principle that only

such measures should be taken as are necessary,

proportionate and least

restrictive of the rights of those concerned.

7

PART II: COMMENTS ON SUBSTANTIVE ASPECTS OF THE

BILL

A. The Need for a distinction between Public

Health & Healthcare, and addition of a separate

chapter on Public Health Emergencies 1. Current Position under the Bill

Although the instant Bill is titled as the ‗Right to Healthcare Bill‘ (emphasis supplied), it regulates both public

health as well as healthcare without any clear demarcation between the two. For example, it includes prevention,

treatment, and control of epidemics as an obligation of the government [Clause 7(j)]. However, the rights and

duties of stakeholders, obligations of the Government, regulatory architecture, grievance redressal mechanisms

etc. are have not been separated from each other, thus creating scope for confusion.1 At the same time, the

public health aspects of the bill are inadequate and require more careful articulation and implementation

mechanisms.

2. Vidhi’s Comments

The field of health law has traditionally recognised a distinction between public health and healthcare. This

distinction is generally captured in the following terms:

―[public health] is a collective (―public‖) responsibility, geared toward improving the health and well-being of

an entire community—or state, or country—as opposed to diagnosing or treating particular individuals. In

addition, public health addresses the ―conditions to be healthy,‖ meaning that it is focused on ―the prevention

of disease and the promotion of health‖ … as opposed to medical care for those who are already ill…Public

health studies the causes and distribution of disease and injury in populations. This is one of the defining

differences between public health and healthcare.‖2

Further, the World Health Organisation has defined ‗public health law‘ in the following terms:

―Public health law refers to the formal set of laws – and to the legal processes for implementing and enforcing

them – that seek to ensure the conditions for people to live healthy lives. Apart from laws pertaining directly

and palpably to health infrastructure and health regulation, a robust public health system uses a combination

of laws, regulations, public awareness, public trust, and public participation mechanisms – under an umbrella

of recognized human/ health rights – to promote community and individual health (physical, mental, social,

etc.) in the society. Such mechanisms include focus on larger social, economic, and political factors that

promote or discourage health behaviours.‖3

Thus, laws relating to public health generally aim to prevent the potential outbreak of diseases, tackle public

health emergencies, and generally ensure the overall health and well-being of a population. On the other hand,

laws relating to healthcare aim to provide citizens with the best possible standards of medical diagnosis and

treatment by, inter alia, regulating clinical establishments. 1 See comments on Chapters II & III of the Bill. 8 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

The aims being distinct, the rights and duties as well as regulatory approach which is adopted to secure them are

also different. As such, India (as well as other jurisdictions) has traditionally enacted separate legislations to

address each aspect. For example, the state of Rajasthan itself addresses public health through third-tier

legislations such as the Rajasthan Municipalities Act, 2009 and the Rajasthan Panchayati Raj Act, 1994, or

through specific laws such as the Rajasthan Vaccination Act, 1957, while healthcare is addressed through laws

such as the Rajasthan Medical Act, 1952 and the Clinical Establishments Act, 2010.

In the interests of clarity, ease and efficiency of administration, and enforceability of the rights and duties, the

Bill should be divided into two clear Parts. The Part which addresses public health may contain, inter alia,

provisions relating to the public health functions of the State Government and third tier bodies, rights and duties

of citizens, etc. while the Part relating to healthcare may contain, inter alia, provisions relating to the rights of

patients, duties of clinical establishments etc. A common authority with oversight over both may be retained,

provided that its functions and powers in relation to public health and healthcare are clearly delineated. The Part

dealing with public health should have a chapter solely dedicated to public health emergencies, given the powers

required to be exercised in order to tackle them, and the special duties and responsibilities which arise in such

conditions. 2 Scott Burris et al, 'The New Public Health Law: A Transdisciplinary Approach to Practice and Advocacy' (Oxford University Press, 2018),

pp.4-5. 3 WHO, ‗Advancing the right to health: The Vital Role of Law‘, 2017.

9

B. Interface of the Bill with Existing Laws 1. Current Position under the Bill

The Bill attempts to harmonise its provisions with existing laws relating to healthcare and public health in

Rajasthan.4 This is sought to be achieved in the following manner:

o Generally speaking, the Bill is to be applied in uniformity with, and not in derogation of, any other laws

in force in Rajasthan which deal with the same subject matter.5

o However, in the event of a conflict between this Bill and other laws, the provisions of this Bill are to

prevail over the other laws to the limited extent of the conflict.6

Notwithstanding these precepts, the Bill enjoins the State Government to undertake comprehensive reviews of

the existing laws on health within one year of this Bill coming into force, in order to ensure the compatibility of

those other laws with this Bill.


Instead of laying down a set of general rules governing the interaction between existing laws and the Bill, the

potentially conflicting laws should first be identified. The conflicts should then be explicitly addressed in the text

of the Bill.

The Rajasthan State Government has already enacted the following legislations which touch upon various

aspects of public health and healthcare:

o Clinical Establishments (Registration and Regulation) Act, 2010: this Act enables the registration and

provides for the regulation of clinical establishments.

o The Rajasthan Para-Medical Council Act, 2008: this Act provides for the constitution of a Para-Medical

Council, regulation of Para-Medical profession, and recognition of institutions imparting education or

training in Para-Medical subjects in the State and for matters connected therewith or incidental thereto.

o The Rajasthan Medical Act, 1952: this Act provides for the registration of Medical Practitioners in

Rajasthan.

o The Rajasthan Vaccination Act, 1957: this Act makes the vaccination of children compulsory.

o The Rajasthan Panchayati Raj Act, 1994: this Act obligates the Panchayati Raj institutions to perform

certain public health functions.

o The Rajasthan Municipalities Act, 2009: this Act obligates the urban local bodies to perform certain

public health functions.

o A careful mapping of the provisions of these laws must first be undertaken and potential conflicts must

be identified. After decisions have been made on how these conflicts are to be addressed, appropriate

provisions may be placed in the body of the Bill explaining its interface with these existing laws. For

instance, there must be clarity on the mechanisms that will be used to fix prices for healthcare services

at healthcare establishments. Currently, the Central Government exercises this power under the

Clinical Establishments Act, 2010. The power of price fixation for services in clinical establishments in

the state of Rajasthan already exists under rule 9(ii) of the Clinical Establishments Rules, 2012, read

with section 52 of the Clinical Establishments Act, 2010. This power is currently exercised by the

Central Government in consultation with the concerned State Government. If this power is now

proposed to be exercised under the proposed law, any overlap with the Clinical Establishments Act

must be appropriately clarified. In the same vein, the Clinical Establishments Act, under which

standards for healthcare establishments are set must also ensure that such standards meet the rights 4 Rajasthan Right to Health Care Bill, 2022, s.18. 5 Rajasthan Right to Health Care Bill, 2022, s.18(b)

6 Rajasthan Right to Health Care Bill, 2022, s.18(c). 10 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

of accessibility, affordability, and quality guaranteed under the proposed law. For all future

laws/rules/regulations/notifications/other instruments dealing with public health or healthcare, the

State Government should ensure that these are fully compatible with the provisions of the Bill. 11

C. Rights and Duties of Stakeholders 1. Current position under the Bill

Chapter-II of the Bill provides for the rights and duties of residents and health care providers.

Residents have been defined as persons who are bona fide residents of Rajasthan or are currently residing in

Rajasthan. These residents have been given a range of rights and duties only in the domain of healthcare.

Rights of Residents

According to Clause 3, Residents have the right to:

o collect information to make themselves healthy

o free consultation, drugs, diagnostics, emergency transport and emergency care at all public health

institutions

o free/affordable care for surgeries at all public hospitals

o avail free services the empaneled hospitals, if they are covered under insurance scheme through

o avail free services from the private hospitals established through land allocation on concession rates as

per the terms and conditions mentioned at the time of the allotment of the land

o receive information, records and reports of self from the health care establishment, be it public or

private

o informed consent at all health care establishments, be it public or private

o confidentiality at all health care establishments

o safe and quality care according to standards prescribed for different levels of health care

establishments run or managed by Government or private institutions.

o proper referral transport by all health care establishments be it public or private

o take treatment summary in case of patient, leaving against the medical advice

o be heard and seek redressal from health care establishment if any grievance occurred after availing

services

o receive the dead body of the deceased person, to be exercised by the family member/authorized person,

irrespective of payment due status from every health care establishment

Duties of Residents

According to Clause 4, Residents must:

o Avail of tertiary healthcare services only after following referral from primary or secondary level institutions

or service providers

o Provide healthcare providers with relevant and accurate information 12 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

o Comply with the prescribed healthcare

o Sign a discharge certificate or release of liability if they refuse to accept or continue the recommended

treatment

o Not pollute the premises where the treatment is being provided

o Refrain from misconduct and misbehaviour with healthcare providers, and treat them with respect and

dignity

o Refrain from physical assault on healthcare personnel or damage to property

o Report illegal or unethical behaviour

o Permit post-mortem to be done in case of unnatural death

Healthcare providers (―HCP‖s) have been defined as persons who are authorised by the Government to engage

in identifying, preventing, and/or treatment of illness and/or disability.

Rights of healthcare provider

According to Clause 5, healthcare providers have the right to:

o protection from complaints relating to adverse consequences on providing services of any kind as long as

the provider has acted bonafide to the best of their professional capability through application of standard

treatment procedure and judgment, and in the best interests of the residents and exercised all reasonable

care

o be treated with respect and dignity by the patients and attendants.

o decent working conditions and training.

o right of physical safety and security at the workplace. o

availability of protective measures for any accidental exposure to harm.

Duties of healthcare provider According to Clause 6, healthcare providers must:

o Follow the standard treatment guidelines and protocols as notified from time to time, and using the

clinical judgement in the best interest of the resident.

o Maintain confidentiality, privacy, dignity of residents, and treat them with respect.

o Respect the rights of residents to take a decision to get a lab investigation or to purchase medicines from

a vendor of their choice.

o Ensure informed consent is taken before every procedure.

o Regularly explain and inform either patient or relatives regarding the severity of the disease, progression,

treatment and prognosis. 13


Rights of residents

o It is commendable that ‗residents‘ has not been defined in a restrictive way that requires proof of

domicile, citizenship, etc. However, there should be a differentiation between rights of residents and

users. While certain rights like state health insurance may be reserved for residents of the state, certain

rights such as emergency health care, information, quality of care, etc. should be applicable to any user

or patient.

o The chapter mentions ‗Collective‘ rights, but most of these rights are individual rights, and community

health rights have been left out of the draft. There is scope here for the inclusion of rights of marginalised

communities, rights of participation in decision-making and representation, articulation of broader public

health rights, etc.

o In the same vein, some rights such as right to confidentiality, treatment summary, receive dead body,

etc. should be part of ‗user rights‘ as opposed to ‗rights of residents‘.

o In 2018, the Ministry of Health and Family Welfare (―MoHFW‖), Government of India, adopted a Charter

of Patient Rights, on the basis of a list prepared by the National Human Rights Commission. It has since

been updated and approved by the National Council for Clinical Establishments.7 As per this charter, a

patient/ user and their representative has the following rights with respect to a clinical establishment:

o To adequate relevant information about the nature, cause of illness, proposed investigations and care,

expected results of treatment, possible complications and expected costs

o To information on the Rates charged for each type of service provided and facilities available. Clinical

Establishment shall display the same at a conspicuous place in the local as well as in English language.

o To access a copy of the case papers, patient records, investigation reports and detailed bill (itemized).

o To informed consent prior to specific tests/treatment (e.g. surgery, chemotherapy etc.)

o To seek second opinion from an appropriate clinician of patients' choice, with records and information

being provided by the treating hospital.

o To confidentiality, human dignity and privacy during treatment.

o To have ensured presence of a female person, during physical examination of a female patient by a

male practitioner.

o To non-discrimination about treatment and behaviour on the basis of HIV status

o To choose alternative treatment if options are available

o Release of dead body of a patient cannot be denied for any reason by the hospitals.

o It was recommended that patient seeking transfer to another hospital/discharge from a hospital will

have the responsibility to "settle the agreed upon payment".

7 ‗Charter of Patients‘ Rights and Responsibilities‘, <http://clinicalestablishments.gov.in/WriteReadData/3181.pdf>. 14 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

o It may be specified in the charter that no discrimination in treatment based upon his or his illness or

conditions, including HIV status or other health condition, religion ethnicity, gender (including

transgender), age, sexual orientation, linguistic or geographical/social origins.

o Informed consent of patient should be taken before digitization of medical records Right to care

according to prescribed rates wherever relevant.

o Right to choose source for obtaining medicines or tests

o Right to protection and compensation for patients involved in clinical trials, as per Drugs and

Cosmetics Act and other Government Guidelines.

o Right to protection and compensation for participants involved in biomedical and health research as

per ICMR and other Government Guidelines.

o Right to Patient Education

o Right to be heard and seek redressal: Every Hospital shall have/establish a time bound Grievance

redressal mechanism to address the grievances of the patients. A Grievance redressal officer will be

identified by the hospital and his name and contact details will be displayed at a conspicuous place in

local language and in English. The records of grievances received and remedial action taken will be

maintained. The name and contact details of the district registering authority will also be displayed

who may be contacted in case of non-redressal of the grievance of patients to their satisfaction

o Right to proper referral and transfer, which is free from perverse commercial influences

▪ In case of referral by the hospital, the referring hospital will provide proper referral transport

facility in the most appropriate vehicle/ambulance for transfer of patient to the nearest

possible hospital where facilities for appropriate and timely management of the condition of

the patient, are available.

▪ Such transfer of patient will not be refused even if not referred by the treating hospital and

even if the patient is leaving against medical advice (LAMA). The applicable reasonable

charges may be levied by the Clinical Establishments for such transfers. However, in case of

an emergency situation, such referral transport will be provided free of cost as far as possible

and will not be refused for want of any payment.

▪ State/UT Government may consider to define various charges for different types of

ambulance for compliance by the hospitals and other clinical establishments. The Clinical

Establishments will be required to display the rates of charges of ambulance(s)

▪ The referring hospital shall provide a qualified and trained person to monitor and manage the

condition of the patient enroute till the patient is received by the referee hospital

Since the state government is empowered by the Constitution to implement such rights through statelevel laws,

MoHFW had written to the states to do the same in 2019. Although the draft of this Bill

mentions some of these rights under Clause 3, a more comprehensive articulation of all the rights

articulated in the Charter of Patient Rights is crucial under ‗user rights‘ in healthcare establishments.

o The ‗right to collect information to make themselves healthy‘ is vaguely worded and therefore difficult

to operationalise. A more detailed public awareness and information right, with specific allocation of

duties, would be more useful here. 15

o Although the title of the Act mentions that it is a Right to Health Care Bill and not a public health law,

certain public health provisions (such as inclusion of public health emergencies) have been included in

the draft. In that context, public health rights should be included in the bill, and there should be separate

sections/ clauses dealing with public health and healthcare rights. Separate sections on these two

categories of rights would help in appropriate allocation of responsibilities for their implementation.

o There is no mention of allied rights which pertain to underlying determinants of health – such as food,

water, sanitation, housing, etc.

o While availability, accessibility, and quality of health care services have been guaranteed, there has been

no mention of acceptability (which refers to cultural suitability and approachability of the health system).

Rights of Health Care Providers

o There should be a section on rights of HCP vis-à-vis the government, and appropriate modifications may

be made in other health-related laws in the state (which currently lack a rights-based approach for HCP).

Apart from registered medical practitioners, other healthcare workers and frontline workers involved in

public health functions (ASHA workers, sanitation workers, ANMs, etc.) should be included within the

ambit of such rights. Apart from working conditions, safety, pay, dignity, etc. health insurance

mechanisms (especially in situations of public health emergencies) may be envisaged here.

o The right to be treated with respect and dignity by patients and attendants is vague. Since the violation

of any right under this law is a ground for grievance redressal (as per Clause 13), the rights should be

worded more carefully and specifically.

o Rights to decent working conditions, physical safety, security, etc. should be drafted in clearer and more

detailed ways. There are two ways of doing this – (a) Mention the components of these rights in the

body of the Bill, (b) Refer to appropriate labour or service laws.

Duties of residents and HCP

Ideally, duties of residents and HCP should not be part of state-level legislation. By not only including duties in

the legislation but also placing rights and duties in the same chapter, the draft fails to highlight the justiciability

of rights over duties.

o Some of these provisions (such as providing accurate information to HCPs, complying with prescribed

healthcare, etc.) are better suited to be part of service rules, patient charters, HCP training programmes,

public awareness programmes, etc. – as opposed to being legislated. Imposing legally enforceable duties

on all residents and HCPs will make them susceptible to disproportionate and unfair legal claims/

procedure under this Bill, and infringement of their other rights.

o More appropriate and efficient alternative mechanisms are already in use in case of some of these duties.

For grave violations such as physical assault of HCPs by residents and medical negligence by HCPs,

criminal law provisions and criminal court procedure are used. In case of littering or pollution of premises,

fines may be imposed at the institutional level.

o Some of these duties (e.g. availing tertiary healthcare only after obtaining referral, signing a discharge

certificate or release of liability if they refuse to accept or continue recommended treatment, etc.) are

excessive and restrictive. Legislating them within this Bill is likely to result in harassment of users and

infringements of their rights to healthcare and health services. The practise of ‗discharge against medical

advice‘ is often a result of a breakdown of trust between HCPs and patients/relatives/next friends. To

address this, more emphasis is needed on training HCPs in a process of shared decision-making, rather

than on imposing a potentially legally enforceable duty on patients. 16 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

o Some of the duties, such as the duty to report illegal or unethical behaviour, refrain from misconduct or

misbehaviour, etc. are worded in vague and undefined terms. Since the grievance redressal mechanisms

do not clarify grounds for complaint or appeal, and any violation pertaining to the Bill may be brought

within the ambit of a grievance, such vague articulation is likely to be harmful to users. Instead, there

should be an easily accessible mechanism that allows users to report grievances against HCPs or

healthcare establishments.

o Duties of HCPs pertaining to obtaining informed consent, maintaining confidentiality, respecting the

right to take a decision to get a lab investigation or to purchase medicines from a vendor of their choice,

informing patients regarding severity of the disease, progression, treatment and prognosis, etc. would

be better framed under ‗rights of users‘.

Some specific comments on Clauses 4 and 6

o Traditional public health duties, such as duty to self-report symptoms of a contagious disease, or

operating an established community reporting or surveillance system for the same, are missing from this

draft. These may be included in the proposed chapter on Public Health Emergencies, with specific

reference to the contours and limits of the duties, the powers of the government vis-à-vis the

enforcement of such duties, and their overall implications.

o It is not clear as to what an HCP should do if a user does not possess the capacity to consent under this

law. The capacity to consent has been defined in Clause 2 of the Bill, but does not find any use in the

rest of the Bill.

o The duty to inform patients or relatives – there should be careful consideration of the patient‘s right to

privacy and confidentiality when informing relatives. 17

D. Obligations of the State Government 1. Position under the Bill

Chapter-III of the Bill (Section 7) lays down the general obligations of the government under this law. It includes

obligations ranging from resource optimization and budgetary allocation, alignment of services and schemes

towards a robust health system in the state, notification of safety and quality standards, setting up coordination

mechanisms, and education and empowerment of people regarding health issues.


o ‗Appropriate state budget should be provided‘ is a vague obligation that cannot be operationalized in the

absence of clearly laid down procedural, output-based, and/ or impact-based obligations

o The chapter mentions arbitrary timelines for implementing and developing a Human Resource Policy,

without describing the vision, components, or intended impact of the same.

o Six months have been provided for setting up social audit and grievance redressal mechanisms under

this Bill. Please refer to Chapter II. E of this document for more details on the issues with the mechanisms

envisaged therein.

o Clause 7(d) mentions that the state government should ‗align all health services and schemes‘ within one

year of enactment of this Bill. Please refer to Chapter II. B of this document for more details regarding

this.

o Safety and quality standards are better suited to the Clinical Establishments Act of respective states.

Therefore, such functions should be performed under the suitable legislation instead of creating multiple

overlapping laws, while ensuring that such standards meet the rights-based guarantees under this Bill.

o Certain provisions, such as consideration of criteria such as distance, geographical area, population

density, etc. for allocation of health services – are better dealt with by existing programmes under the

National Health Mission (―NHM‖) or existing standards such as the Indian Public Health Standards

(―IPHS‖). Partial duplication of the same in this Bill may cause unnecessary confusion.

o The chapter includes the obligation to set up coordination mechanisms among relevant government

departments to facilitate other determinants of health such as food, drinking water, and sanitation. The

mechanism envisaged under this Bill in Chapter IV (the State and District Health Authority), which

includes representation from diverse departments pertaining to various components of public health, is

better suited for such coordination function, rather than the governance, executive, and grievance

redressal functions assigned to these authorities under this Bill. 18 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

E.Regulatory Architecture/Administration 1. Current Position under the Bill

The Bill sets up regulators at two tiers: state (State Health Authority and State Executive Committee) and district

(District Health Authorities).

State-level: State Health Authority & State Executive Committee

The State Health Authority (‗SHA‘) is the primary regulator/administrator under the Bill.

The composition of the SHA is as follows:8

o Chief Secretary of the State Government of Rajasthan – Chairperson.

o Secretary in charge of the Medical, Health and Family Welfare Department – Co-Chairperson.

o Director of Health Services (Public Health) – Member-Secretary.

o Secretaries in charge of a range of relevant departments:

1. Medical Education

2. Public Health Engineering

3. Women & Child Development

4. Panchayati Raj and Rural Development

5. Social Justice and Empowerment

6. Tribal Area Development

7. Urban Development

8. Finance

9. Information and Public Relations

10. Revenue

11. Ayurveda, Yoga, Naturopathy, Unnai, Siddha, and Homeopathy

12. Education

13. Relief

14. Rehabilitation

o Three members of the Legislative Assembly to be nominated by the State Government.

o Three persons from the Government Medical Teachers, especially from clinical specialties.

o Four non-official persons from the following classes:

1. Public health experts to be nominated by the Chairperson.

2. Representatives of health associations to be nominated by the Chairperson.

3. Civil society organisations to be nominated by the Chairperson.

4. One member from a reputed NGO, preferably working in Rajasthan, to be nominated by the Chairperson.

o A Representative of the Chairman of the State Pollution Control Board.

o Three representatives from patient groups, to be nominated by the Chairperson.

The SHA is expected to perform 5 broad kinds of functions:

1. Advise the Government on all matters concerning public health.9

2. Formulate the health goals of the State and get these included in the mandate of the Panchayati Raj

institutions and urban local bodies,10 formulate the state-level strategic plans for implementation of

8 Rajasthan Right to Health Care Bill, 2022, s.8(b).

9 Rajasthan Right to Health Care Bill, 2022, s.8(d)(I).

10 Rajasthan Right to Health Care Bill, 2022, s.8(d)(II). 19

the Act including action on the determinants of health, viz., food, water, and sanitation,11 and

formulate a comprehensive policy/plan to prevent, track, mitigate, and control a public health

emergency.12

3. Monitor the preparedness of the State to manage public health emergencies,13 and develop

mechanisms for regular medical, clinical, and social audits to ensure quality healthcare at all levels.14

4. Involve the community as active co-facilitators, help them in identifying key indicators, and create

tools for monitoring, providing feedback, and validating any data that is collected as a result of such

feedback or monitoring.15

5. Delegate its functions by constituting committees/scientific panels/technical panels,16 and associate

with institutions, experts, NGOs etc. to ensure that its functions are efficiently discharged.17

To enable efficient discharge of functions, SHA has been given the following powers:

o It may require any person to furnish information by resorting to sections 176 and 177 of the Indian

Penal Code, 1860 (‗IPC‘).18

o It may enter any building or place if they have reason to believe that any document relating to the

subject matter of an enquiry may be found there. It may proceed to seize such documents, subject to

section 100 of the IPC.19

o It may fix responsibilities and hold to account private institutions, facilities, buildings or places, which

provide inpatient or outpatient services.20

o The Government may regulate prices for packages and ensure that rates for the packages are

displayed in the public domain.21

o During a pandemic or during any other public health emergency, the Government may take-over

buildings, facilities, services, and duties of human resources from private institutions, and also

prescribe rates for treatment provided by private institutions.22

State Executive Committee

The State Executive Committee (‗SEC‘) is an independent body under the Bill, to be set up by the SHA.23 It

essentially appears to be the executive arm of the SHA, as its functions are to implement the

plans/policies/strategies formulated by the SHA.

The composition of the SEC is as follows:

o Secretary in charge of Medical, Health, and Family Welfare Department – Chairperson.

o Secretaries in charge of a range of relevant departments:


2. Women & Child Development

3. Panchayati Raj and Rural Development

11 Rajasthan Right to Health Care Bill, 2022, s.8(d)(III).

12 Rajasthan Right to Health Care Bill, 2022, s.8(d)(IV).

13 Rajasthan Right to Health Care Bill, 2022, s.8(d)(V).

14 Rajasthan Right to Health Care Bill, 2022, s.8(d)(VI).

15 Rajasthan Right to Health Care Bill, 2022, s.8(d)(IX).

16 Rajasthan Right to Health Care Bill, 2022, s.8(d)(VII).

17 Rajasthan Right to Health Care Bill, 2022, s.8(d)(VIII).

18 Rajasthan Right to Health Care Bill, 2022, s.12(b).

19 Rajasthan Right to Health Care Bill, 2022, s.12(c).

20 Rajasthan Right to Health Care Bill, 2022, s.12(c).

21 Rajasthan Right to Health Care Bill, 2022, s.12(d).


23 Rajasthan Right to Health Care Bill, 2022, s.9(a). 20 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan


5. Elementary education

o Mission Director (National Health Mission), Rajasthan.

o Director of Medical and Health Services (Public Health).

o Additional Director (Hospital/Administrator), Rajasthan.

o Nodal officer (under this Act), Rajasthan.

o Three persons from the Government Medical Teachers, especially from clinical specialties.

o Four non-official persons from the following classes:




4. One member from a reputed NGO, preferably working in Rajasthan, to be nominated by the Chairperson.

o A Representative of the Chairman of the State Pollution Control Board.

The SEC is expected to perform 5 broad kinds of functions:

1. Implement the state-level strategic plans formulated by the SHA for implementation of the Act

including action on the determinants of health, viz., food, water, and sanitation,24 implement the

comprehensive policy/plan formulated by the SHA to prevent, track, mitigate, and control a public

health emergency, as well as situations of outbreaks or potential outbreaks in the state.25

2. Ensure that the State Government is prepared for the management of public health emergencies.26

3. Ensure that there are mechanisms for regular medical, clinical, and social audits to ensure quality

healthcare at all levels.27

4. Monitor the health status of the population to identify and solve community health problems.28

District-level: District Health Authority

The District Health Authorities (‗DHAs‘) are the federated units of the SHA at the district level. Their primary

function is to implement the plans/policies/strategies of the SHA and coordinate between departments and

agencies of the State Government to ensure that the interests of the districts are adequately safeguarded.

The composition of the DHAs is as follows:

o District Collector – Chairperson

o CEO of the Zila Parishad – Co-chairperson

o Chief Medical & Health Officer (CMHO) – Member Secretary

o Senior most officers from the following departments in the district:

1. Public Health Engineering

2. Social Justice and Empowerment

3. Integrated Child Development Services (ICDS)

4. Women Empowerment

5. Local Body

6. Education



25 Rajasthan Right to Health Care Bill, 2022, s.9(d)(II).

26 Rajasthan Right to Health Care Bill, 2022, s.9(d)(III): it may be noted that this is Vidhi‘s understanding of the clause. The text itself reads:

―to ensure the State for management of public health emergencies‖.

27 Rajasthan Right to Health Care Bill, 2022, s.8(d)(IV).

28 Rajasthan Right to Health Care Bill, 2022, s.8(d)(V). 21

o Pramukh, Zila Parishad of the district and three Pradhans‘ of the Panchayat Samitis in rotation.

o Four non-official members:




4. One member from a reputed NGO, preferably working in Rajasthan, to be nominated by the

Chairperson.

The DHA is expected to perform the following broad kinds of functions:

o Implement the policies, recommendations, and directions of the SHA.29

o Formulate and implement strategies and plans of action for the determinants of health, viz., food, water,

sanitation, and environment.30

o Formulate a comprehensive policy/plan to prevent, track, mitigate, and control a public health emergency,

as well as situations of outbreak or potential outbreak based on the state plan.31

o Coordinate with government departments and agencies to ensure availability of and access to safe food,

water and sanitation throughout the district.32

o Organise hearings for beneficiaries coming to hospitals to improve healthcare services.33

o Involve the community as active co-facilitators, help them in identifying key indicators, and create tools for

monitoring, providing feedback, and validating any data that is collected as a result of such feedback or

monitoring.34


The composition of the SHA and the DHAs should include full-time executive members

o Every member of the SHA and DHAs are ex-officio appointees. As a result, they are all ‗multi-hatting‘,

i.e., their regular occupation is entirely different, and they are administering these authorities only as

an additional obligation. In order for a body of this nature to function effectively and efficiently, it

requires a class of full-time executive functionaries (a CEO, a CFO, directors, and officers, and

employees.) as is the case with a majority of statutory regulators. In its present form, the SHA and

DHAs are functionally not regulators or authorities, but mere platforms for coordination.

o The following regulators at the central level have full-time executive members:

▪ Agricultural and Processed Food Products Export Development Authority: Consists of a fulltime Chairman shall be

appointed by the Central Government and is to be the CEO of the

Authority.

▪ Airports Authority of India: Consists of a full-time Chairperson who is to be appointed by the

Central Government. The other members of the Authority may be appointed as full-time or

part-time members as the Central Government may think fit.

▪ Airports Economic Regulatory Authority of India: All three members of the Authority are to be

full-time members. These are the Chairperson (who is also the CEO of the Authority) and two

other members.

▪ Atomic Energy Regulatory Board: Currently, the Board consists of a full-time Chairman, an exofficio Member, four

part-time Members and a Secretary.

▪ Central Electricity Regulatory Commission: Consists of a full-time Chairperson who is also to

be the CEO of the Commission, and three other full-time members.

▪ Central Pollution Control Board: Consists of a full-time Chairman and a full-time member

secretary.

29 Rajasthan Right to Health Care Bill, 2022, s.11(c)(I).

30 Rajasthan Right to Health Care Bill, 2022, s.11(c)(II).

31 Rajasthan Right to Health Care Bill, 2022, s.11(c)(III).

32 Rajasthan Right to Health Care Bill, 2022, s.11(c)(IV).

33 Rajasthan Right to Health Care Bill, 2022, s.11(c)(V).

34 Rajasthan Right to Health Care Bill, 2022, s.11(c)(VI). 22 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

▪ Coal Regulatory Authority of India: Consists of a full-time Chairperson and four other full-time

members with expertise in legal, financial, technical and consumer interest.

▪ Coffee Board: consists of full-time executive functionaries (a CEO, a CFO, directors, and

officers, and employees.)

▪ Competition Commission of India: The Chairperson and all other members of the CCI are

whole-time members.

▪ Food Safety and Standards Authority of India: Full-time Chairperson and other part-time

members.

▪ Inland Waterways Authority of India: Consists of a Chairman, a Vice-Chairman, not more than

three full-time members and not more than three part-time members.

▪ Insurance Regulatory and Development Authority of India: Consists of a full-time Chairperson,

not more than five whole-time members and not more than four part-time members.

▪ Pension Fund Regulatory and Development Authority: Consists of a full-time Chairperson,

three whole-time members and three part-time members.

▪ Petroleum and Natural Gas Regulatory Board: Consists of the following full-time members:

Chairperson, a Member (Legal) and three other members to be appointed by the Central

Government.

▪ Reserve Bank of India: Full-time Governor and Deputy Governors.

▪ Rubber Board: consists of full-time executive functionaries (a CEO, a CFO, directors, and


▪ Securities and Exchange Board of India: Currently, it consists of a full-time Chairperson, two

full-time members and four part-time members.

▪ Spices Board: consists of full-time executive functionaries (a CEO, a CFO, directors, and


▪ Tea Board: consists of full-time executive functionaries (a CEO, a CFO, directors, and officers,

and employees.)

▪ Telecom Regulatory Authority of India: Consists of a Chairperson (full-time), not more than

two full-time members, and not more than two part-time members to be appointed by the

Central Government.

▪ Tobacco Board: consists of full-time executive functionaries (a CEO, a CFO, directors, and


o At the state-level in Rajasthan, the Rajasthan Electricity Regulatory Commission consists of a full-time

Chairperson who is also to be the CEO of the Commission, and three other full-time members.

o Specifically, in relation to regulators in the field of health, the Governing Board of the National Health

Authority consists of one full-time member, that is the CEO of the NHA.

The composition of the SHA should include representation from third-tier bodies

o The SHA has no members from Urban Local Bodies or Panchayati Raj institutions. This may pose a

problem with coordination and overlap in jurisdiction/functions, as it is these entities which are

obligated to perform public health actions at the granular level under the third-tier laws.

o If the concern is that owing to the large number of these bodies, it may be difficult to distribute

membership in an equitable manner, representatives from these bodies can be made rotating members

with fixed metrics for rotation (for e.g., at least one representative from municipalities which have

consistently performed poorly in public health metrics).

The composition of the SHA & DHAs should be stratified, with a clear delineation of functions

o Although both the SHA and the DHAs are composed of different classes of members (for e.g.,

secretaries of government departments, MLAs, representatives of patient groups, etc.) there is no

stratification of these classes. As a result, the functions of each class have not been separately

identified and delineated. This reduces clarity in the roles to be played by each member, leading to a

potential loss of efficiency. 23

o The SHA and DHAs may consist of three distinct classes of members: non-executive supervisory

members such as the Chairperson and Vice-Chairperson (MLAs, Chief Secretary etc.), an advisory

board (directors of relevant departments of the State Government, public health and healthcare

professionals etc.) and the full-time executive members (CEO & CFO of the SHA, officers, directors,

and employees).

o For an example of this kind of structure, one may refer to the National Institute for Health and Care

Excellence, United Kingdom (‗NICE‘) is an independent, standard-setting body constituted under the

Health and Social Care Act, 2012, which is responsible for providing National Health Service staff with

clear and robust advice on quality of care. The composition of NICE is stratified in nature. It is

composed of the Board and the Senior Management. The former sets out strategic priorities and

policies, and determines the broad framework, while the latter is responsible for day-to-day decisionmaking and

implementation in general. The organization is further split into six directorates for

performance of its functions. The CEO of the Senior Management team is also a member of NICE‘s

Board. The Board is composed of experienced health and social care professionals with wide

experience in management, trusteeship and administration. The Senior Management is composed of

technical experts from the areas of medicine, health technology, health policy etc. and is responsible

for NICE‘s day to day functioning.

The number of members of the SHA should be reduced

o The 31-member SHA is large and unwieldy, and is required to meet only twice a year. Decisionmaking is likely to be

a laborious process, with the SHA being unable to fulfil all its functions through

bi-annual meetings.

o While all the members may be obligated to convene on a bi-annual basis, the full-time executive

members should dedicate the entirety of their time to the administration of the SHA or the DHAs, as

the case may be.

The powers of the SHA should not be conflated with those of the State Government & reasonable safeguards

should be introduced to prevent potential abuse/misuse of powers

o The provision which deals with general powers of the Authorities is not the ideal place to house the

power of the Government to regulate prices for healthcare in private institutions. The power may

either be transferred to the SHA, or a separate section may be framed to enable the Government to

exercise this power.

o It may be noted that as it stands, the power of price fixation for services in clinical establishments in

the state of Rajasthan already exists under rule 9(ii) of the Clinical Establishments Rules, 2012, read

with section 52 of the Clinical Establishments Act, 2010. This power is currently exercised by the

Central Government in consultation with the concerned State Government. If a new power to fix

prices is to be given under the Bill, a rigorous compatibility review will thus be necessary.

o The provision which deals with general powers of the Authorities is not the ideal place to house the

power of the Government during a pandemic or a public health emergency. A separate Chapter should

be framed for this purpose. Further, given the extraordinary nature of the powers which have been

granted to the Government, certain minimum safeguards should be put in place to prevent the

possibility of misuse or regulatory overreach.

The SEC should not be a separate body

o Having an executive arm for the SHA is a sound proposition. However, no purpose is served by making

this an independent body, as its sole function is to execute the plans/strategies prepared by the SHA.

There is no scope for disagreement/difference in opinion. 24 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

o In any case, there is significant overlap between both the composition and the functions of the SHA

and the SEC which leads to redundancy and may present problems with coordination.

o Moreover, representatives from the CSOs and NGOs should ideally be members of the supervisory

body, and not the executive arm, as they cannot be expected to dedicate all their time to undertaking

the activities of the SHA.

o The aim of creating a separate executive arm can be better achieved by designating certain members

of the SHA as full-time executive members. This is the standard model followed by the majority of

statutory regulators in India, as has been explained in the comments above.

25

F. Grievance Redressal Mechanisms 1. Current Position under the Bill

The Rajasthan Right to Health Care Act 2022 (The Healthcare Act) has laid down a provision for setting up a

grievance redressal mechanism through its Clause 13. The said act, has laid down time-sensitive obligations for

the state to set up a complaint forum. The Healthcare Act:

o Obligates the Government to frame rules on issues pertaining to denial of services and infringement of

rights under the Healthcare Act

o Envisages setting up of a web-portal and a user-friendly helpline

o Lays down specific timelines within which the concerned officers should resolve the complaint

o Lays down timeframes for each level of grievance redressal to redress the complaint within a stipulated

timeframe. Its failure to do so will result in escalation of the complaint to a higher authority.


Lack of mechanisms to ensure accountability of the State Government and the authorities set up under the

Bill

There are several issues in the manner with which the Healthcare Act approaches grievance redressal. Firstly,

the act only considers the need for grievance redressal when a service is denied or rights under the healthcare

act are infringed upon. While it has not been specifically mentioned, it may be presumed that only complaints

against healthcare providers are being considered under the ambit of Chapter V. The larger question regarding

the accountability of the State Health Authority and District Health Authorities set up under the act should be

considered while drafting the chapter on grievance redressal.

In addition to setting up a grievance redressal mechanism to redress complaints against healthcare

establishments, a distinct and independent monitoring mechanism for ensuring accountability of the State

Government and the authorities should be established. This body should ideally consist of sectoral experts that

will specifically consider the performance of obligations by the State Government set out in Clause 7 of the Bill.

For instance, The National Health Bill, 2009 imagines a monitoring and accountability mechanism that comprises

the establishment of a health information system, governmental mechanisms through establishment of

committees, and community-based monitoring framework. Further, the National Rural Health Mission envisaged

an accountability framework through the following mechanisms: community-based monitoring, external

surveys, and stringent internal monitoring. Rogi Kalyan Samitis are facility-level community-based committees to

monitor the performance of health facilities and health outcomes at such facilities.35 These may be considered

in devising an independent monitoring mechanism under the proposed law.

Obligations pertaining to Web based portal/user-friendly helpline

According to the Act, a resident can file a complaint at a specified web-portal or a customer friendly helpline

number. The accessibility of these measures to the common user should be considered while designing them.

35Guidelines for establishing grievance redressal and health helpline, National Health Mission,

<http://nhm.gov.in/images/pdf/programmes/Grievance_Redressal_System/Guidelines_for_Establishing_Grievance_Redressal_and%20_He

alth_Helpline.pdf>. 26 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

Further, the reader of the act faces an ambiguity in terms of understanding where such mechanisms are

stationed, and who has the obligation of maintaining them.

The Healthcare Act should clearly mention the body/institution/establishment in charge of setting up of the

web-based portal/ user-helpline and the kinds of complaints or grievances that may be lodged.

Accountability of Grievance Redressal Bodies

Under Clause 13 of the Bill, if the concerned officer does not respond to a complaint within 30 days, the

complaint may be forwarded to the District Health Authority and then elevated to the State Health Authority if

required. However, it is not clear under the Act whether there will be any legal consequences, in the nature of

penalties, for the failure of the concerned officers or authorities to resolve the complaint.

Non-performance of duties to redress complaints within the timeframe stipulated in the act should have a

performance-related disincentive for the concerned officer.

Lack of Appellate Mechanisms to redress grievances

Even as the failure of the concerned officer to redress a complaint escalates it to the higher authority, nothing

in the act provides for the right of a complainant to appeal in cases where they do not find the redressal

satisfactory. This is especially problematic, as the act further bars the jurisdiction of civil courts in matters

pertaining to this act.

A provision which allows the complainant to appeal to the higher authority should be included within the ambit

of the proposed law.

Lack of independence of the grievance redressal bodies

Under the Healthcare Act, District Health Authority and State Health Authority, both of which are functionaries

under this act, have been recognized as grievance redressal bodies. From a reading of this act, the relationship

between the proposed in-house complaints‘ redressal forum that the government is required to constitute under

Clause 13, and the District Health Authority, and the State Health Authority is unclear.

Conflicts of interest would arise if District Health Authorities and the State Health Authority play the role of

administrators and adjudicators at the same time. We suggest that instead of making District Health Authorities

and State Health Authorities function as grievance redressal mechanisms, independent ombudsperson offices

be set up at various levels, through this Bill.

The concept of an ombudsperson in facilitating healthcare delivery, and as a means to resolve grievances in

healthcare delivery, is not new. In Brazil, Municipal Health Ombudspersons are appointed. For instance; in the

State of Minas Girais, the Municipal Health Ombudsperson was observed to have been acting as an ―instrument

of power and access to the rights of ‗Brazilian Unified Health System users.'36 'The Role of such an ombudsperson

is said to have been to listen and to clarify issues regarding Brazilian Unified Health Systems Operations and

procedure, and to support resolution of health problems.

In the UK, the Health Service Ombudsperson for England draws his powers almost wholly from the Health

Service Commissioners Act 1993.37 The general remit of the powers of such an ombudsperson is to act on

36 Rita de Cássia Costa da Silva et al, ‗Ombudsmen in health care: case study of a municipal health ombudsman‘, 48 (1) Rev Saude Publica

2014, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206117/#fn03>.

37 Health Service Commissioners Act, 1993. 27

complaints made in relation to failure in a service by a service provider, failure of a body to provide a service,

and maladministration in provision of services.

In Rajasthan, we can look at ombudsperson as a body that either facilitates resolution of grievances at the local

level, or resolves them in a more formalistic manner, if resolution at the local level is not possible. Here, there is

a possibility of gradation in the kind of disputes, infringement of rights, non-fulfilment of obligations etc.

regarding which a local ombudsperson at the block level can be approached, and grievances for which the

complainant may have to go to ombudspersons at a higher level (i.e., at the district and then the state level), were

such resolution at local level unsuccessful or dissatisfactory.

The Bill also must provide examples of the kinds of grievances or complaints that can be brought to local

ombudspersons. For instance, these will broadly include the denial of healthcare services and the infringement

of user rights. Whether these occur at private or public healthcare establishments, the ombudsperson will have

the power to take action to resolve them. On the other hand, the Bill must also clarify the kinds of issues that

the ombudsperson will not be able to adjudicate on, i.e. awarding damages or compensation, or cancelling the

licence of healthcare establishments. Their role should largely deal with investigation of grievances, ordering

inquiries, directing healthcare establishments to issue apologies or conduct internal audits to prevent such

complaints from recurring, etc.

Bar of jurisdiction of civil courts

Ombudspersons (or other grievance redressal mechanisms envisaged under this Bill) would not possess the

ability, resources, or authority to adjudicate on legal claims that may result in awarding damages or

compensation, or cancelling the license of healthcare establishments. Given that it will not be practicable or

appropriate for them to adequately address all infarctions, infringements, disputes, claims etc., jurisdiction of civil

courts should not be barred through a blanket provision such as Clause 16. In any case, it may be noted that

owing to the current position of law, writ petitions before the jurisdictional High Court or the Supreme Court

cannot be barred. 28 Comments on the Rajasthan Right to Health Care Bill, 2022: Submissions to the Government of Rajasthan

PART III: DETAILS THAT REQUIRE CLARITY

THROUGH RULES Implementation of any law requires delegated legislation or rules that clarify components, constituents, and

procedure under the umbrella of the parent law. In order to reduce ambiguity and ensure that the vision of the

law is realised to the fullest extent, careful and detailed drafting of rules – with adequate scope for flexibility and

modification where necessary – is important.

In particular, the following aspects of the Bill require clarity through rules:

o Detailed components of each right (of residents, users, and HCPs) envisaged in Chapter II of the Bill.

This could be in the form followed by the general comments on the Articles of the International

Covenant on Economic, Social and Cultural Rights (ICESCR).

o The following provisions under Clause 7 of the Bill (Obligations of the Government) require clarity

through Rules:

o The process and timelines for budget allocation for health in the state, through a

comprehensive analysis of various funds (under the NHM, state‘s own funds, funds under

diverse schemes, state health insurance, corporate social responsibility or CSR plans, etc.).

Appropriate flexibilities for decentralised fund planning and use at the district and lower

levels, as well as during emergent situations, should be provided here.

o Details of the Human Resource Policy envisaged here should be thoroughly planned and in

line with diverse schemes and programmes pertaining to the same. A common portal which

takes into account district and institutional flexibilities, and details of deputation, may be

created.

o The availability, quality, and affordability norms provided here should be details in line with

existing standards under the Clinical Establishments Acts and Rules at the central and state

levels, NHM, IPHS, etc.

o Composition, powers, functions, accountability structures, and procedure pertaining to the

coordination mechanism envisaged under Clause 7 (i)

o Components, procedure, timelines, and circumstances pertaining to health impact assessment [Clause

2(v)] and social audit [Clauses 2(vv) and 7(c)] - as well as the details and limits of powers, duties, and

functions of the authorities assigned to plan and implement the same.

o Components, procedure, timelines, and circumstances pertaining to the proposed chapter on public

health emergencies - as well as the details and limits of powers, duties, and functions of the

authorities assigned to plan and implement the same.

o Apart from incorporating recommendations provided in Chapter II. E of this document, details of the

composition, appointment/ transfer/ resignation/ termination/ dismissal of functionaries, procedural

norms, etc. pertaining to regulatory architecture and administration.

o Apart from incorporating recommendations provided in Chapter II. F of this document, details of the

composition, appointment/ transfer/ resignation/ termination/ dismissal of functionaries, procedural

norms, formats for complaint and appeal, etc. pertaining to grievance redressal mechanisms.

o Contours, process, responsibility, and accountability pertaining to compatibility review and other

processes envisaged under Clause 18.

___________ 20 The Legal Framework for Public Health in West Bengal – Vidhi Centre for Legal Policy

www.vidhilegalpolicy.in

Vidhi Centre for Legal Policy

D-359, Defence Colony

New Delhi – 110024

011-43102767/43831699

[email protected]

Jan Swasthya Abhiyan Rajasthan

Government of Rajasthan‟s Draft of “Rajasthan Right to Heath Care Act 2022”

Government of Rajasthan

Department- of Medical, Health and Family Welfare

Rajasthan Right to Heath Care Act 2022

Clause

no.

Clause in Govt. Draft Suggested Changes Justification for

the suggested

change/clause

PREAMBLE

To provide protection and

fulfilment of rights, equity in

relation to health and well-

being for achieving the goal of

health care for all through

guaranteed access to quality

health care to all the residents of

the State, without any

catastrophic out-of-pocket

expenditure.

And whereas the persisting

inequitable accessibility and

denials in the matter of health

care in the State are a concern to

all.

The Government of

Rajasthan is committed to ensure

that people's right to health care

is realized. The most important

stakeholders in realization of

right to health care are the people

themselves. Therefore, people's

participation is crucial and

critical for realization of people's

right to health care services.

The constitution of India

incorporates provisions

Article 21 of the constitution

guarantees protection of life and

personal liberty to every-citizen.

21 of the constitution guarantees protection of life and personal liberty to every-citizen.

To provide for protection and

fulfilment of rights and equity in

relation to health and well-being

under Article 47 of the Indian

constitution to accomplish the goal of

health care for all through guaranteed

access to quality health care to all the

residents of the State, without any

medical out of pocket expenditure.

And whereas every resident

of the state of Rajasthan is entitled to

enjoyment of the highest attainable

standard of physical, mental,

intellectual and social well-being and

health, conducive to living a life in

dignity;

And whereas the right to

health care is an inclusive right

extending not only to timely health

care but also to the underlying socio-

economic, cultural and

environmental determinants of

health;

And whereas to address the

persisting iniquitous accessibility

and denials in the matter of health

care in the State;

And whereas the

Government of Rajasthan is

committed to ensure that

people's right to health care is

realized. The most important

stakeholders in realization of

right to health care are the people

themselves. Therefore, people's

The Preamble

ought to exhibit

a clear intent of

the Act in

symmetry with

the rights laid

down in the

constitution and

those stipulated

in different

covenants.

participation is crucial and

critical for realization of people's

right to health care services.

And whereas there is also a

need to set a broad legal framework

to ensure availability, accessibility,

acceptability and quality (AAAQ)

comprehensive health care services

and functions including powers to

respond to public health

emergencies.

It is hereby enacted in the

Seventy second Year of the

Republic of India as follows:-

Chapter-I: Short title, Extent and Commencement-Definitions

2(a) Affordable

It should be removed. It is absolutely

difficult to

measure the

affordability

(food or non-

food

expenditure) of

individual

families because

of the wide

variations even

within the same

economic

cohort.

2(tt) Resident

To be modified that no proof of

residence would be asked for.

It could be a

barrier if proof

of residence is

dended as many

patients may not

have it or not

readily

available.

Suggest

ed new

definiti

on 1

Accessible

(This term is being used in the

draft but not defined)

Basic primary care within half an hour

of walking distance, comprehensive

primary care within 12 kms, secondary

level care within an hours distance by

motorized vehicle and tertiary care

within 150 kms.

Parameters of

accessibility are

paramount as

this only

ensures

realization of

the obligations

under the Act.

Suggest

ed new

definiti

on 2

Out of pocket expenditure.

(This term is being used in the

draft but not defined)

Medical expenditure –Drugs,

diagnostics, consultation, ambulance

services, surgical procedures, charges

of blood

Non-medical: Transport, lodging,

food, attendant charges.

Out of pocket is

measurable.

Chapter-II: Collective and Individual Rights in Relation to Health Care

3. Rights of residents 3(a) Residents will have the right to

collect information to make

themselves healthy.

Residents will have the right to the

following information communicated

to them in a manner most appropriate to their capacity with due respect and

minimum use of unfamiliar or

complicated technical terminologies:

i) rights and entitlements

stipulated under this Act, and any other statutes, rules, policies or regulations which directly or indirectly concern right to health or health care.

ii) health care goods, facilities, services, schemes, programmes, technologies available at all health care establishments, their costs and how, where and when to access them

iii) health concerns prevalent in the community, including methods of prevention, control, treatment and counselling to lead a healthy and active life;

iv) provisions, procedures and processes to seek redressal for any violation of their rights under this Act

The modified

clause explicitly

outlines the kind

of health

information the

residents would

be entitled to

receive.

3 (b) Residents will have the right to free

consultation, drugs, diagnostics,

emergency transport and emergency

care at all public health institutions

as may be prescribed

by rules made under this Act;

Residents will have the right to free

and dignified consultation, drugs,

diagnostics, emergency

transport, emergency care and

counselling at all public health

institutions as may be prescribed by

rules made under this Act

To signify access

to ―dignified‖

health care and

the component of

―counselling‖.

3 (c) Residents will have the right to

free/affordable care for surgeries at all

public

hospitals as may be notified by rules

made under this Act;

Residents will have the right to free,

dignified, SOP care for surgeries at all

public hospitals as may be notified by

rules made under this Act;

Removed word

―affordable‖. All

the services at

public health

facilities must be

free for everyone.

3(d) Residents covered under insurance

scheme will have the right to avail free

services

under the insurance scheme through the

empanelled Hospitals as notified in

terms

and conditions of the insurance scheme

when in force and as modified from time

to

time;

Residents covered under health

insurance scheme will have the right to

avail all the health care services, except

those which are excluded, without

bearing any out of pocket payment from

an empanelled private hospital under the

scheme only on being referred from a

public health care establishment or in

the case of emergency;

In fact, there is no

need of any health

insurance scheme

unless it is

universal because it

adds to miseries of

patients rather than

any relief. Public

health facilities

ought to be kept out

of the insurance

schemes.

3 (e) Residents will have the right to free

services from the private hospitals

established through the land allocation

on concession rates as per the terms and

conditions mentioned at the time of the

allotment of the land;

Residents will have the right to free,

ethical, safe and as per SOP services

from the private hospitals established

through the land allocation on

concession rates as per the terms and

conditions mentioned at the time of the

allotment of the land;

Ideally no private

institution should

be provided land on

concessional rates

and other subsidies

because it is very

difficult to get and

monitor free

services from them

3 (f) Right to receive information, records

and reports of self from the health care

establishment be it public or private;

Every user shall have the right to be informed about the following by relevant and qualified healthcare workers at all health care establishments in a manner most appropriate to the capacity of the user with due respect and minimum use of unfamiliar or complicated technical terminology : i) identity and professional status of

the health care providers providing

him/her services and of any rules

and routines of the establishment

which would bear on his/her care.

ii) his/her health status including the

medical facts about his/her health

condition, required health care,

together with the potential risks and

benefits, costs and consequences

generally associated with each

option of health care

iii) alternatives to the proposed health

care, including the implications,

risks and effects of refusal of health

care;

iv) the diagnosis, prognosis and

progress of health care;

v) and any other information that may

be pertinent to the user in taking a

decision, providing consent or to

understand his/her current and

possible future health status.

Every user shall also have the right to:

i) his/her medical files and technical

records and to any other files and

records pertaining to his/her

diagnosis, treatment and care

(including X-ray, laboratory reports

and other investigation reports)

and to receive a copy of own files

and records or parts thereof; and

ii) request for and to be given a

written summary of his/her

diagnosis, treatment and care and in

case of an inpatient, the complete

discharge report at the time of

The modified clause explicitly outlines the kind of medical information and records the patients or their families would be entitled to receive.

discharge, which must also include

the advised, follow-up actions to be

taken by the user.

3 (g) Right to informed consent at all

health care establishments be it public

or private;

Every user shall have the right to informed consent before accessing any health care intervention proposed for him at all health care establishments be it public or private. In the case of emergency or when the user is unable to express his/her consent due to medical reasons, his/her authorised representative, close relative or caregiver’s consent shall be taken and in the absence of all when the medical intervention is urgently needed to save user’s life, the consent of the user may be presumed. When the user lacks full capacity to give

consent, due to his/her being a minor or

due to any proven mental disability,

temporary or permanent, shall to the

extent of incapacity, have the right to be

supported or substituted only where

absolutely necessary by a decision-

making on his/her behalf, through a de

jure or de facto guardian, next friend or

personal representative, whose

credentials are clear to the service

provider;

The modified clause explicitly outlines “consent” under different circumstances.

3 (h) Right to confidentiality through all

health care establishments as may be

defined by rules made under this Act.

Every user has the right that all

information about his/her health status,

medical condition, diagnosis;

prognosis and health care and all other

information of a personal kind

(identified or identifiable to him/her)

must be kept confidential by all health

care establishments, even after his/her

death, and such confidential

information can only be disclosed if

the user gives explicit consent or any

law expressly provides for this; it may

be used for study, teaching or research

only with the authorization of the user,

the head of the health care

establishment concerned and the

institutional ethics committee of the

establishment.

The modified

clause explicitly

explains what

confidentiality

signifies.

3 (i) Right to safe and quality care

according to standards prescribed for

different levels of health care

establishments run or managed by

Government or private institutions.

3 (j) Right to proper referral transport by

all healthcare establishments be it-

public or

private as per the procedures detailed

in the rules made under the act.

Every user has the right to be

provided with proper referral

transport from the health care

establishment be it public or

private as per the procedures detailed

in the rules made under the act.

Referrals will be considered valid

only on the following grounds :

(i) the referring healthcare establishment does not have the capacity, resources or expertise to fulfil the healthcare user’s right to healthcare;

(ii) the transfer is in the best interest of the user, and is unlikely to cause any injury or death;

(iii) the referring healthcare establishment has provided the user or their caregiver with a written explanation for referral and transfer;

(iv) the referring healthcare establishment has arranged, in a timely manner, free or affordable and quality transportation to the healthcare user. Provided that until the user is transported to and received by the receiving healthcare establishment, the referring healthcare establishment shall bear the sole responsibility for the health, safety and wellbeing of the healthcare user.

The modified

clause details out

referrals.

3 (k) Right to take treatment summary in

case of patient, leaving against the

medical

advice.

Every user will have the right to take

treatment summary in case of patient,

leaving against the medical advice.

3 (l) Right to be heard and seek redressal

from health care establishment in

case of any

grievance occurred after availing

services.

Every user will have the right to be

heard and seek redressal from

health care establishment or

through the state established

grievance redressal mechanism or

through legal intervention in case of

any grievance which occur during or

after availing services.

The right to seek

legal

intervention in

case not satisfied

with

departmental

grievance

redressal is

crucial.

3 (m) Right to the family

member/authorized person of the

Family member/authorized person of the deceased user will have the

The modified clause details

deceased to receive dead body

irrespective of payment due status-

from every health-care establishment.

right to receive the dead body, medical records, sensitive information and all the belongings of the deceased irrespective of the payment due status from every health care establishment be it public or private, other than for necessary medical reasons, to comply with legal obligations or in case of a public health emergency.

out what all information etc of the deceased the family would be entitled to receive.

Suggest

ed

clause 1

Right to outreach services Residents will have the right to free,

dignified and SOP compliant

outreach health care services in both

rural and urban areas through public

health care establishments as per the

services mandated to be delivered as

outreach under various government

schemes and programs.

Access to

outreach health

care services is

crucial and must

be stipulated in

the Act.

Suggest

ed

clause 2

Right to not be discriminated Residents shall have the right to receive

health and healthcare information and

services from all health care

establishments be it public or private

without any kind of direct or indirect

discrimination, including but not limited

to, discrimination on the basis of their

age, caste, criminal antecedents,

disability, financial status, gender

identity or gender expression,

geographical location or residence,

health status or condition, language,

level of education, marital status,

nationality or citizenship, occupation,

place of birth, race, religion, sexual

orientation, sex characteristics and/or

any other social, economic, cultural or

political characteristics.

It is an important

right to receive

health care services

without any

discrimination and

must be stipulated

in the Act.

Suggest

ed

clause 3

Right to not be coerced Residents shall have the right to not be

subjected to any kind of direct or

indirect coercion, force, threat or denial

of his/her fundamental rights by the state

or health care providers, public or

private, in the absence of their explicit,

autonomous and informed consent to

receive a health care procedure or

medical intervention.

Coercion of any

kind in accessing

health care must

not be tolerated

and this needs to be

outlined in the Act

explicitly.

Suggest

ed

clause 4

Right to second opinion Residents will have the right to obtain a

second or more opinion from another

health service provider and choose to

seek health care, medicines, diagnostics,

vaccines, devices or implants from a

source most suitable to them.

Every user must be

entitled to right to

seek second

opinion if they wish

to and the Act must

have a clause on

the same.

Suggest

ed

clause 5

Right to refuse or halt medical

intervention

Every user shall have the right to

refuse or to halt a medical intervention

at any health care establishment be it

public or private and on his/her

exercising such right, the implications

This clause lays

down a crucial

right of the

patient to refuse

or halt treatment

of 'refusing or halting such an

intervention must be carefully

explained by the service provider to the

user, provided that the refusal or

halting comes to the knowledge of the

provider;

if not satisfied

with the services.

Suggest

ed

clause 6

Right to attendant Every user whether in-patient or out-patient shall have the right to be accompanied by or have access to at least one attendant/caregiver of their choice. In the absence of an attendant/ caregiver, a qualified healthcare worker shall be provided by the healthcare establishment to deliver caregiving services either within the healthcare establishment or elsewhere.

Every patient has the right to be accompanied by an attendant and this must be stated in the Act.

Suggest

ed

clause 7

Right to protection of persons/patients

under clinical trial

Right to protection for persons/patients

involved in clinical trials, biomedical

and health research as defined by

concerned clause in the rules;

The right of

persons/patients

under clinical trial

to be protected

must be stipulated

in the Act.

4. Duties of Residents 4 (a) Tertiary health care services can be

availed by following referral from

primary and

secondary level institution or a service

provider.

Remove

4 (b) Provide health care providers with

the relevant and accurate

information for health

care, subject to the user's right to

confidentiality and privacy.

Remove

4 (c) Comply with the prescribed health

care. Remove

4 (d) Sign a discharge certificate or

release of liability if he or she

refuses to accept

recommended treatment.

Remove

4 (e) Ensure that the premises occupied

by the residents are kept clean and

indulge in no

activity that pollutes the atmosphere

physically or otherwise.

Remove

4 (f) Refrain from misconduct and

misbehavior with any health care

providers, and treat

them with respect and dignity.

Retain

4 (g) Refrain from physical assault on any

healthcare personnel or damage to

property.

Retain

4 (h) Report illegal or unethical behavior. Retain

4 (i) Permit post-mortem to be done in

case of unnatural death. Retain

5. Rights of Health Care Provider

5 (a) Protection from complaints relating

to adverse consequences on

providing his/her services of any

kind as long as the provider has

acted bonafide to the best if his/her

professional capability through

application of standard treatment

procedure and judgment, and in the

best interests of the residents and

exercised all reasonable care;

5(b) Be treated with respect and dignity by

the patient and attendants.

5 (c) Decent working conditions and

training.

Enunciate a policy on living and

working conditions, training and

accreditation for health care

providers especially in the primary

health care for their continued

nursing and medical education and

career advancement.

The modified

clause details

out the right to

decent

working

conditions and

training to

make it more

explicit.

5 (d) Right of physical safety and security

at the workplace.

5 (e) Availability of protective measures

for any accidental exposure to harm.

6. Duties of Health Care Provider

6 (a) Follow the standard treatment

guidelines, protocols as notified

time to time under the rules made

under this Act, and using the clinical

judgement in the best interest of

resident.

6(b) Maintain confidentially, privacy,

dignity of residents, and treat them

with respect.

6 (c) Respect the rights of residents to take a

decision for getting either a lab

investigation or medicines be purchased

from the vendor of his/her choice.

6 (d) Ensure informed consent is taken before

every procedure

6(e) Explain and inform either patient or

relatives regarding the diseases severity,

progression, treatment and prognosis

regularly.

Chapter-III: Obligations of the Government

7 Government has the following general

obligations at all times, by enhancing the

quantum of the resources towards the

time bound realization of health and

wellbeing of every resident in the state;

7(a) Appropriate State budget would be

provided.

Incrementally enhance state health

budget to 10% of the state budget in

next five years or 3% of the GSDP

whichever is more, to satisfy the

obligations and rights set out herein,

for ensuring planning and rational

allocation and attributions of resources

for various health care related issues

and concerns ;

The Act should

clearly state in

the Act itself what

it is committing in

terms of financing

the health care

how the State

aims to increase

its health budget

to meet the

obligations

stipulated in the

Act.

7 (b) Within six months of the enactment,

develop and institutionalise a Human

Resource

Policy for Health to ensure

availability and equitable distribution

of doctors, nurses

and other ancillary health

professionals and workers at all

levels of healthcare as

notified in the rules under the act.

Within six months of the enactment,

develop and institutionalise a Human

Resource

Policy for Health stipulating norms

for transfers and promotions to

ensure availability and equitable

distribution of doctors, nurses

and other ancillary health

professionals and workers at all

levels of healthcare as

notified in the rules under the act.

7 (c) Within six months, set up the social

audit and grievance redressal

mechanisms as notified under the rules

under this Act.

Within six months, set up mechanisms

for social audit of public health care

services, public dialogues at PHC, block

and district levels, and grievance

redressal processes as notified under this

Act.

Social Audits and

Public Dialogues

are as crucial as

grievance redressal

and the

mechanisms for the

same must also be

devised at the

earliest as the Act

is legislated.

7(d) Within one year, align all health

services and schemes to strengthen

a system of

health services to empower and make

residents aware for preventive,

promotive and protective health care,

not merely an absence of disease.

7 (e) Within one year, lay down and

notify standards for quality and

safety of all levels

of health care as notified under the

Within one year, lay down and notify

specific standards and norms for safety

and quality assurance of all aspects of

health care including health care

IPHS/NABH

should be the

standards the

government

rules. services and processes, treatment

protocols, infrastructure, equipments,

drugs, diagnostics, medical devices,

ambulance service, health care

providers at all levels of public health

care establishments and for outreach

health care services;

Provided that the Government shall

adopt for itself the Indian Public

Health Standards (IPHS)/NABH for

the Health Institutions under its control

and may review and expand such

standards in scope and contents to suit

the needs of the State of Rajasthan;

should aim for.

7 (f) Guarantee availability of

government funded healthcare

services as per distance or

geographical area or considering

population density which will

include health care

institutions, free medicine, test &

diagnostics of notified items and

ambulance services as per standards

to be notified under the rules.

Guarantee basic health care services

through public health care

establishments to every resident Basic

primary care within half an hour of

walking distance, comprehensive

primary care within 12 kms, secondary

level care within an hours distance by

motorized vehicle and tertiary care

within 150 km..by skilled human

resource with state of the art

infrastructure, free medicines, tests,

blood bank, equipments and 24X7 free

ambulance service.

The clause must

specify how

exactly does the

government plans

to ensure that

health care

services are

accessible to all.

7 (g) Ensure that there will not be any

directly or indirectly denial, to

anyone, for any government funded

health care services at appropriate

health care establishment and as per

guaranteed services mentioned in

clause (a) of section 4 and

clause(f) of section 7.

Ensure that patients won‘t have to incur

any out of pocket expenditure at any

public health care establishment and that

there will not be any direct or indirect

denial to anyone for any government

funded health care service at appropriate

health care establishments as per the

guaranteed services mentioned in clause

(a) of section 4 and clause(f) of section

7.

Apart from

eliminating denials

of any sort the Act

must also call for

no out of pocket

expenditure at

public health

facilities.

7 (h) Mobilize and enact any other

budget, plan, or policy required to

ensure the above guarantees

7 (i) Set up co-ordination mechanisms

among the relevant government

departments to facilitate nutritionally

adequate and safe food, adequate

supply of safe drinking water and

sanitation

7 (j) Institute effective measures to

prevent, treat and control epidemics

and other public

health emergencies and public

health issues notified from time to

time under this

Act.

7 (k) Take appropriate measures to

inform, educate - and empower

people about health

issues.

Take appropriate measures to

inform, educate and empower

people about health

issues through sustained and regularly

updated state and local level IEC

programme which reflect the latest

developments in the

laws/policies/schemes/programs and the

best available scientific knowledge.

The modified

clause highlights

the significance

of regularly

updating and

evolving IEC

tools and

mechanisms.

Suggested

clause 1

Obligation to safeguard rights Take effective measures to safeguard

all the rights related to health and

health care as laid down under Chapter

II

Suggested

clause 2

Obligation to devise a system for

referrals to tertiary hospitals

Devise a robust system of referral

to ensure that there‘s no

unnecessary crowding at Tertiary

health care services. Ensure that

Tertiary care can be availed by

following referral from primary and

secondary level institution or a

service provider or in the case of

emergency.

Ensure that every resident family is

provided with the health card and

assigned to a designated primary health

care provider who would be the first

port of call for health problems not

warranting emergency hospitalisation.

Persons travelling could locate and

access nearest Health and Wellness

Centre through mobile phone.

Suggested

clause 3

Obligation to provide alternate

measure in case the required

health care service could not be

delivered

Fix alternate measures in case a patient

fails to receive due medical attention or

health service, drugs or diagnostics

because of absence of the doctors or

any other medical staff or due to lack

of essential equipments or supplies in a

public health care establishment or a

private health care establishment

empanelled to deliver public funded

health care services

Suggested

clause 4

Obligation to ensure transparency

at the health care establishment

Ensure that all health care

establishments be it public or private

maintain transparency by explicitly

displaying the following information

within their premises at a place where

it is clearly visible and in a language

easily understood by majority of the

local population :

- List of services available along

with their costs or if free it

being clearly specified

- List of free drugs, diagnostics

available

- List of packages covered under

public funded health insurance

scheme available.

- Schedule/timings when the

available services can be

accessed

- List of serving doctors and

other health care staff with

their names and designations

and if they are entitled to Non

Practicing Allowance (NPA) if

serving in public health

establishments.

- Name and contact details of

the in house

complaints/grievance redressal

officer as well as the details of

government portal or helpline

number where the grievance

could be registered in case the

user is not satisfied by the in

house response to his/her

complaint.

- Accreditations if any

- Patients‘ rights charter

Awareness materials on major health

care schemes/programs/entitlements or

information on prevention of diseases,

healthy lifestyle etc.

Suggested

clause 5

Obligation to monitor health care

establishments and prescription

practices

Devise and implement structure and

plans for the following :

i)routine inspection of all health care

establishments be it public or private.

ii) routine prescription audits at all

public health care establishments.

iii) Formation of drugs

formular and creation

of drugs and

therapeutic committees

in each institution .

Suggested

clause 6

Obligation to regulate private

health care establishments

Implement Clinical Establishments Act

2010 and devise and execute rules and

plans for the regulation of all health

care establishments be it public or

private.

Suggested

clause 7

Obligation to regulate government

doctors also practicing from homes

Ensure that doctors from public health

establishments who also practice from

home after duty hours only prescribe

medicines and diagnostics which are

under the free medicines and free

diagnostic lists devised and updated by

the State from time to time and that

patients are able to avail them from

public health care establishments for

free. Such doctors should only be

allowed to charge consultation fee

from the patients as per the rates fixed

by the State.

Suggested

clause 8

Obligation to regularly devise and

review policies, budgets, plans etc

Promote health research and devise,

adopt, implement and regularly review

health policies, strategies and plans of

action on the basis of epidemiological,

sociological, anthropological,

economic and environmental evidence

to address the health concerns of

various population of the state;

Suggested

clause 9

Obligation to ensure transparency

in budget, policy etc formulations

Ensure transparency in the

formulation, amendments and

implementation of health care budgets,

policies, programs and schemes and

involve participation of different

stakeholders including community

members and civil society

representatives in their development

processes.

Suggested

clause 10

Obligation to strengthen

community action for health

Constitute, orient and empower

Village, Health, Sanitation and

Nutrition Committees (VHSNCs) in

every village of the state as outlined in

the MoHFW guidelines, provide them

with the annual untied fund that they

are entitled for and engage them in

community-based and decentralised

health monitoring, evaluation,

governance and planning.

Suggested

clause 11

Obligation to ensure access to

health care services for the

specially abled

Devise policy and ensure that all health care establishments be it public or private have the required orientation, arrangements and infrastructure to make healthcare facilities and services easily and in a sensitive manner accessible to persons who are specially abled.

Suggested

clause 12

Obligation to ensure access to

health care services for persons

with rare diseases

Ensure that every resident has access to latest facilities and technologies for the timely diagnosis and prognosis of rare diseases and that persons with rare diseases have access to the latest and scientifically sound information, required resources and services for leading a life with dignity and for timely treatment and care.

Suggested

clause 13

Obligation to ensure proper waste

management at health care

establishments

Ensure sanitation and environmental

hygiene, including waste management

for every kind of waste in all health

care establishments.

Suggested

clause 14

Obligation to ensure quality meals

for the inpatients

Ensure availability of safe and quality

food for the inpatients at all public

health care establishments.

Suggested

Obligation to ensure safe drinking

water at health care establishments

Ensure regular water supply and

availability of safe potable water for

clause 15

the users as well as health care

providers at all public health care

establishments.

Suggested

clause 16

Obligation to ensure power supply

at health care establishments

Ensure regular power supply and

arrangements for power back up at all

public health care establishments.

Suggested

clause 17

Obligation to provide protective

gears to health care workers

Ensure that doctors and healthcare workers at the all levels have timely and adequate access to standardised safety and protective gears/equipments and are well oriented on their usage.

Suggested

clause 18

Obligation to promote other

codified systems of medicines

Promote different codified systems of

medicines and ensure adequate

financial allocations for them;

Suggested

clause 19

Obligation to carry out Health

Impact Assessments

Devise and implement plans for Health

Impact Assessment (HIA) of all new

development projects;

Chapter-IV: Constitution, Power and Duties of State Health Authority, State Executive Committee and District Health Authority

8. Constitution and Duties of State Health Authority

8 (a) The Government shall, by notification in the official gazette, constitute an independent 'body as State Health Authority, to exercise powers conferred on, and perform the functions assigned to that Authority under this Act;

The authority

should be the

apex body for

execution of the

obligations of the

State under the

Right to Health

Care Act.

8 (b) The State Health Authority shall consist

of the following members, namely:-

I. The Chief Secretary,

Government of Rajasthan, -Chairperson,

II. Secretary in-charge of Medical,

Health and Family Welfare Department-

Co-Chairperson,

III. The Director of Health Services

(Public Health), Rajasthan,

- Member-

Secretary

IV. Secretary in-charge of the following

departments shall be members, namely

1. Medical Education Department,

2. Public Health Engineering,

The State Health Authority shall consist

of the following members, namely:-

I. The Chief Secretary, Government of

Rajasthan, -Chairperson,

II. An independent person with at least

30 years experience of public health

in the state- Co-Chairperson

III. Secretary in-charge of Medical,

Health and Family Welfare

Department- Executive Chairperson,

IV. The Director of Health Services

(Public Health), Rajasthan,

- Member Secretary

V. Secretary in-charge of the following

departments shall be members,

namely:

1. Medical Education Department,

It is to be an

independent body

therefore it ought

to be headed by

an independent

person with 30

years experience

of public health in

the state.

Representation by

non government

members must be

increased.

3. Women & Child Development,

4. Panchayati Raj and Rural

Development,

5. Social Justice and Empowerment,

6. Tribal Area Development,

7. Urban Development,

8. Finance,

9. Information and Public Relations,

10. Revenue,

11.Ayurveda, Yoga, Naturopathy,

Unani, Siddha, and Homoeopathy,

12. Education department,

13. Relief and

14. Rehabilitation

V. Three members of the Rajasthan

Legislative Assembly as nominated by

the State Government,

VI. Three persons from the

Government Medical Teachers of the

State especially from clinical specialties,

VII. Four non-official persons,

1. Public health experts to be nominated

by the Chairperson,

2.Representatives of health associations

to be nominated by the Chairperson,

3.Civil society organizations to be

nominated by the Chairperson,

4. One member from an NGO of repute,

preferably working in the state

to be nominated by the Chairperson.

VIII. Representative of Chairman, State

Pollution Control Board, and

IX. Three representatives of patient

groups - nominated by the Chairperson.




Development,


6. Tribal Area Development,

7. Urban Development,

8. Finance,

9. Information and Public Relations,

10. Revenue,


Unani, Siddha, and Homoeopathy,

12. Education department,

13. Relief and Rehabilitation

VI. Three members of the Rajasthan

Legislative Assembly as nominated by

the State Government,

VII. Two persons from the Government

Medical Teachers of the State

especially from clinical specialties,

VIII. Representative of Chairman,

State Pollution Control Board, and

IX. Two representatives of

government medical officers from

PHCs/CHCs (On rotation)

X. Two representatives of nursing

staff (On rotation)

XI. Two representatives of ASHAs

(On rotation)

XII. Four PRI representatives (On

rotation):

1- zila pramukh

1 – pradhan

2- sarpanch

XIII. Eight non-official persons,

1. Public health experts to be nominated

by the Chairperson,

2.Representatives of health associations


3.Civil society organizations to be


4. One member from an NGO of repute,

preferably working in the state to be

nominated by the Chairperson.

5. Four representatives of patients

groups (On rotation).

Of the non-official or nominated

members at least 50% should be

women and 50% S.C., S.T. and BPL

8 (c) I. The appointment of each member of

the State Health. Authority, except the

ex-officio appointees, shall be for three

years.

II. The State Health Authority shall meet

at least once in six months; and

8 (d) The State Health Authority shall carry

out the following functions:-

I. To advise the Government on any

matter concerning public health,

including preventive, promotive,

curative. and rehabilitative aspects of

health and occupational, environmental,

and social determinants of health;

II. Formulate State's health goals and get

these included in the mandate of

Panchayati Raj Institutions and urban

local bodies;

III. Formulate state level strategic plans

for implementation of Right to Health

Care Act provisions, including action on

the determinants of health - food,

water and sanitation:

IV. Formulate a comprehensive written

State Public Health Policy/plan for

prevention, tracking, mitigation, and

control of a "public health emergency",

as well as situations of "outbreak" or

"potential outbreak "in the State;

V. To monitor the preparedness of the

State for management of public health

emergencies;

VI. To develop mechanisms and systems

for regular medical, clinical, and social

audits for good quality of health care at

all levels;

VII. The State Health Authority may, as

and when it considers necessary,

constitute one or more

committees/scientific panels/technical

panels for the

efficient discharge of its functions;

VIII. The State Health Authority may,

as and when it considers necessary,

associate with institutions, experts, Non-

Government organizations for the

efficient discharge of its functions;

IX. The State Health Authority through

the community-based monitoring

methods, as may be prescribed by rules

made under this Act, shall involve

the communities as active co-facilitators

articulating their needs, helping in

identification of key indicators and

creation of tools for monitoring,

ADDITIONAL FUNCTIONS TO BE

ADDED :

i) Overseeing the functioning of Block

and District Health Authorities;

ii) Establishing specific, time-bound

and verifiable benchmarks, and

indicators for each of the obligations

under the Act;

iii) Formulating human resource

development plans/policies for

health to ensure availability,

efficiency and regular capacity

building of healthcare workers

iv) Overseeing the functioning of

grievance redressal mechanisms and

ensure effective investigation and

redressal of grievances in a time

bound manner as and when

complaints are escalated for its

consideration to the State Health

Authority or suo moto in case of

grave violation of health/patient‘s

right as and when it comes to its

notice.

providing feedback as well as validating

the data collected by these methods; and

X. Carry out other functions as may be

defined by rules made under this Act.

9. Constitution and Duties of State Executive Committee 9 (a) The State Health Authority shall,

by notification in the official

gazette, constitute an independent

body as State Executive

Committee, to exercise powers

conferred on and perform the

functions assigned under this Act;

The State Executive Committee

shall consist of the following

members, namely: -

I. Secretary in-charge of Medical,

Health and Family Welfare

Department -

Chairperson,

II. Secretary in-charge of the

following departments shall be

members, namely


Department,



Development

4. Ayurveda, Yoga, Naturopath,

Unani, Siddha, and

Homoeopathy,

and

5. Elementary Education

department

III. Mission Director (National

Health Mission), Rajasthan -

Member,

IV. The Director Medical

Health

Services (Public

Health),Rajasthan - Member,

V.Additional Director (Hospital

Administrator), Rajasthan-

Member,

VI. Nodal officer (Right to

Health Care Act), Rajasthan-

Member Secretary,

VII. Three persons from the

Government Medical Teachers of

the State especially from clinical

specialties, to be nominated by

the Chairperson.

VIII. Four non-official persons,

1. Public health experts to be


2. Representatives of health

associations to be nominated by

the Chairperson

3. Civil society organizations to be


4. One member from an NGO of

repute, preferably working in

the state

to be nominated by the

Chairperson.

IX. Representative of Chairman, State

Pollution Control Board

9(c) I. The appointment of each

member of the State Executive

Committee, except

the ex-officio appointees, shall be

for three years.

II. The State Executive

Committee shall meet at least

once in three months; and

9(d) The State Executive Committee

shall carry out the following

functions: -

I. Implement state level strategic

plans for implementation of Right

to Health

Care Act provisions, including

action on the determinants of

health - food,

water and sanitation;

II. Implement a State Public

Health Policy/plan for prevention,

tracking,

mitigation, and control of a

"public health emergency", as

well as situations

of "outbreak" or "potential

outbreak "in the State.

III. To ensure the State for

management of public health

emergencies;

IV. To ensure mechanisms and

systems for regular medical,

clinical, and social

audits for good quality of health

care at all levels,

V. To monitor population health

status to identify and solve

community health

problems,

VI. Carry out, other functions as

given by Chairperson from time

to time.


ADDED:

i) Facilitating and organising periodic

public dialogues to ensure and

strengthen direct accountability of

the health system to the community

and beneficiaries

ii) Ensure that the standards,

benchmarks and targets formulated

by the State Health Authority for

health care improvement in the state

are met.

iii) Ensure effective functioning of

grievance redressal mechanisms as

suggested in the Act

iv) Ensure effective execution of

community-based monitoring

methods through active participation

of community members, especially

via VHSNCs.

10. Meeting of State Health Authority 10(a) The State Health Authority shall

meet at least two times in a year,

by giving such

reasonable advance notice to its

members and shall observe such

rules of procedure regarding the

transaction of business at its

meetings as may be prescribed by

rules

made under this Act.

Provided that if, in the opinion of

the Chairperson, any business of

an urgent nature is to be

transacted, he/she may convene a

meeting of the authority at such

time as he/she thinks fit for the

aforesaid purpose.

10 (b) The meetings of the Authority

and the mode of transaction of

business at such meetings,

including quorum etc., shall be

governed by such regulations as

may be prescribed by rules made

under this Act.

11. Constitution and Duties of District Health Authority 11 (a) The Government shall constitute an

independent body as District Health

Authority within one month from the

date of constitution of State Health

Authority;

11 (b) The District Health Authority shall

consist of the following members,

namely:-

I. The District Collector -

Chairperson,

II. Chief Executive Officer, Zila

Parishad - Co-Chairperson

III. The CM&HO - Member

Secretary,

IV. Senior most officers of the

district from the departments shall be

members, namely .



3. ICDS,

4. Women Empowerment,

5. Local Body,

6. Education, and

7. Ayurveda, Yoga, Naturopathy,

Unani, Siddha, and Homoeopathy

V. Pramukh, Zila Parishad of the

district and three Pradhans' of the

Panchayat

The District Health Authority shall


namely:-

I. The District Collector -

Chairperson,

II. A person with at least 20 years of

public health experience and preferably

belonging to the district – Co-

Chairperson

III. Chief Executive Officer, Zila

Parishad – Executive Chairperson

IV. The CM&HO - Member

Secretary,

IV. Senior most officers of the

district from the departments shall be

members, namely .



3. ICDS,

4. Women Empowerment,

5. Local Body,

6. Education, and


Samitis in rotation, as may be

prescribed by rules made under this

Act.

VI. Four non-official members,

namely

1. Public health experts, to be



associations, to be nominated by the

Chairperson,

3. Civil society organizations

preferably working in health sector,



repute, preferably working in the

district in the health sector, to be


Unani, Siddha, and Homoeopathy

V. Two representatives of medical

teachers if there are any.

VI. Two representatives of

government

medical officers from PHCs/CHCs

VII. Two representatives of nursing

staff.

VIII. Two representatives of ASHAs

IX. Pramukh, Zila Parishad of the

district and two Pradhans of the

Panchayat

Samitis and two sarpanchs in

rotation, as may be prescribed by

rules made under this Act.

IX. Six non-official members,

namely

1. Public health experts, to be



associations, to be nominated by the

Chairperson,

3. Civil society organizations

preferably working in health sector,




district in the health sector, to be


5. Two representatives of patients

groups.

Of the non official or nominated

members at least 50% members should

be women and 50% S.C. , S.T. and BPL

(c) The District Health Authority shall

carry out the following functions:-

I. Ensure implementation of the

policies, recommendations, and

directions of

State Health Authority;

II. Formulate and implement

strategies and plans of action for the

determinants

of health, especially food, water,

sanitation, and environment.

III. Formulate a comprehensive

written plan for prevention,

tracking, mitigation, and control of a

"public health emergency", as well as

situations of "outbreak" or "potential

outbreak "in the district based on

State Plan.

IV. Coordinate- with the relevant


ADDED:

i) Ensure that the standards,

benchmarks and targets formulated

by the State Health Authority for

health care improvement in the state

are met.

ii) Ensure effective functioning of

grievance redressal mechanisms in

the district as suggested in the Act

Government departments and

agencies to

ensure availability and access to

adequate and safe food, water and

sanitation throughout the district.

V. Organize hearing of the

beneficiaries coming to the hospital

once in three

months with a view to improve the

health care services; and

VI. District Health Authority

through the community-based

monitoring

methods, as may be prescribed by

rules made under this Act, shall

involve

the communities as active co-

facilitators articulating their needs,

helping in



providing feedback as well as

validating the data collected by these

methods.

VII. Carry out other functions as may

be defined by rules made under this

Act.

12. Powers of the State Health Authority and District Health Authority 12 (a) For purposes of carrying out the

inquiry under this Act, the authority

shall nominate

one or more persons / committees for

the efficient discharge of its

functions, as may

be prescribed by rules made under this

Act.

12 (b) The authority shall have the power of

only official purpose to require any

person, to

furnish information on such points or

matters as may the subject matter of

the

inquiry and any person so required

shall be deemed to be legally

bound to furnish such

information within the meaning of

sections 176 and 177 of the Indian

Penal

Code (45 of 1860).

12 (c) The authority or any other officer

authorized on this behalf by the State

Health

Authority and District Health

Authority may enter in any building

or place where

the authority has reason to believe

any document relating to the subject

matter of an

inquiry may be found, and may seize

any such document or take extracts or

copies

therefrom subject to the provisions of

section 100 of the code of Criminal

Procedure,1973, in so far may be

appliable.

12 (d) Fixing responsibility and

accountability of private institutions,

facilities, buildings,

or places, whether for profit or not,

operated to provide inpatient and/or

outpatient

services. The government shall have

the power to regulate prices for the

packages

and ensure display of rates for each

of the packages in public domain, as

may be

notified by rules made under this Act.

I. In case of a pandemic, or any other

public health emergency the

government

shall have the right; -'

1. to takeover building of private

institutions;

2.to takeover facilities of private

institutions;

3. to takeover services of private

institutions;

4. to takeover duties of human

resources working in private

institutions; and

5. to prescribe treatment rate of

services provided by private

institutions during the pandemic, as

may be specified in the

government notification issued under

this Act.

12 (e) Other powers as defined under the

rules of the act.

Suggested

Clause 1

Constitution of Block Health Authority

The Block Health Authority shall


namely:-

I. Pradhan, Panchayat Samiti,

Chairperson

II. A person with at least 10 years

of public health experience and

preferably belonging to the Block – Co-

Chairperson

Block Health

Authorities must

be formed to

ensure

decentralised

planning and for

gathering regular

grassroots

feedback on

III. The Block CM&HO - Member

Secretary,

IV. Senior most officers of the block

from the departments shall be

members, namely .


2. ICDS,

3. Education, V.Two representatives of government

medical officers from PHCs/CHCs

VI. Two representatives of nursing

staff.

VII. Two representatives of ASHAs

VIII. Block Development Officer

(BDO)

IX..Four sarpanchs in rotation, as

may be prescribed by rules made

under this Act.

X. Eight non-official members,

namely

1. Four representatives of CBOs to be

nominated by the

Chairperson,

2. Two members from an NGO of


block in the health sector, to be


3. Two representatives of patients

groups.

Of the non official or nominated

members at least 50% members should

be women and 50% S.C. , S.T. and BPL

delivery of health

care services and

health care needs.

Suggested

Clause 2

Duties of Block Health Authority I. Review, plan and execute

preventive, curative, palliative and

health promotion activities and

programmes in the overall guidance of

State and District Health Authorities.

II. Formulate and implement

strategies and plans of action for the

determinants

of health, especially food, water,

sanitation, and environment.

III. Formulate a comprehensive

written plan for prevention,

tracking, mitigation, and control of a

"public health emergency", as well as

situations of "outbreak" or "potential

outbreak in the block based on

District and State plans.

IV. Coordinate- with the relevant

Government departments and

agencies to

ensure availability and access to

adequate and safe food, water and

II.

sanitation throughout the block.

V. Organize hearing of the

beneficiaries coming to the hospital

once in three

months with a view to improve the

health care services; and

VI. Block Health Authority

through the community-based

monitoring

methods, as may be prescribed by

rules made under this Act, shall

involve

the communities as active co-

facilitators articulating their needs,

helping in



providing feedback as well as

validating the data collected by these

methods.

VII. Carry out other functions as may

be defined by rules made under this

Act.

Suggested

Clause 3

Meetings of Block Health Authority Block Health Authority will hold

meeting every month.

Suggested

Clause 3

Meetings of District Health Authority

District Health Authority will hold

meeting every two months.

Chapter-V: Grievance Redressal and Social Accountability Mechanism

13. Grievance Redressal Mechanism

13 (a) The Government shall constitute in-

house complaints forum at an

appropriate level

within one year from the date of

notification of the provisions of this

Act,

13 (b) The Government shall define rules,

within six months from the date of

notification

of the provisions of this Act, which

may include,-

I. On denial of services and

infringement of rights provided by

the right to

health care Act, residents can lodge

the grievances for redressal -at a

specified web-portal and helpline

banda,

II. On denial of services and

The Government shall define rules,

within six months from the date of

notification

of the provisions of this Act, which

may include,-

I. Every health institution would have

designated complaint officer like a

public authority who would receive

complaint related to the health

facility and address it within 10

days to the satisfaction of the

complainant.

The component of

having a

designated

Complaints

Officer at the

health institution

level is crucial to

streamline

grievance

redressal process.

The stipulated

time period for

infringement of rights provided by

the right to

health care Act, residents can lodge

the grievances for redressal at a

specified web-portal and a user-

friendly helpline center. The web-

portal/

helpline centre will forward the

grievances received to the concerned

officer

and his/her immediate supervisors

within 24 hours,

III. The concerned officer must

respond to the complainant within 30

days. The

grievances and their redressals will

be noted in the personnel file of the

respective staff member,

IV. If the complaint is not resolved

by concerned officer within 30

days the

complaint will be forwarded to

District Health Authority, as the case

may be,

V. District Health Authority will

investigate the grievance/complaint

and share

the summary of the investigation

with the complainant and in public

domain, within 60 days. District

Health Authority will invite the

complainant and try to resolve and

close the grievance within 30 days.

VI. If the grievance is still not

resolved within 30 days by the

district health authority, then the

complainant will be escalated to the

State Health Authority within 30

days.

II. On denial of services and

infringement of rights provided

by the right to

health care Act, residents can

lodge the grievances for redressal

at a

specified web-portal or a user

friendly helpline centre or in

writing to the Complaint Officer

of the concerned health facility.

The web-portal/helpline centre

must forward the grievances

received to the concerned

Complaint Officer within 24

hours. The concerned officer

must respond to the complainant

within 15 days. The

grievances and their redressals

will be noted in the personnel file

of the

respective staff member,

III. If the complaint is not resolved by

concerned officer within 15 days

the complaint will be forwarded

to Block Health Authority, as the

case may be,

IV. The Block Health Authority will

investigate the

grievance/complaint and share the

summary of the investigation in

speaking order with the

complainant and in public

domain, within 15 days. Block


complainant and try to resolve

and close the grievance within 30

days of receiving the complaint.

The travel cost borne by the

complainant during such visits

will be reimbursed by the state.

V. If the grievance is still not


Block health authority, then the

complainant will be escalated to

the District Health Authority

within 15 days.

VI. The District Health Authority will

investigate the





domain, within 15 days. District






resolving

complaints must

be reduced.



VII. If the grievance is still not


District health authority, then the

complainant will be escalated to

the State Executive Committee

within 15 days.

VIII. The State Executive

Committee will investigate the





domain, within 30 days. State








Chapter-VI: Penalties and Procedures

14. Penalties

14 (a) Any contravention due to negligence as defined in detail in rules of any provisions of this Act or any Rule or Order made or issued there under shall be punishable with a fine not exceeding Rupees ten thousand for the first contravention and not exceeding Rupees twenty-five thousand for the repeat contravention.

Any contravention due to negligence as defined in detail in rules of any provisions of this Act or any Rule or Order made or issued thereunder shall be punishable with a fine not exceeding Rupees twenty five thousand for the first contravention and not exceeding Rupees one lakh for repeat contraventions.

The range of penalty amount has been increased in the modified clause to consider violations of all kinds of gravity into account.

15. Appeals

15 (a) Any person or body aggrieved by

order of the District Health

Authority passed under the

provision of this Act can appeal

against the said order to the State

Executive Committee within 30

days as per the detailed procedure

notified under the rules

The complainant would have the right to

appeal to the Block Health Authority

within 15 days if not satisfied with the

decision of the concerned institution

who would have powers to impose fine

on the erring official which would not be

more than Rs. 10,000.00 and also call

for a departmental enquiry in case of

gross negligence.

The complainant may appeal to the

District Health Authority within 15 days

if not satisfied by the decision of the

Block Health Authority who would have

The right to appeal

to a higher

Authority if not

satisfied with the

decision cannot be

denied to the

aggrieved.

The provision of

departmental

inquire against an

official if found

guilty must also be

there.

powers to impose fine on the erring

official which would not be more than

Rs. 25,000.00 and also call for a

departmental enquiry in case of gross

negligence.

Any person or body aggrieved by

order of the District Health

Authority passed under the

provision of this Act can appeal

against the said order to the State

Executive Committee within 30

days as per the detailed procedure

notified under the rules. State

Executive Committee who would have

powers to impose fine on the erring

official and also call for a departmental

enquiry in case of gross negligence.

16. Bar of Jurisdiction

No civil court shall have

jurisdiction to entertain any suit

or proceeding in respect of any

matter which an Appellate

Authority constituted under this

Act is empowered by or under

this Act to determine, and no

injunction shall be granted by any

court or other authority in respect

of any action taken or to be taken

in pursuance of any power

conferred by or under this Act.

This clause must be removed To deny an

aggrieved the

right to seek legal

course of action if

not satisfied with

the departmental

inquiry and

decision goes

against the

principle of

natural justice

and curtails

constitutional

rights. This clause

therefore must be

removed entirely.

Naina Seth

Suggestions on the Draft Rajasthan Right to Health Care Act, 2022

Submission to the Department of Medical, Health & Family

Welfare, Government of Rajasthan

At the outset, and as articulated in a previous letter to the Secretary of Department of Medical,

Health & Family Welfare, Government of Rajasthan, we desperately urge the Department to

extend the date of submitting suggestions/comments/objections to the draft of the proposed

Rajasthan Right to Health Care Act, 2022 and to hold statewide consultations. We are willing to

facilitate these consultations and present the findings to the government at a state-level

consultation. This will enable the Department to include views and suggestions of those who can

otherwise contribute to the framing of this important legislation but are being left out because a

wider set of consultations are not being held, and in this way, prepare a more comprehensive and

enforceable law. Due to the limitations of the current deadline in place (which we could not

adhere to due to the consultative nature of our exercise), however, we, the listed members from

civil society groups working in public health and human rights in Rajasthan and

other parts of the country, want to bring the following suggestions to the Department‘s notice.

Broad set of suggestions and objections to the draft Act:

1. Unclear vision and attendant incoherence in the drafting of the Act. The vision and

framework of the right to health care legislation must be clear from the Preamble itself,

which it currently lacks. Therefore, we have provided an alternative to the currently

drafted Preamble, with a short statement setting out the aim of the Act, viz. ―to provide

for free, accessible and quality health care to all the residents of the State‖. Similarly,

the draft Act does not emphasise on issues of equity in health care access. In this way,

it completely misses provisioning for non- discrimination in seeking, accessing, and

receiving health care services.

2. Quality, safety, and accessibility standards. The specific standards for quality, safety,

and accessibility of health care services must be clearly spelled out in the text of the Act,

and not be left for notification in the rules.

3. The private health care sector. The draft Act seems to be silent on the dominance of

private sector providers in healthcare, including their presence in financing in health

care financing and service delivery. It, therefore, does not set out any provisions for

regulating the private health care sector, the absence of which will keep the state short of

achieving the goal of universal health coverage, in an equitable manner.

4. State funding. The Act must state the commitment of the State of Rajasthan by

outlining the share of the state budget that would be allocated to the health care sector,

and in this way towards realising the rights and obligations set out in the Act.

Detailed suggestions on the draft Act:

Serial No.

Section and Clause No.

Suggestions (Addition/ Modification/ Deletion/ Others)

Details of the suggestion or exact wording of the proposed addition/ modification/ deletion/ others

Remarks

1 Preamble Modification and Addition

Preamble to be read as: "To provide for free, accessible, and quality health care to all the residents of the State, and with a progressive reduction in out-of-pocket expenditure and removal of any catastrophic expenditure in seeking, accessing or receiving health care. Whereas, the State is to provide for improving the level of nutrition, the standard of living, and public health as per Article 47 of the Constitution of India, and secure the right to health as per the expanded definition of Article 21 of the Constitution of India. And whereas every resident of the state of Rajasthan is entitled to enjoying the highest attainable standard of physical, mental, intellectual, and social well-being and health, conducive to living a life with dignity; And whereas the right to health care is an inclusive right extending not only to timely health care but also to the underlying socio-economic, cultural, and environmental determinants of health; And whereas to address the persisting iniquitous accessibility and denials in the matter of health care in the State; And whereas the Government of Rajasthan is

committed to ensuring that people's right to health care is realized. The most important stakeholders in the realization of the right to health care are the people themselves. Therefore, people's participation, and transparency and accountability to the people themselves, is crucial and critical for realization of peoples right to health care services."

2 Section 2(a) Others Section 2(a) on the definition of affordability to be revisited conceptually and modified.

There is variation in the definition of catastrophic household healthcare expenditure, especially depending on the income level of the household, and it needs to be clarified why this particular threshold in monthly consumption and non-food consumption expenditures is being used.

Further, how will it be verified that health care expenditure exceeds 10% of total monthly consumption expenditure and/or 40% of monthly non-food consumption expenditure?

Sections 2(b) Addition Curative, rehabilitative and palliative care to be added to the definition of basic primary healthcare services.

Therefore, Section 2(b) to be read as “”Basic Primary Healthcare Services” means preventive, promotive, curative, rehabilitative and palliative care, as defined from time to time for health & wellness centers at sub-centers. They include consultation, drugs and diagnostics, among other services.”

Section 2(e) Modification and Addition

Section 2(e) to be read as “”Capacity to consent” means the ability of an individual, including a minor or a person with mental illness, assessed by a healthcare provider on an objective basis, to understand and appreciate the nature and consequences of proposed healthcare or of a proposed disclosure of health-related information, and to make an informed decision in relation to such health care or disclosure. In order to ensure that the person concerned makes an 'informed decision', it will be the duty of the State to ensure that: 1. All information is made available to the user in simple language, which such user understands or in sign language or visual aids or any other means to enable him to understand the information. 2. Pro-active facilitation is provided to enable the person to access the information and use it."

Note that "mentally challenged" is a term whose usage has been discontinued post the enactment of the Rights of Persons with Disabilities Act, 2016. It should also be noted that Section 4 of the Mental Healthcare Act, 2017 which deals with people’s capacity to mental healthcare and treatment decisions states the following: 4. (1) Every person, including a person with mental illness shall be deemed to have capacity to make decisions regarding his mental healthcare or treatment if such person has ability to— (a) understand the information that is relevant to take a decision on the treatment or admission or personal assistance; or (b) appreciate any reasonably foreseeable consequence of a decision or lack of decision on the treatment or admission or personal assistance; or (c) communicate the decision under sub- clause (a) by means of speech, expression, gesture or any other means. (2) The information referred to in sub- section (1) shall be given to a person using simple language, which such person understands or in sign language or visual aids or any other means to enable him to understand the information. Therefore, the proviso on how an informed decision can be made needs to be outlined.

Section 2(o)(IV) Modification Section 2(o)(IV) to be read as “inform, educate, and empower people about health issues by enabling their access to information on an individual and collective basis and through ensuring community-based monitoring (CBM) and social audits on a regular basis.”

The modification helps provide the conditions under which it would be possible to inform, educate and empower people on health issues in an effective manner.

Section(o)(VII) Modification Section 2(o)(VII) to be read as "enforce laws and regulations that protect and ensure public health and safety, including the regulation of private sector health care providers"

While the section on essential public health functions is a progressive addition to the draft Act, the provisions do not clearly specific the regulatory role of the government.

Section 2(o)(X) Addition The function may also include affordability, i.e. Section 2(o)(X) should be read as "evaluate effectiveness, accessibility, quality, and affordability of personal and population-based health services,"

Section(o)(XII) Addition Section(o)(XII) to be read as "efficient and equitable health care financing"

Section 2(o)(XIII) Addition Section 2(o)(XIII) to read as "health protection, including management of environmental, food, toxicological and occupational safety"

Health protection, particularly in Rajasthan's context, where for instance pneumoconiosis is a significant occupational disease among mining workers in the state, should be a critical component of essential public health functions.

Section 2(t) Addition The term ‘health care worker’ or 'frontline health worker' could be defined to include a wider set of workers in health care, such as ASHAs, ANMs, etc. who are involved in health prevention and promotion, as well as identification and treatment of illness and/or disability.

Section 2(v) Modification Section 2(v) to be read as "“Health impact assessment” means a combination of procedures, methods, and tools, including mandatory participatory planning, CBM and social audit, for identifying, predicting, evaluating, and mitigating potential effects of a proposed law, policy, program, project, technology, or a potentially damaging activity, in relation health prior to taking decisions thereon and making commitments thereunder, on the health of the population, and other relevant effects, and the distribution of those effects within the population, and any reference to health impact assessment shall mean the same;"

Section 2(w) Modification Instead of the phrase “relates to” use the phrase “allows specific identification of an individual’s past. Present, future….”

which implies, Section 2(w) should be read as "“Identifiable health information” means any information, whether oral, written, electronic, visual, pictorial, physical or any other form, that allows specific identification of an individual's past, present or future physical or mental health status, condition, treatment, service, products, purchased or provision of care, and reveals that identity of the individual or that of a group of people, whose health care is the subject of the information, or there is a reasonable basis to believe the information could be utilized (either alone or with other information) to reveal the identity of the individual"

Section 2(x) Addition Add the following: Information disseminated will include the use of platforms such as Jan Soochna Portal where information not exempt under Section 8 of the RTI Act will be made openly available on a transaction basis so that people do not have to resort to using of the RTI to obtain information related tot he public health sector.

Section 2(kk) Addition Add the following after the phrase “governmental organizations and private institutions"...

Section 2(nn) Addition Add the following after the phrase “part or whole of” infrastructure, operations and/or costs of care.

Section 2(oo) Addition Add the following: Provided that such surveillance while ensuring the privacy of the individual is protected will be governed by transparent and participatory norms.

1. State must provide reasoned explanations for how the parameter of information collected will contribute to meeting the objectives of this Act 2. The process of arriving at the list of parameters of information that will be collected and analysed must be in a participatory and transparent manner.

Section 2(vv) Modification Replace with "Social audit to be conducted as per the Auditing Standards of Social Audit as laid down by the C&AG."

Section 2(yy) Addition Need to include family members/support system of patients.

Section 2(zz) Addition Add the following definitions after 2(zz) Complaint: "complaint" means a complaint lodged under Section (13) in relation to,-

a. any failure in the functioning of a public health institution or violation of any law, rules, or schemes currently in force; b. any grievance relating to, or arising out of, a failure in the delivery of goods or provision of services notified by the State Government under this Act; or c. any violation of duties and obligations upon public officials responsible for delivery of goods or rendering of services under this Act; Explanation.- For removal of doubts, a complaint does not include grievance relating to the service matters of a public servant whether serving or retired. Grievance Redress Officer: Every public authority shall, within one-twenty days from the date of commencement, designate as many officers as the Grievance Redress Officer in all administrative units or offices under it may be necessary to receive complaints and provide redressal of grievances in accordance with this Act: Provided that the Grievance Redress Officer so designated is at least one level superior to the official in charge of delivery of service and shall be deemed to have administrative control over the concerned official delivering the service

Section 2(aaa) Addition and Others The additional sub-section should mention how the State is defining out-of-pocket expenditure on health care. For instance, as per one source, OOPE on health care could include payments made towards health care provider’s fees, medicine, diagnostics, any surgical procedure, charges for blood, ambulance services, other in-patient and outpatient charges, etc., while non-medical expenditure includes money spent towards traveling expenses, shelter and food charges of self and escort, attendant charges, etc.

Section 3(a) Modification Section 3(a) to be read as "Residents will have the right to receive health interventions (information, services and products) in a manner most appropriate to them for promotion, prevention, and management of health at home, community and at health facilities to lead a healthy and active life, and/or access any rights under this Law."

Section 3(b) Modification Section 3(b) to be read as "Residents will have the right to free, timely and quality consultation, drugs, diagnostics, vaccination, emergency transport and emergency care, and rehabilitation and palliative care, at all public health institutions as may be prescribed by rules made under this Act."

Section 3(c) Modification Section 3(c) to be read as "Residents will have the right to free/affordable and quality inpatient care, surgeries and post-surgical care at all public hospitals as may be notified by rules made under this Act."

Section 3(d) Others It must be clear that all residents will

have the right to be covered under

government- funded insurance scheme,

and once

insured, they will have the right to avail

free services under the insurance scheme through the empanelled healthcare facilities. At the same time, it must be ensured that no one who is uninsured should be denied health care services, including emergency health care services at any health care establishment.

Section 3(e) Modification and Others To be read as “Residents will have the right to free, timely, and quality services from the private hospitals established through the land allocation on concession rates”

At the same time, it should be mentioned that we object to the proviso that says that “terms and conditions mentioned at the time of the allotment of the land” would govern the enforcement of Section 3(e). The Act should be laying the terms of individual contracts and not be governed by them.

Section 3(f) Modification Section 3(f) to be replaced with: Right to receive all information, records, and reports of self, including through authorized persons from the health care establishment be in public or private

Section 3(h) Addition Add the following Provided: All residents shall have a right to all information about the institutions and its funds, functioning, and functionaries as long as it does not violate the right to privacy of any individual user.

Section 3(i) Modification Section 3(i) to be read as "Right to safe and quality care according to standards prescribed for different levels of health care establishments run or managed by government or private institutions, including provisioning barrier-free access and reasonable accommodation."

Section 3(j) Modification Right to free and proper referral transport by all health care establishments, public or private (within 30 minutes from home to facility; and between health care establishments), as per the procedures detailed in the rules made under the act.

Section 3(k) Modification Section 3(k) to be replaced with: Right to details of treatment provided including treatment summaries and all costs incurred, even in cases of patients leaving against the medical advice.

Section 3(l) Modification Section 3(l) to be replaced with: Right to be heard, duly acknowledged, and seek time-bound redressal from health care establishments or through the state established grievance redressal mechanism or through legal intervention in case of any grievances occurring before, during, and after availing services

Section 3(m) Modification Section 3(a) to be read as "Right of family member/authorized person of the deceased user to receive the dead body, medical records, sensitive information and all the belongings of the deceased irrespective of the payment due status from every health care establishment."

Section 3(n) Addition Right to not be discriminated: Residents shall have the right to receive health and healthcare information and services from all health care establishments be it public or private without any kind of direct or indirect discrimination, including but not limited to, discrimination on the basis of their age, caste, criminal antecedents, disability, financial status, gender identity or gender expression, geographical location or residence, health status or condition, language, level of education, marital status, nationality or citizenship, occupation, place of birth, race, religion, sexual orientation, sex characteristics and/or any other social, economic, cultural or political characteristics.

Section 3(o) Addition Right to not be coerced: Residents shall have the right to not be subjected to any kind of direct or indirect coercion, force, threat or denial of his/her fundamental rights by the state or health care providers, public or private, in the absence of their explicit, autonomous and informed consent to receive a health care procedure or medical intervention.

Section 3(p) Addition Residents will have the right to obtain a second or more opinion from another health service provider and choose to seek health care, medicines, diagnostics, vaccines, devices or implants from a source most suitable to them.

Sections 4, 5 and 6 Others Instead of three different sections, there must be one section titled “Model Code of Conduct of Public Health Institutions and Users”. The existing provisions under Sections 4, 5, and 6 can be brought under one section.

Section 4 Modification Section 4 to be read as "Every resident has duties as may be prescribed by rules under this Act as follows, but which shall not constraint the residents' rights under this Act:"

Section 4(a) Others Tertiary health care services can be availed by following referral from primary and secondary level institution or a service provider.

While this is an important inclusion in the draft Act, it would be important to spell out how people would be encouraged to follow this path of seeking healthcare.

Section 4(c) Deletion Section 4(c) to be deleted. While engaging with health care advice is important, complying should not be a necessary condition in all cases.

Section 5(c) Modification Section 5(c) to be read as "Enunciate a policy on living and working conditions, remuneration, training and accreditation for health care providers and workers, especially at the primary health care level for their continued education and career advancement."

The policy must also be inclusive of health workers such as ASHAs, ANMs, health volunteers, etc.

Section 6(b) Modification Section 6(b) to be read as "Maintain confidentiality, privacy dignity of residents, and treat them with respect, including providing reasonable accommodation wherever required."

Section 7(a) Addition and Others Appropriate State budget should be provided so that rights under this law can be realized for all residents of the State. To this extent, the following must be included as part of Section 7(a):

"The state health budget would be progressively enhanced, at least to the extent of 10 per cent of the total state budget by the year 2028, two- thirds or more of which must be allocated to primary healthcare followed by secondary and tertiary care. Further, greater budgetary allocations must be made to desert and tribal districts to facilitate the provisioning of quality health care."

It is to be noted that the National Health Policy, 2017 recommends that a major proportion (up to two-thirds or more) of resources be allocated to primary care followed by secondary and tertiary care (Item 12 on financing of health care).

Section 7(b) Modification Add after the phrase “Human Resources Policy for Health”

including a fair and transparent recruitment, appointment, and transfer policy

Section 7(c) Modification Replace set up with “put in place”

Section 7(e) Modification Section 7(e) to be read as "Within one year lay down, notify and publicize standards for quality and safety of all levels and aspects of health care including job charts of all functionaries in public health institutions, provided that the Government shall: (1) adopt the Indian Public Health Standards (IPHS)/NABH for the health Institutions under its control and may review and expand such standards in scope and contents to suit the needs of the State of Rajasthan; (2) Set up a quality assurance institution that monitors the quality of health care establishments, reviews the evidence and revises standards accordingly from time to time, (3) Put in place a mechanism for quality and safety standards audit which includes community representatives"

Standards outlined in Sections 7(e) and 7(f) should be notified in a Schedule to the Act

Section 7(f) Modification Section 7(f) to be read as "Guarantee basic health care services through public health care establishments to every resident within 3 km (or 30 minutes of walking distance), comprehensive primary health care within 12 km, secondary health care same within 50 km (one hour by transport) and access to tertiary care (including treatment of critical illnesses) within 150 km by

Standards outlined in Sections 7(e) and 7(f) should be notified in a Schedule to the Act

fully skilled human resource with state of the art infrastructure, free medicines, tests, blood bank,

equipment, and 24X7 free ambulance service.

Section 7 Addition After sub-section 7(k), add the following

l. Ensure that a real-time transaction-based information system guides the implementation of this Act. Information from the portal will be shared with the JSP on a continuous basis subject to Section 8 of the RTI Act m. Ensure six-monthly review of the implementation of the Law n. Ensure that the annual report on implementation is laid in the Assembly o. Implement the Clinical Establishments Act 2010 and devise and execute rules and plans for the regulation of all health care establishments be it public or private.

Section 8(IV)(14) and 9(b)(II) and 11(b)(IV)

Addition Add the following after: Any other Department as needed

Section 8(VII) and 9(b)(VIII) and 11(b)(VI)

Modification Replace “Four non official persons” with the following

At least four non official persons with atleast one representative of each of the 4 categories below

Section 8(d)(IX) Modification Replace with: The State Health Authority should build and update a citizens charter which will involve the communities in articulating their needs and the Department in indicating the best ways possible to fulfil those needs. Community participation and monitoring shall be undertaken through concurrent and annual social audit processes as prescribed under this Act. A mandatory planning exercise will be conducted through community- based institutions at each level such as VHSNC etc.

Section 8(d)(X) Addition Add the following after:

XI. Review social audit findings and action taken on the same XII. Prepare the annual report that should be submitted in the Legislative Assembly XIII. Review grievances registered and the action taken thereunder. The Authority shall advise the Government on policy reforms that should be taken

Section 9(d)(VI) Addition Add the following after:

VII. There should be a dedicated secretariat to assist the functioning of the State Executive Committee in ensuring the implementation of the Act.

VIII. The State Executive Committee shall report to the State Health Authority.

Section 11(c)(V) Modification Replace with Organize a quarterly dialogue (samwaad) between the implementing agencies, public and CSOs with a view to improving the health care services.

Section 11(c)(VI) Modification Replace with To ensure that social audits carried out are independent and effective, it will be the responsibility of the District Health Authority to a. ensure that records are provided to the social audit teams 15 days prior to the audit b. ensure participation of concerned implementing agencies in the social audit public hearing c. Review action taken on social audit findings.

Section 12 Others There is no clarity on who is responsible for executing the orders issued by the Authorities. Further, it is not clear on what legal grounds the authorities are being given the powers under IPC.

In the current formulation, the State Health Authority is a collective body. It currently does not have an investigation/inquiry wing. It cannot fulfil the functions defined under this section

Section 12(d) Others and Modification In the current formulation, the State and District Health Authorities are given functions of a monitoring body. Section 12(d) describes the functioning of a regulatory authority. If Section 12(d) is to be actually implemented, a regulatory authority needs to be set up under this Law.

Section 12(d)(5) to be read as "to prescribe treatment rate of services provided by private institutes during the pandemic or any other public health emergency."

Section 13 Modification Replace with

a. Any person who is aggrieved by a denial of any goods and services of the medical establishment, including standards and services laid under this Act shall be entitled to file a complaint.

b. Complaints may be filed through multiple modes including in writing, through existing and specially created helplines, web portals etc

c. All complaints should be duly acknowledged by a dated receipt d. At the time of filing of the complaint, the complainant will be asked whether they would like the proceedings and ATR to be in the public domain. In case privacy and confidentiality are specifically requested by the complainant, personally identifiable information shall be redacted. The rest shall be in the public domain. e. All complaints will be forwarded to the concerned Grievance Redress Officer (GRO)

The time duration of responding to a complainant could be shortened from the 30-day period in the case of an exigency/emergency situation, similar to the RTI Act where the information sought will be supplied in 48 hours if it concerns the life and liberty of a person.

f. The following shall be the duties of the GRO - Inquire into the facts of the case, including a

physical visit to the site of the complaint - Give a hearing to the complainant within 15 days of registration of complaint as prescribed under the rules. The complainant may request that the hearing and the subsequent process of redressal of his/her grievance be held in camera in order to maintain privacy. The complainant may also present witnesses and others to be a part of the proceedings of the hearing. - Submit an action taken report within 30 days to the complainant. ATR will contain steps taken to resolve the grievance and will be furnished as per rules prescribed.

g. If the complainant is dissatisfied with the ATR, he /she has a right to file a first appeal with an Ombudsperson, at the district or state level, as the case may be

h. Failure of submission of an ATR within 30 days aby the concerned GRO will result in the automatic escalation of the complaint as a first appeal with a with an Ombudsperson, at the district or state level, as the case may be

i. Social Audits should be conducted by the independent social audit unit of the State as per the Auditing Standards of Social Audit laid out in the C&AG. j. the Social Audit Unit shall frame a calendar such that 100% of the institutions and their functions undergo a social audit once a year. The same shall be in the public domain k. All social audit Reports shall be in the

public domain l. All social audit findings should be responded to and resolved within 60 days

m. All Action Taken Reports of social audits conducted shall be in public domain

n. Requisite funds as per auditing standards shall be provided to the independent social audit unit which will carry out social audits as per Auditing Standards of Social Audit of the C&AG appropriately modified for the public health sector.

Section 14(a) Modification and Addition

Retitle Section 14 as Penalties and Compensation and add the following

b. The GRO or the Ombudsperson in addition to the penalty prescribed above may upon finding of serious contravention require the initiation of department proceedings, filing of an FIR in case of criminal violation has been found.

c. The GRO or the Ombudsperson may prescribe awarding of compensation to aggrieved persons

Individuals and organisations involved in the discussions (in alphabetical order):

1. Chhaya Pachauli, Prayas

2. Kavita Srivastava, People‘s Union for Civil Liberties (PUCL)

3. Naina Seth

4. Narendra Gupta, Jan Swasthya Abhiyan (JSA)

5. Nikhil Dey, Mazdoor Kisan Shakti Sangathan (MKSS)

6. Pavitra Mohan, Basic Healthcare Services (BHS)

7. Prakash Tyagi, Gramin Vikas Vigyan Samiti (GRAVIS)

8. Rakshita Swamy

9. Sharad Iyengar, Action Research and Training for Health (ARTH) Society

10. Vandana Prasad, Public Health Resource Network (PHRN)

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dh ns[kHkky lsok,¡ nsus dh ckr djrk gSa] ijarq jktLFkku ljdkj }kjk çLrqr bl Mªk¶V esa

dbZ fo"k;ksa esa Li"Vrk dk lh/kk lh/kk vHkko gSa] ;k dgsa fd yksxksa dks ;g lsok,¡ dSls

feysxh bl ckjs esa iwjs Mªk¶V esa dgha ij Hkh bl lanHkZ esa ppkZ ugha dh xbZ gSaA ;|fi

çLrkfor Mªk¶V ls ,slk vo’; çrhr gksrk gSa fd jkT; ljdkj jkT; ds ukxfjdksa dks muds

fudV] xq.koÙkkiw.kZ vkSj fu'kqYd lkoZHkkSfed LokLF; lsok,¡ çnku djus ds fy, fdlh Hkh

çdkj ls ck/; gSA lEiw.kZ nLrkost esa flQZ ;gh dgk x;k gS fd tc fu;e cusaxs rks mleas

foLr̀r fooj.k gksxk] ysfdu fu;e fuekZ.k ds fy;s izLrkfor le; lhek 6 ekg cgqr vf/kd

gSA

jktLFkku ljdkj }kjk çLrkfor Mªk¶V jktLFkku LokLF; dk vf/kdkj dkuwu 2022 dks

v/;;u djus ij ge bl çLrfor Mªk¶V dkuwu esa fuEu la’kks/kuksa gsrq lq>ko izLrqr djrs

gSaA

çLrqr Mªk¶V jktLFkku LokLF; dk dkuwu vf/kdkj ds lEiw.kZ nLrkost esa ge fcanqokj

viuh vkifÙk;ka ,oa lq>ko vkids le{k is'k dj jgs gSa%&

1- ljdkj ls gekjh ;g ekax gS fd dkuwu ds rgr fu;e Hkh dkuwu fuekZ.k ds lkFk gh

vFkok vf/kdre ,d ekg dh vof/k esa izdkf’kr dj fn;s tkus dk izko/kku fd;k tkosA

2- çLrkfor dkuwu esa jkT; dh turk dks LokLF; ns[kHkky lsok,a nsus dk oknk fd;k x;k

gSa ijarq turk ds fy, lHkh LokLF; lqfo/kk;sa dSls lqyHk miyC/k gksxh] bl lanHkZ esa dqN

ugha dgk x;k gSaA jkT; ljdkj dks pkfg, fd izfr 3 fdeh ds Hkhrj cqfu;knh lsok,a] izfr

12 fdeh ds Hkhrj iw.kZ çkFkfed ns[kHkky] izfr 50 fdeh ¼,d ?kaVs dh ;k=k½ ds Hkhrj xaHkhj

chekfj;ksa dk bykt vkSj 150 fdeh ds Hkhrj iwjh rjg ls dq'ky fo'ks"kKksa ds lkFk xaHkhj

chekfj;ksa ds bykt dh O;oLFkk bl dkuwu ds tfj;s lqfuf'pr gksA

3- ejhtksa dks bu lHkh lsokvksa ls tksM+us ds fy, 24x7 ,Ecqysal dh miyC/krk gksA

4- çLrkfor dkuwu esa ljdkj yksxksa dks LokLF; lsok,¡ fu'kqYd vkSj lLrh ¼Affordable½ lsokvksa dk ftØ fd;k x;k gSa ijarq lLrh lsokvksa dks ifjHkkf"kr djrs gq, dgk x;k gS fd

O;fä dh ekfld vk; dk 10% r; fd;k x;k gSa tcfd jkT; ds e/;e] xjhc vkSj

vfrxjhc yksxksa ds fy, ;g Ikzko/kku lgh ugh gSa A ljdkj bl çko/kku esa la'kks/ku djs

vkSj ;g lqfuf'pr djs fd fcuk tsc [kpZ ds mi;qä LokLF; ns[kHkky vkSj lacaf/kr

dk;kZRed midj.k ,oa vU; cqfu;knh <kaps] ,Ecqysal lsok,¡] çf'kf{kr fpfdRlk&dehZ rFkk

midj.kksa o Mk;XuksfLVDl lfgr vko';d nok,sa lHkh fu’kqYd ikus dk vf/kdkj lHkh dks

feysA

5- çLrkfor dkuwu esa LokLF; laLFkkuksa esa cqfu;knh lqfo/kkvksa ds ckjs esa fdlh çdkj dk

ftØ ugh gSA tSls i;kZIr is;ty dh vkiwfrZ] LoPNrk] Hkou] fctyh] lM+d] LokLF;

laLFkku rd igq¡p vkfn A lkFk gh çLrkfor dkuwu esa efgykvksa] yM+fd;ksa ,oa LGBTQ leqnk; ds lnL;ksa ds fy, fdlh çdkj ds dksbZ fo'ks"k çko/kku ugha fd, x, gSa] buds

fy, çLrkfor dkuwu esa fo'ks"k /;ku ds lkFk çtuu LokLF; lsokvksa vkSj ;kSu LokLF;

ns[kHkky ds fy, çko/kku fd, tk,¡ A

6- lHkh vko';d vkSj thou j{kd nokvksa] midj.kksa vkSj Mk;XuksfLVDl dh miyC/krk vkSj

igqap] nokvksa dk rdZlaxr mi;ksx vkSj nok çfrjks/k vkSj çfrdwy çHkkoksa dh fuxjkuh dh

ckr bl dkuwu esa ugha gSa A blls 'kkfey fd;k tk,A

7- ljdkj çLrkfor Mªk¶V dkuwu esa ,d rjQ jkT; dh turk dks eq¶r vkSj lLrh LokLF;

lsok;s¡ nsus dh ckr dj jgh gSa] ogh nwljh vkSj bl dkuwu esa chek vk/kkfjr ;kstukvksa dh

Hkh iSjoh djrh utj vk jgh gSaA gekjh ekax gSa fd ,d dY;k.kdkjh jkT; gksus ds ukrs

ljdkj dh ;g uSfrd ftEesnkjh gSa fd og jkT; dh turk dks eq¶r LokLF; ns[kHkky

lsok;s¡ miyC/k djk;sA chek vk/kkfjr ;kstukvksa dks ljdkj foÙkiksf"kr u djs ] bUgsa iwjh

rjg ls can fd;k tk,A fo’ks"k:Ik ls chek vk/kkfjr ;kstukvksa ds tfj;s futh vLirkyksa ds

fy;s vuki ’kuki iSlk olwyh dk tks }kj [kksy fn;k x;k gS mls iw.kZr% cUn fd;k tkosA

8- çLrkfor Mªk¶V dkuwu esa dgk x;k gS fd jkT; ds mUgh futh LokLF; laLFkkuksa esa

ukxfjdksa dks eq¶r lsok;s¡ feysaxh ftUgsa fdQk;rh nj tehu vkoafVr dh xbZ gS A gekjh

ekax gS fd jkT; ds lHkh futh LokLF; laLFkkuks esa nq?kZVuk] vkdfLed thouj{kd ekeyksa

esa eq¶r bykt dh O;oLFkk gksuh pkfg,A

9 -ljdkj }kjk cuk;s x;s ijUrq ckn esa lapkyu gsrq ihihih ekWMy ij futh dkWjiksjsV ds

gkFk esa ns fn;s x;s vLirkyksa dk ljdkj iqu% vf/kxzg.k dj [kqn lapkyu djsA crkSj

mngkj.k t;iqj ds ekuljksoj ds ekul vkjksX; vLirky dks esVªks dks ns fn;k x;k Fkk

vkSj lhdj jksM+ ds Vªksek vLirky ftls lksuh vLirky dks ns fn;k x;k Fkk] us ckn esa

efuiky vLirky dks csp fn;k] dks iqu% ljdkj vius fu;a=.k esa ysdj [kqn lapkfyr

djsA

10 - xzkeh.k {ks=ksa esa vLirkyksa esa fpfdRldksa dks tkus ds fy, rS;kj djus o muds Bgjko

dks lqfuf'pr djus ds fy, muds vkokl dh lqfo/kk,a lqyHk djokus ds lkFk lkFk muds

cPpksa dh f'k{kk ds fy, ogka dsaæh; fo|ky; ds cjkcj Lrj ds ekWMy Ldwy Hkh [kksyus

t:jh gSA bu lqfo/kkvksa ds lkFk gh ,d le;kof/k rd MkDVjksa dk xzkeh.k {ks=ksa esa jksLVj

ds tfj, Bgjko laHko gSA

11 - ;g egRoiw.kZ gS fd jktLFkku ukxfjd eap ds lq>ko dks vaxhdkj dj nw/k o [kk|

inkFkksaZ dh 'kq)rk dh tkap&ij[k ds fy, vkius gky gh çns'k esa eksckby yscksjsVªh pykus

dk QSlyk fd;k gS] ftldk ge gkfnZd Lokxr djrs gSaA blds lkFk gh mldh lqpk:

ikyuk dh ftEesnkjh vkSj fu;e dk;ns cukus Hkh mrus gh t:jh gSaA [kksyh xbZ eksckby

rFkk LFkk;h tkap yscksjsVªh ds ckjs esa tkudkjh o tupsruk txkus ds fy, vko';d çpkj

çlkj Hkh t:jh gSA

blds lkFk gh nw/k dh ek=k c<+kus ds fy, xk; HkSal dks fn;s tkus okys batsD'ku vkSj Qy

lfCt;ksa dks tYn idkus ds fy, fn;s tkus okys batsD'ku Hkh iwjh rjg ls çfrcaf/kr gksA

12 - vLirky rd igqapkus ls igys vkikrdkyhu LokLF; lsokvksa ds eísutj ^^LokLF;

fe=^^ tks thou j{kkFkZ vko';d bykt ds ckjs esa foK cukus gsrq de vof/k ds ØS'k dkslZ

ds çf'k{k.k dsaæ [kksydj mUgsa t:jh bykt o nok ds çf'k{k.k fn;s tkus pkfg,A bu

dkslsZt ds tfj;s Ik;kZIr la[;k esa nok forj.k gsrq QkesZflLV ,oa gksfe;ksiSFkh fpfdRld

rS;kj fd;s tk ldrs gSaA ;s fpfdRld tgka lkekU; lnhZ tqdke tSlh ekSleh leL;kvksa

dh fLFkfr esa xzkeh.k turk dks Rofjr lsok miyC/k djok ldrs gSa ogha mUgs csjkstxkjh ls

Hkh dqN futkr feysxhA QkesZflLVksa ds ykbZlsal fdjk;s ij fy;k tkdj nok fodzsrkvksa }kjk

QSyk;k tk jgk Hkz"Vkpkj jksdus gsrq Ik;kZIr la[;k esa QkesZflLV bl rjhds ls miyC/k fd;s

tk ldrs gaSA

13- dkuwu esa LokLF; ns[kHkky lsokvksa ds ekudksa ds ckjs esa Hkh Li"Vrk ugha gSa] çLrkfor

Mªk¶V dkuwu esa dgk x;k gS fd dkuwu ds rgr tks fu;e cusxs mlh ds vuqlkj ekud

r; gksaxsA tcfd gekjs ns'k esa Hkkjrh; lkoZtfud LokLF; ekud ¼IPHS) vkSj us'kuy

,ØhfMVs'ku cksMZ Q‚j g‚fLiVYl ,aM gsYFkds;j çksokbMlZ ¼NABH) igys ls ekStwn gSa A

blfy, dkuwu esa IPHS vkSj NABH dks vk/kkj ekudj] buds vuqlkj LokLF; ns[kHkky

lsokvksa vkSj lqfo/kkvksa dks lqfuf'pr djuk pkfg,A

14- LokLF; vkSj ifjokj dY;k.k ea=ky;] Hkkjr ljdkj vkSj jk"Vªh; ekuokf/kdkj vk;ksx

¼NHRC½ rS;kj fd, x, jksxh ds vf/kdkjksa ds ?kks"k.kki= dks ykxw djukA¼—i;k

NHRC }kjk viuk, x, pkVZj v‚Q is'ksaV~l jkbV~l dks ns[ksa½A

çLrkfor dkuwu esa bldk dksbZ ftØ ugh gSa A

bl v/;k; ds fcUnw Øekad 14 ¼a½ esa çLrkfor dkuwu ds fdlh Hkh çko/kku ds igyh ckj

mYya?ku ij ek= 10000@& ¼nl gtkj½ #i, vkSj nksgjko ij vf/kdre tqekZuk

25000@& ¼iPphl gtkj ek=½ çLrkfor fd;k x;k gS A ;g tqekZuk çko/kkuksa ds igyh

ckj mYya?ku ij 25000@& ¼iPphl gtkj ek=½ rFkk nksgjko ij de ls de 50000@&

¼ipkl gtkj #i,½ fd;k tkuk pkfg,A

bl v/;k; ds fcUnq Øekad 16 esa bl dkuwu ds vuxZr xfBr vihyh; çkf/kdj.k ds

fdlh Hkh vkns'k ;k xfrfrof/k ds fo#) U;k;ky; es tkus ls jksdrk gSa] tks xyr gS vkSj

turk dks LokLF; vf/kdkj nsus dh jkg esa eqf'dy iSnk djsxk] blfy, bl çko/kku dks

gVk;k tkuk pkfg,A

15- bl dkuwu ds varxZr jkT; ljdkj ds ikl fuxjkuh ds fy, ,d fuxjkuh ç.kkyh vkSj

lR;kiu ds fy, ,d lkekftd ys[kk ijh{kk ra= vfuok;Z :i ls gksuk pkfg, A ,d

çHkkoh] vktek, gq, vkSj ijh{k.k fd, x, fu;ked <kaps esa] ftlesa Lora= fuxjkuh]

okLrfod lkoZtfud Hkkxhnkjh vkSj xSj&vuqikyu ds fy, naM 'kkfey gSa] jkT; ljdkj dks

lkoZtfud LokLF; laLFkkuksa dks rhljs i{kksa ds çca/ku vkSj pykus dh ftEesnkfj;ksa dks

lkSaius esa vR;f/kd lko/kkuh cjruh pkfg,A ljdkj dks futh fgr/kkjdksa dks çkFkfed]

ek/;fed vkSj r`rh;d lkoZtfud LokLF; ns[kHkky dh ftEesnkjh ugha lkSaiuh pkfg,] blds

ctk; jkT; vkSj lkoZtfud /ku dk mi;ksx djds lkoZtfud ç.kkfy;ksa dks etcwr djuk

pkfg,A çca/ku ij dlkoV ds fy, tulgHkkfxrk dh Hkwfedk lqfuf'pr dh tkuh pkfg,A

16- lHkh Lrjksa ij LokLF; ns[kHkky vf/kdkjksa ds fy, ukxfjdksa ls mRiUu gksus okyh lHkh

f'kdk;rksa vkSj fooknksa dks laHkkyus ds fy, ,d çHkkoh vkSj Rofjr f'kdk;r fuokj.k ç.kkyh

dh vko';drk gSA f'kdk;rksa ds fuokj.k ds fy, f'kdk;r ra= lHkh laLFkkxr Lrjksa ij

LFkkfir dh tkuh pkfg,A ukxfjdksa dh f'kdk;rksa dks rqjar lacksf/kr djus vkSj can djus ds

vykok] ;g ftyk vnkyrksa vkSj vU; mPprj eapksa ij fooknksa dh la[;k dks Hkh de

djsxkA f'kdk;r fuokj.k dk tks <kapk bl çk:i esa n'kkZ;k gS og tehuh Lrj ij dSls

fØ;kfUor gksxk\ bldk mYys[k fd;k tkuk pkfg,] çLrkfor <kaps esa ejht vkSj LokLF;

lsok çnkrk ds chp fdlh çdkj ds laokn dh ckr ugh dgh xbZ gS mls lqfuf'pr djokus

ds çko/kku fd, tk,A

17- nok fodzsrkvksa vkSj futh fpfdRldksa }kjk tSufjd nokvksa ds ek/;e ls dh tk jgh

turk dh ywV dks iw.kZr% jksds tkus gsrq izHkkoh dne mBk;s tkosaA

18- lHkh QSfDVª;ksa] dk;Z’kkykvksa vkfn esa Jfedksa ds fy;s LokLF;dkjh O;oLFkk,sa dh tkosaA

vukSipkfjd vkSj vkSipkfjd {ks=ksa esa Jfedksa ds fy, jk"Vªh; O;kolkf;d lqj{kk fn'kk

funsZ'kksa ds vuqlkj fofHkUu LokLF; vf/kdkfj;ksa }kjk ljdkjh o futh LokLF; laLFkkuksa dk

O;kolkf;d LokLF; lqj{kk ds –f"Vdks.k ls fujh{k.k dh vuqlwph r; djuk vkSj

O;kolkf;d LokLF; ds fofHkUu eqíksa dks çLrkfoÙk dkuwu esa 'kkfey djuk vko';d gS A

bl fo"k; ij fo’ks"k ppkZ gsrq gekjh Vhe lnSo rRij gSA

ldkjkRed ifj.kke dh vis{kkvksa ds lkFkA

jktLFkku ukxfjd eap

1. Mr. Sandeep Vijay 2. Dr gulam Ali Kamdar 3. Mr. Rajkumar

Sharma, 4. Dr. Mayank Agarwal

Rajasthan Right to Healthcare Act 2022

The broader notion of the ‗right to health‘ emphasizes its interlinkages with rights and

regulations relating to the protection of life and liberty, privacy, education, housing, transport,

environmental protection and labour standards among others.

The traditional notion of healthcare has tended to be individual-centric and has focused on

aspects such as access to medical treatment, medicines and procedures. The field of professional

ethics in the medical profession has accordingly dealt with the doctor-patient relationship and the

expansion of facilities for curative treatment. In such a context, healthcare at the collective level

was largely identified with statistical determinants such as life-expectancy, mortality rates and

access to modern pharmaceuticals and procedures. It is evident that such a conception does not

convey a wholesome picture of all aspects of the protection and promotion of health in society.

There is an obvious intersection between healthcare at the individual as well as societal level and

the provision of nutrition, clothing and shelter.

Furthermore, the term ‗public health‘ has a distinct collective dimension and has an inter-

relationship with aspects such as the provision of a clean living environment, protections against

hazardous working conditions, education about disease-prevention and social security measures

in respect of disability, unemployment, sickness and injury. Special emphasis is laid on elements

such as women‘s reproductive health and the healthcare of children.

The incorporation of health concerns in the ‗rights‘ discourse, the onus on governmental

agencies goes beyond aspects like the regulation of the medical profession and support for

research and development (R&D) in the medical field. It also includes policy-choices pertaining

to education, housing, environmental protection, labour laws, social security provisions and the

protection of intellectual property among others.

CHAPTER-I


qualifications and relevant licenses required to be obtained by them.

Section 2- Define ―Quackery‖

CHAPTER-II

Section 3(c)- Replace all public hospitals to public health institutions as defined.

Section 3(j)- Proper referral transport includes the cost incurred in acquiring the vehicle,

equipment, medicines, trained staff etc., which should be clearly mentioned.

Healthcare facilities, especially private hospitals, cannot bear the cost of such

services by themselves.


Section 3(m)- Unfavorable for the Private Healthcare Facilities as the Provision allows patients

to not pay their dues for an indefinite period. Should only be allowed to take the

body of the deceased after providing an assurance/bond to pay the dues within a

specific period of time and within the limits of capping of dues on total bill.

Section 4- Should include duty of patients to pay the all the bills and dues for services rendered

to private healthcare establishments before discharge.


and Medicare Service Institutions (Prevention of Violence and Damage to

Property) Act, 2008.


Section 5- Include right to:

- practice profession without undue pressure, distress and harassment

- refuse treatment to patients indulging in disruptive and violent behavior

- refuse treatment to patients if required services are not available

- report unruly patients and attendants

- receive timely payments for services

Section 5(a)- no criminal proceedings against healthcare providers such as FIR/arrest should be

initiated without obtaining a report from district level committee of subject

specialists.

Section 5(d)- Right to have physical safety and security at the workplace , through proper safety

measures by government.

CHAPTER-III

Section 7- Include:

- Ensure proper safety and prevention of violence against health care workers

and establishments. Enact proper rules and stringent laws against physical

violence, verbal abuse, mob lynching harassment etc. for the same and direct

all concerned authorities to implement them.

- Make provisions to prevent quackery and crosspathy by unqualified persons in

health care. Respective authorities like CMHO, District Collector or SDM of

the concerned territory must be made liable and accountable to prevent

quackery.

CHAPTER-IV

Section 8(b)VII 2. - Specify representatives of health associations: must be from office bearers

of Indian Medical Association and Private Hospital association. Chairperson

should not appoint any representative by ―Pick & Choose‖ method. Exclusive

power to the Chairperson to appoint the representatives can create a bias.

Section 9(b)VI 2. - Specify representatives of health associations: must be from office bearers of

Indian Medical Association and Private Hospital association. Chairperson should

not appoint any representative by ―Pick & Choose‖ method. Exclusive power to

the Chairperson to appoint the representatives can create a bias.

Section 11(b)(VI)- Should also include President/Secretary of Indian Medical Association

(IMA), representatives of Private Hospital associations. Exclusive power

to the Chairperson to appoint the representatives can create a bias.

Section 12(b) – IPC section 176 and 177 should not be applicable. Required information must be

defined properly.

Section 12 (c) – Totally unconstitutional provisions. Any authority or officer should not be given

rights for a search and seize operation. Only related documents and records can be

asked to produce according to section 91 of CrPC.

Section 12 (d) – Unconstitutional provision of fixing responsibility and accountability of private

institutions for services. Clear Contraventions of Article 19 1(g) of constitution of

India. State Health Authority and District Health Authority can have only

supervision and advisory rights. Not acceptable to extent of deciding the prices for

private hospitals as the services provided at each establishment are diverse.

The government shall have powers to regulate prices for the packages of

government schemes only. Private institutions should not have any bindings for

participation and empanelment of such government schemes. State Health

Authority and District Health Authority committee may have powers to send

recommendations to revise the rates of packages of government schemes to

concerned departments to encourage participation of more and more private

institutions.

CHAPTER-V


1. Institutional Level

2. District Level: Must have members from representative of local

medical association, subject medical specialist and CMHO

3. State Level: Must have members from representative of state

medical association, subject medical specialist from Medical

College

Section 13 (b) – No grievance, complaint and investigation summary should not be shared on

public domain. Goodwill and reputation of health care providers and

institutions must be properly preserved and maintained.

Section 13 – Include following provisions:


- Must have penalty provisions for frivolous and misleading complaints.

- Health care providers and institutions should be allowed to lodge complaints

against any person, groups and authorities against infringement of their rights.

CHAPTER-VI

Section 16 – Totally unconstitutional provision, legal remedies and appeals are constitutional

rights and principal of natural justice. Should be deleted.

We believe that the said act should be beneficial to public and health care providers. No

adverse relationship between public and health care providers] should develop in the

society due to vague provisions of the act.

Mr. Ganesh Sharma, IMA Jaipur Branch

Oxfam India

Documents

Transcript of Oxfam India