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From UHC to UHA: Re-imagining the Right to Health
Universalising access to and attainment of the highest levels of health standards has been a long-cherished goal. This “right to health” (RtH) was defined in the constitution of the World Health Organisation (WHO) as the enjoyment of the highest attainable standard of physical and mental health. It was further reinforced by Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which conceptualised it as the right to the highest attainable standard of physical and mental health.
Universal Health Coverage Foundations
To ensure the operationalisation of this right, the Alma-Ata Declaration’s call for “Health for All (HFA)” sought to create the conditions that offer the opportunity to reach and maintain RtH throughout one’s life. It was re-emphasised in Universal Health Coverage (UHC), defined as everyone having “access to the health services they need, when and where they need them, without suffering financial hardship.” UHC was to be mapped and tracked through population coverage, service coverage, and financial risk protection.
Constitutional Basis and Infrastructural Requirement for Right to Health in India
The Indian Judiciary has led the way in the pursuit of the RtH. They have expanded Article 21’s right to life to encompass health as a fundamental right in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996). In doing so, it transformed health services from discretionary welfare provisions to justiciable entitlements. The Supreme Court in State of Punjab v. Mohinder Singh Chawla (1997), acknowledging that RtH is a socio-economic right that can be progressively realised by the States, implicitly recognised its non-negotiable minimum core.
Health policies in the 21st century began with the need for expanded public health infrastructure and decentralised healthcare delivery. It currently envisions UHC for the highest possible level of health and well-being for all its citizens through universal access to high-quality primary healthcare with Ayushman Arogya Mandirs (AAMs) and health cover for secondary and tertiary care for the vulnerable population with Pradhan Mantri Jan Arogya Yojna (PM-JAY). While these policies focus on creating the conditions for RtH, they fall short in terms of their justiciability and as an entitlement of citizens.
In Pursuit of a Justiciable Right to Health
The journey towards Viksit Bharat, with its citizens having guaranteed access to RtH, requires moving beyond the globally accepted goal of UHC to Universal Health Assurance (UHA). UHA emphasises equity, quality, and timeliness of services, ensuring that health systems deliver care that is not only available but accessible to all. The shift from coverage to assurance re-centres the constitutional right to health for every individual, especially the marginalised. And there are enough instances for the same within India’s political Economy.
The Right to Food and the subsequent National Food Security Act (NFSA) experience offers foundational principles for defining a minimum core entitlement, creating asymmetric Centre State fiscal responsibilities, mandating grievance redressal architecture, dynamic beneficiary identification using real-time socio-economic data platforms, phasing private sector obligations with reimbursement certainty, and mandating provisions for rural posting and mid-level provider recognition, and expansion of medical education, recognising that rights without provisioning infrastructure are hollow. Similarly, the State of Rajasthan provides a useful precedent with its Right to Health Act, establishing the right to free OPD and IPD services at all public health facilities and emergency care at select private hospitals.
There are strong foundations for it: Article 21 implicitly guarantees health via Supreme Court rulings, bolstered by the Ayushman Bharat Digital Health Mission, Aadhaar-linked IDs, PM JAY’s hospital network, and telemedicine infrastructure. A statutory Right to Health creates a justiciable entitlement system, with courts as previously proven catalysts for health rights. However, several challenges also persist public health spending falls short of NHP targets, human resources and infrastructure are inadequate and defining minimum core obligations risks being too narrow or unrealistically broad, rights demand matching investment to materialise. Thus, the architecture exists, what remains is the political will to build it, and to question whether India can afford to not have an autonomous Right to Health Act.
For a more detailed discussion on this, please refer to CUHA’s flagship report: Road to Viksit Bharat: From Achieving Universal Health Coverage to Attaining Universal Health Assurance – ISPP | India’s Leading Public Policy Institution