• Free cervical cancer vaccines for girls aged 9 to 16

Cervical cancer is a major public health challenge in India, ranking as one of the most common cancers among women. It accounts for a significant percentage of female cancer deaths in the country, with the human papillomavirus (HPV) identified as the primary cause. The MVA government’s proposal to provide free HPV vaccines for girls aged 9 to 16 is a proactive approach to addressing this issue. This initiative is not only a public health priority but also a critical step toward achieving health equity, particularly for families with limited financial resources. Cervical cancer disproportionately affects women in low- and middle-income countries, and India bears a large share of this global burden. The lack of access to preventive healthcare, regular screenings, and costly treatments leads to high mortality rates, especially in under-resourced communities. HPV, a sexually transmitted infection, is a significant risk factor, causing nearly all cervical cancer cases. The infection often goes undetected for years, with symptoms only surfacing in advanced stages when treatment is more challenging and outcomes are poor.

• Expansion of the Mahatma Phule Jan Arogya Scheme

The Mahatma Phule Jan Arogya Scheme (MPJAY), Maharashtra’s flagship health insurance program, has historically provided financial support for select ailments and covered certain treatments in government and empanelled private hospitals. MPJAY primarily focusses on critical and high-cost ailments rather than general health issues, covering around 1,000 types of procedures related to specific heart and kidney diseases, cancer treatments and neurological disorders, amongst others. The goal was to address life-threatening and severe medical conditions that could lead to financial catastrophe if left untreated. The scheme primarily benefited low-income families, giving them access to critical medical treatments they might not otherwise afford. 

Now, the MVA government proposes a significant expansion of MPJAY to cover all diseases, including those resulting from accidents. This transformative change aims to offer a broader safety net, shielding Maharashtra’s economically vulnerable populations from the financial hardships often associated with healthcare expenses. Expanding MPJAY is also an important step toward achieving Universal Health Coverage (UHC) for Maharashtra. In line with the goals of the National Health Mission, which advocates for accessible and affordable healthcare for all, MPJAY’s expansion contributes to creating a more inclusive healthcare system that ensures everyone can access quality medical services.

• Review and expansion of health insurance schemes

Recognising that the current health insurance schemes have limitations, the MVA manifesto proposes a thorough review to identify gaps and expand coverage accordingly. Many existing policies don’t cover all necessary treatments, and out-of-pocket expenses remain high. Enhanced insurance schemes will give citizens better access to advanced healthcare services, benefiting especially middle-income families who often struggle to cover medical costs. Expanding insurance coverage could also help the government partner with private providers to offer subsidised treatments.

• Free medicine availability in government hospitals

Access to free essential medicines in government hospitals is a cornerstone of affordable healthcare. This proposed policy would address the problem of patients not completing treatments due to high medication costs. Providing medicines for free ensures that economic barriers do not prevent people from receiving necessary care, especially for chronic conditions requiring lifelong medication. It also aligns with the National Health Policy’s goal to increase the availability of generic drugs in government facilities.

• Policy for Universal Healthcare Rights

By adopting a Universal Healthcare Rights policy, MVA envisions Maharashtra joining the global efforts to make healthcare accessible and equitable for all. This proposed policy includes a commitment to improving healthcare infrastructure, human resources, and service delivery in rural and urban areas alike. It prioritises inclusive care by ensuring that even the most remote regions of Maharashtra have access to high-quality healthcare.

• Equipping district hospitals with comprehensive facilities

Upgrading district hospitals to provide full medical services is essential for bridging healthcare disparities between urban and rural areas. District hospitals in Maharashtra lack the infrastructure to offer specialised treatments, forcing patients to travel long distances to larger cities. With comprehensive facilities, these hospitals can address a broader spectrum of health needs locally, reducing delays in critical care and improving health outcomes for rural populations.

• Lowering population criteria for Primary Health Centres (PHCs)

In Maharashtra, remote, hilly, and tribal regions often have limited access to healthcare facilities due to challenging terrains, dispersed settlements, and low population densities. By reducing the population requirement for establishing Primary Health Centres (PHCs) from 20,000 to 10,000 in these areas, the MVA aims to address these logistical challenges and bring healthcare closer to the people. This initiative is particularly significant for Maharashtra’s tribal communities, which represent around 9% of the state’s population. These communities, often located in the Sahyadri and Satpura ranges, face not only geographic isolation but also economic and educational barriers to healthcare. Increasing the number of PHCs in these regions will allow residents to access basic health services such as maternal and child health, immunisation, and treatment for common diseases within their localities. This approach helps address longstanding healthcare disparities in Maharashtra, particularly in districts like Gadchiroli, Nandurbar, and Palghar, where the need for accessible healthcare is critical.

Reducing the population threshold to 20,000 for setting up PHCs in other rural parts of Maharashtra will also potentially bring healthcare access within reach for rural communities across the state. PHCs play a crucial role in providing first-level medical care, handling outpatient services, preventive health education, and early diagnosis for common illnesses. By making these centres more widely available, the initiative reduces the need for residents to travel long distances to larger hospitals for minor ailments and preventive care. This not only saves time and costs for rural families but also alleviates the burden on district and sub-district hospitals, allowing them to focus on more complex cases. For rural districts like Ahmednagar, Solapur, and Jalgaon, where many residents rely on agriculture and face seasonal challenges with limited income, the increased accessibility of PHCs can make a significant difference in overall community health. With improved proximity to primary healthcare, early detection and prevention of diseases such as diabetes, hypertension, and respiratory illnesses can be achieved, helping reduce the need for hospitalisations and fostering a healthier rural population.

• Expansion of ambulance services to 2,000

The MVA’s promise to expand Maharashtra’s ambulance fleet to 2,000 vehicles is a commitment to strengthening emergency healthcare access across the state, especially for rural and remote communities where medical facilities can be hours away. In emergencies such as road accidents, natural disasters, childbirth complications, or sudden critical health conditions like heart attacks, timely medical intervention is often a matter of life and death. The increase in well-equipped ambulances, staffed by trained paramedics, will ensure that more people receive rapid, essential care at the scene and on the way to hospitals, significantly reducing response times and potentially lowering mortality rates in critical situations.

This expansion would make a tangible difference for Maharashtra’s rural districts and remote tribal areas, where many communities are located far from the nearest healthcare facility. Regions like Vidarbha, Marathwada, and the tribal areas of the Western Maharashtra, where emergency services are often hard to access, will benefit from the MVA’s focus on bridging these healthcare gaps. By proposing to increase the ambulance fleet, the MVA government aims not only to provide faster emergency responses but also to build a more resilient healthcare infrastructure that can serve all citizens, even in times of large-scale crises. This pledge shows a strong commitment to ensuring that life-saving healthcare is available and accessible across Maharashtra, delivering critical peace of mind to families statewide.

• Right to healthcare policy development for Maharashtra

Crafting a dedicated healthcare policy that aligns with state and national standards will set clear benchmarks for healthcare services in Maharashtra. This policy will provide a foundation for accountability, ensuring all residents have equal access to healthcare. It will also streamline government operations to ensure that healthcare services reach urban and rural populations effectively.

• Increasing the healthcare budget

An increase in healthcare spending is essential for supporting such a comprehensive healthcare program. The manifesto suggests incrementally raising the healthcare budget to 8% of the state’s total budget, aligning with recommendations in the National Health Policy. These funds will be directed towards upgrading infrastructure, expanding facilities, and ensuring sufficient medical supplies, enabling sustainable development of Maharashtra’s healthcare system.

• Construction of a 100-Bed modern hospital in each Taluka

Maharashtra’s 358 talukas represent the administrative backbone of the state, and establishing a 100-bed hospital in each taluka will create a decentralised healthcare system. These hospitals will provide emergency care, specialised services, and in-patient facilities, reducing the burden on tertiary hospitals and ensuring more timely care for residents in their communities.

• Community-based healthcare oversight

Activating community health committees will foster transparency and accountability in public healthcare. These committees will give local representatives and social organisations a voice in healthcare planning, empowering them to shape services that directly address their community’s needs. This model proposed by the MVA promotes citizen engagement, ensuring that healthcare remains responsive to changing local dynamics.

• Health workforce policy and regularisation of contractual nurses

Maharashtra faces significant challenges in maintaining a sufficient and well-trained healthcare workforce, particularly in public health facilities. The state’s healthcare system is often stretched thin, especially in rural and remote areas where the availability of medical professionals is limited. The proposal for introduction of a Health Workforce Policy by the MVA government seeks to address this critical issue by prioritising the filling of existing vacancies in both urban and rural healthcare settings. This policy will focus on recruiting doctors, nurses, paramedics, and other healthcare professionals to ensure that public health centres and district hospitals are adequately staffed. A key component of this initiative is the regularisation of contractual nurses, many of whom work in precarious conditions without job security or benefits. By transitioning these nurses into permanent roles, the policy will not only offer them the stability and financial security they need but also improve their long-term commitment and investment in patient care. Nurses play a central role in the healthcare delivery system, and providing them with permanent positions will lead to better continuity of care, reduced staff turnover, and improved morale. This move will also help Maharashtra address regional disparities, ensuring that both urban and rural areas have access to a well-supported and consistent healthcare workforce, which is essential for the quality of care and patient outcomes across the state.

• Increased remuneration for ASHA and Anganwadi Workers

Accredited Social Health Activists (ASHA) and Anganwadi workers play a critical role in grassroots health services. Maharashtra aims to increase their remuneration, recognising the demanding and often underpaid nature of their work. Despite their critical role, these workers often receive low pay, inadequate benefits, and limited job security, which has resulted in low morale and high turnover rates. Recognising their immense contribution, the MVA government has promised to increase their remuneration. This move will not only provide these workers with a fairer income but also acknowledge the demanding nature of their roles, especially in rural Maharashtra where access to healthcare facilities is limited. By improving the financial recognition of ASHA and Anganwadi workers, Maharashtra aims to ensure that these workers remain motivated and able to continue their vital work in improving community health, thereby reducing health inequalities in rural and underserved areas. Improved pay aligns with practices in states like Kerala, where higher compensation has boosted job satisfaction and led to better health outcomes in rural communities. As of March 2024, the monthly honorarium for an Accredited Social Health Activist (ASHA) worker in Maharashtra is ₹13,000, which is a ₹5,000 increase from the previous amount, bringing it to one of the highest paying states.

• Expanded generic medicine centres and free essential medicines

Offering free essential medicines and expanding generic medicine centers will make treatments more affordable, especially for marginalised communities. Generic centres reduce dependency on costlier branded medicines, encouraging patients to adhere to prescribed treatments and preventing diseases from worsening.

• ‘Stree Shakti’ initiative for women’s health

With over half of India’s women facing anemia, the ‘Stree Shakti’ initiative addresses a critical health issue that affects women’s productivity, pregnancy outcomes, and quality of life. This proposed initiative by the MVA will provide supplements and healthcare support, targeting anemia reduction and improving maternal and child health, leading to a healthier future generation.

• Malnutrition control and Tribal Health and Nutrition Missions

Malnutrition remains a challenge in India, especially in tribal regions. A dedicated Malnutrition Control Board and Tribal Health and Nutrition Mission will coordinate resources and interventions to tackle this problem. The Tribal Health and Nutrition Mission proposed by the MVA in particular, will focus on unique health challenges faced by tribal populations, such as sickle cell anemia and other genetic disorders, improving health equity across Maharashtra.

• Free medication for chronic diseases and preventive health initiatives

Chronic conditions such as diabetes and hypertension are rising in India. According to the manifesto of MVA, they will be providing free medication and encourage early screening so that complications can be prevented, hospitalisations can be reduced, and patients’ quality of life can be removed. Initiatives to control malaria, dengue, TB, and chikungunya reflect a proactive stance on public health.

• Expanded mental health services

Today, mental health issues like depression, anxiety, and digital addiction are being openly discussed and have also become a priority. Establishing counselling centres across the state will make mental health services more accessible, promoting mental well-being and helping residents manage life’s pressures more effectively.

• Transparency and accountability in healthcare services

By implementing a Patient Rights Charter and setting up grievance cells, MVA envisions Maharashtra to make healthcare services more accountable. This transparency will improve trust in public healthcare, giving patients the security of knowing their rights are protected and they have recourse if standards are not met.

• Telemedicine helpline and clean drinking water initiatives

As proposed by the MVA, the telemedicine helpline will provide a valuable resource for remote communities who face challenges accessing healthcare facilities. Clean drinking water campaigns, like ‘Nirmal Jal,’ will combat waterborne illnesses, improving health outcomes in regions such as Marathwada and Vidarbha.

• Addressing the safety of healthcare workers in Maharashtra

The safety of doctors and healthcare professionals is a growing concern in Maharashtra, as across the country, the rise in assaults on medical staff has become a significant issue. These incidents not only jeopardise the physical safety of doctors and staff but also undermine the overall healthcare system, creating an environment of fear and discouragement among medical professionals. To address this, the MVA government has recognised the need for robust measures to protect healthcare workers, emphasising the importance of maintaining a safe working environment for medical staff. The government is committed to taking necessary precautions, such as implementing stricter laws and enforcement against those who resort to violence, introducing better security systems in hospitals, and training healthcare workers in conflict resolution techniques. In addition, the creation of a more supportive environment, including the establishment of dedicated grievance redressal mechanisms for healthcare workers, can help prevent such incidents and ensure that healthcare providers can focus on delivering quality care without the fear of physical harm.

The MVA’s approach to tackling violence against healthcare workers is not just about improving security measures but also about changing the broader culture of healthcare in Maharashtra. The government’s focus on preventing assaults on doctors and medical staff involves not only legislative action but also enhancing public awareness about the importance of treating healthcare workers with dignity and respect. Public campaigns and outreach programs will educate the public on the challenges faced by doctors, especially in high-stress environments like government hospitals where the patient load is often high, and resources are limited. Moreover, strengthening hospital security through the installation of CCTV cameras, increasing the presence of trained security personnel, and enforcing protocols for handling volatile situations will create a safer space for healthcare providers. In the long run, these efforts will encourage more healthcare professionals to work in public hospitals, knowing that their safety and well-being are a priority, thereby improving the overall healthcare system in Maharashtra.

• Target to raise life expectancy to 77 years

Aiming to increase life expectancy reflects Maharashtra’s commitment to a holistic approach to health. Improved public health, accessible healthcare services, and initiatives focused on clean water, sanitation, and preventive care will contribute to a healthier, longer-living population, ultimately enhancing the state’s social and economic development.

Building an inclusive and comprehensive healthcare system for all

The MVA’s healthcare manifesto sets the stage for a transformative shift in Maharashtra’s healthcare landscape, focusing on inclusivity and equity in access to medical care. By implementing a universal healthcare policy, the government aims to ensure that no one, regardless of their economic background, geographic location, or social status, is left behind. The promise to expand primary healthcare services in rural, remote, and tribal areas—by reducing the population threshold for establishing Primary Health Centres (PHCs)—will bring essential healthcare services closer to communities that have historically faced challenges in accessing quality care. The increase in ambulance services to 2,000 vehicles ensures faster and more reliable emergency medical response, reducing delays that can be the difference between life and death in critical situations. This approach will help alleviate the burden on overextended urban hospitals, offering decentralised healthcare options that empower local communities.

Moreover, the commitment to free medicines, vaccination programs, and cancer treatment for women highlights the government’s drive to make healthcare affordable and accessible for all. The MVA’s initiatives will improve health outcomes in marginalised communities, such as the tribal regions of Vidarbha, Marathwada, and the Western Ghats, by addressing health disparities that have persisted for years. This focus on preventive healthcare, including expanding the availability of HPV vaccines, malnutrition control programs, and maternal and child health initiatives, will help reduce the long-term disease burden, improving overall population health and reducing the pressure on expensive hospital treatments. These measures form the foundation of a healthcare system where quality care is guaranteed as a right, not a privilege, contributing to the overall well-being of every citizen across the state.

Sustainable healthcare infrastructure and empowerment of medical workers

The MVA manifesto’s vision extends beyond just expanding access; it aims to build a sustainable healthcare infrastructure that is robust, resilient, and future-ready. With initiatives like equipping every sub-district hospital, building 100-bed modern hospitals in each taluka, and enhancing district hospital facilities, the MVA government is ensuring that Maharashtra’s healthcare infrastructure will be able to handle both present and future challenges. The inclusion of Mohalla clinics in urban areas will make healthcare services more accessible on a local level, while the creation of a Health Workforce Policy and the regularisation of contractual nurses will ensure that the state is equipped with a skilled and motivated healthcare workforce. By addressing the remuneration and job security of crucial grassroots workers like ASHA and Anganwadi workers, the MVA government is directly improving the quality of healthcare at the community level, empowering those who are often the first point of contact for rural and underprivileged populations.

These initiatives, which focus on both infrastructure and workforce development, are designed to create a healthcare system that can withstand future pressures, such as a growing population or emerging health crises. The promise to improve security measures for doctors and prevent assaults further strengthens the healthcare ecosystem by ensuring that medical professionals can work in a safe, supportive environment. Together, these transformative changes will not only increase the state’s healthcare coverage but also foster an environment where medical professionals, from frontline health workers to doctors, can thrive. By prioritising healthcare as a fundamental right and building a system that supports both patients and providers, MVA envisions Maharashtra to be on the path to becoming a model state for healthcare, one that sets new standards for accessibility, quality, and sustainability.

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The post The MVA promise to uphold right to healthcare in Maharashtra: A visionary approach to equitable and comprehensive health access appeared first on SabrangIndia.

The Kolkata rape and murder case, a 31-year-old trainee doctor who was brutally raped and killed by a civic volunteer at the campus of Kolkata’s RG Kar Medical College and Hospital on August 9, 2024 is only one among the recent of horrific such crimes in a country that records 86 or 87 rapes every day. (Details can be read here) The young doctor was attacked while on night duty. Her body was found the next morning, bearing severe injuries to her eyes, face, mouth, neck, limbs, and private parts. The violence and brutality that the deceased had to suffer at the hands of the accused shocked the nation and led to widespread calls for vengeance and justice. Thousands of doctors and other medical staff had, thereafter, taken to the roads to protest the increasing instances of violence against medical professions, especially women, and to demand stringent laws providing for their safety.

The Supreme Court had, on following the nationwide outrage, taken suo-moto cognisance of the Kolkata rape and murder case, on a Sunday, August 18, and the bench of comprising Chief Justice of India DY Chandrachud, Justices JB Pardiwala and Manoj Misra heard the matter on August 20 and over the next days. The Supreme Court had reportedly said that “The reason why we have decided to take this suo moto matter is because this is not a matter related to a particular murder which took place in a hospital in Kolkata. It raises systemic issues related to the safety of doctors across India.”

In the first order issued by the bench on August 20, the bench directed the prompt establishment of a “National Task Force” (NTF) comprising of medical professionals to give recommendations –within three months–on the modalities to be followed all over the country to ensure the safety of medical professionals in their work spaces. The bench noted that several states such as Maharashtra, Kerala, Telangana, West Bengal, Andhra Pradesh, Tamil Nadu etc. have framed state laws to deal with violence against doctors. However, these laws do not address deficiencies in institutional safety standards. “Therefore, we must evolve a national consensus. There must be a national protocol to create safe conditions of work. If women cannot go to a place of work and feel safe, we are denying them equal opportunity. We have to do something right now to ensure that the conditions of safety are enforced,” CJI had orally stated during the highly publicised hearings.

It is essential to note that the said National Task Force will constitute a total of ten members (details below). The order provided that the NTF will be headed by Surgeon Vice Admiral Arti Sarin AVSM, VSM. Director General Medical Services (Navy). The other members of the task force are Dr D Nageshwar Reddy, Chairman and Managing Director, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, Dr M Srinivas, Director of Delhi-AIIMS, Dr Pratima Murthy, Director, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Dr Goverdhan Dutt Puri, Executive Director, AIIMS Jodhpur, Dr Saumitra Rawat, Chairperson, Institute of Surgical Gastroenterology, GI and HPB Onco-Surgery and Liver Transplantation and Member, Board of Management, Sir Ganga Ram Hospital, New Delhi. In addition to this, the NTF will also include Professor Anita Saxena, Vice-Chancellor, Pandit B D Sharma Medical University, Rohtak, former Dean of Academics, Chief Cardio thoracic Centre and Head Cardiology Department AIIMS, Delhi, Dr Pallavi Saple, Dean, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, and Dr Padma Srivastava, formerly Professor at the Department of Neurology, AIIMS Delhi.

The bench said the cabinet secretary and the home secretary to the Union government, secretary, Ministry of Health, chairperson, National Medical Commission and president, National Board of Examinations shall be the ex-officio members of the task force.

The bench has also directed that the NTF formulate an action plan under two sub-heads –Preventing violence, including gender-based violence against medical professionals; and providing an enforceable national protocol for dignified and safe working conditions for medical professionals.

The intervention of the SC and formation of the National Task Force has been hailed by many as a significant step towards ensuring the safety of the medical professionals as well as changing the scenario of impunity and lawlessness when it comes to committing violence against medical staff.

While it is certainly a step in the right direction, such a significant move has unfortunately excluded a large section of health care professionals hailing from the informal sector. Despite a wider definition by the World Health Organisation (WHO) on who constitutes health workers, it appears that this vast network of women health workers in urban and rural India may not figure at all, especially as their work situations are not structured and easy to find solutions for.

The order specifies that the medical professions being referred to in the order are only interns, residents, senior residents, doctors, nurses and all medical professionals. This further begs the question of The same brings us to the question of whether, by limiting the ambit of the NTF to the aforementioned medical staff, the Supreme Court has implied that the issue of violence against medial professions is an issue of concern or restricted to only middle class workspaces and urban areas, when predominantly informal workers in the cities and health workers in rural areas –such as Accredited Social Health Activists (ASHA workers) and Anganwadi workers and gender violence issues faced by them –will not be looked into by the NTF?

The World Health Organization (WHO) defines health workers as people who work to improve health, including doctors, nurses, midwives, and other professionals. The same also includes health sanitation workers. The WHO classifies health workers into five broad categories: health professionals, health associate professionals, and personal care workers in health services, health management and support personnel, and other health service providers. Despite this, the said order of the Supreme Court overlooks the equally critical and vulnerable segment of rural health workers, including Anganwadi workers and Accredited Social Health Activists (ASHA).

Who are India’s ASHA workers? Employed under the Ministry of Health and Family Welfare since 2005—over 10.52 lakh ASHAs (2022 figures) who are trained female community health activists from our village communities who are those that reach our communities on basic public health.[1] Besides Anganwadi workers and helpers are part of the union government’s “services’ programme though there have been demands for regularisation and de-casualisation of their work. They provide and reach early childhood care, pregnant women and lactating mothers, monitor children’s growth and –with healthcare professionals—also reach and provide health needs like primary healthcare, referral services and immunisation. Presently, India has close to 12,93,448 Anganwadi workers and 11,64,178 Anganwadi helpers, not an insignificant number.

These individuals, who are the backbone of rural healthcare, face not only violence but also systemic neglect, low pay, and lack of support, making their struggles invisible in the broader discourse. While formal sector medical professionals receive attention and advocacy, the plight of these rural workers remains largely unaddressed, highlighting a glaring disparity in how we value and protect different tiers of our healthcare system. With a significant section of the medical staff absent from even being considered by a task force established especially to consider the concerns raised by medical professionals. Can safety be ensured for those in the medical fraternity of India without ensuring that those who are the most marginalised, ignored and vulnerable are excluded from being granted protection?

Details of the Supreme Court order:

The Supreme Court observed in its order that Medical Associations have persistently highlighted the lack of workplace safety in healthcare institutions.  Noting that medical professionals, including doctors, nurses, and paramedic staff, have increasingly become targets of various forms of violence while carrying out their duties, the intervention of the Supreme Court thereafter outlines a solution. With hospitals and medical facilities operating 24/7, these professionals work tirelessly around the clock. The unrestricted access to all areas within healthcare institutions has further exposed them to potential threats. In moments of distress, patients’ relatives often hastily blame unfavourable outcomes on the perceived negligence of medical staff, exacerbating the vulnerability of those dedicated to saving lives.

Specifically referring to the difficulties faced by women, the order stated “Women are at particular risk of sexual and non-sexual violence in these settings. Due to ingrained patriarchal attitudes and biases, relatives of patients are more likely to challenge women medical professionals. In addition to this, female medical professionals also face different forms of sexual violence at the workplace by colleagues, seniors and persons in authority. Sexual violence has had its origins even within the institution, the case of Aruna Shanbag being a case in point. There is a hierarchy within medical colleges and the career advancement and academic degrees of young professionals are capable of being affected by those in the upper echelons. The lack of institutional safety norms at medical establishments against both violence and sexual violence against medical professionals is a matter of serious concern.” (Para 7)

According to the judges of the Supreme Court, the issue of safety of medical professionals goes beyond merely protecting doctors; rather it is to be taken as a matter of national interest to ensure the safety and well-being of all health providers. The court noted in its order that as more women enter the workforce in advanced fields of knowledge and science, it is crucial for the nation to guarantee safe and dignified working conditions. The constitutional principle of equality mandates this, leaving no room for compromise on the health, safety, and well-being of those who care for others. The bench then states that the nation cannot afford to wait for a tragedy, such as a rape or murder, before implementing real and necessary changes.

The order stated “The constitutional value of equality demands nothing else and will not brook compromises on the health, well-being and safety of those who provide health care to others. The nation cannot await a rape or murder for real changes on the ground.” (Para 7)

In the present order, the bench led by CJI Chandrachud identified several critical issues affecting medical professionals:

1. Medical staff on night duty often lack adequate rooms for rest, with no separate facilities for men and women.
2. Interns, residents, and senior residents are frequently subjected to 36-hour shifts in environments lacking basic hygiene and sanitation.
3. The absence of security personnel at hospitals is more common than not.
4. Medical professionals often face inadequate toilet facilities.
5. Housing for medical staff is often located far from hospitals, with insufficient transportation options.
6. Many hospitals lack properly functioning CCTV cameras for monitoring.
7. Patients and their attendants have unrestricted access to all areas of the hospital.
8. There is a lack of screening for weapons at hospital entrances.
9. Hospital premises are often dingy and poorly lit.

The bench has ordered the constitution of a ten-member National Task Force so that a national consensus can be reached—through thorough consultation with all stakeholders—on the urgent need to establish protocols addressing the issues being faced by the medical fraternity.

Through its order, the bench empowered the NTF to make recommendations on all aspects of the action-plan on preventing violence and providing an enforceable national protocol for dignified and safe working conditions, as well as any other aspects which the members seek to cover. The order further noted that “The NTF shall also suggest appropriate timelines by which the recommendations could be implemented based on the existing facilities in Hospitals. The NTF is requested to consult all stake-holders.” (Para 14)

The Ministry of Health and Family Welfare will provide all logistical support including making arrangements for travel, stay and secretarial assistance and bear the expenses of the members of the NTF, the order stated.

As a part of clarification of who all will fall under the phrase medical professionals, the order stated that “It is clarified that the phrase medical professionals used in this judgment encompasses every medical professional including doctors, medical students who are undergoing their compulsory rotating medical internship (CRMI) as a part of the MBBS course, resident doctors and senior resident doctors and nurses (including those who are nursing interns).” (Para 13)

The complete order may be read below:

It is pertinent to highlight here that previously, in the month of July of 2024 itself, the Supreme Court bench of Justices Sanjiv Khanna, Sanjay Karol and Sanjeev Kumar had refused to entertain a petition filed by the Delhi Medical Association (DMA) seeking measures to prevent violence against doctors by observing that legislations are already in place. Moreover, the bench had clarified that the petitioners were at liberty to approach the concerned courts in respect of particular instances of violence. Thus, within a period of a month, the Supreme Court went from dismissing the issue of violence against doctors and medical staff by observing it as individual cases to the same being a “systemic” concern, following the outrage in the Kolkatta murder-rape case.

The order may be read here:

“Systematic” exclusion?

Healthcare workers (HCWs) are individuals who deliver care and services to the sick and ailing. This involves team effort from doctors, nurses, laboratory technicians, pharmacists, ambulance drivers, medical waste handlers, Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), Anganwadi workers and several others. ASHAs, ANMs and Anganwadi workers form an integral part of the grassroots-level health workers under the National Health Mission.  As part of the government’s National Rural Health Mission (NRHM), a new group of baseline health workers called Accredited Social Health Activists (ASHA workers) was formed in 2005 to address health related demands of the rural population, especially women and children, who find it arduous to access basic health services.

In the ongoing conversations about the protection and recognition of healthcare professionals, the vital contributions of ASHA (Accredited Social Health Activists) workers, Anganwadi workers and sanitation workers are often marginalised, overshadowed by the focus on urban and elite doctors. These individuals are the cornerstone of India’s rural healthcare system, delivering essential services to some of the country’s most remote and underserved populations. Yet, despite their critical role, they are largely excluded from the protections, benefits, and honour that are routinely extended to their urban and formal sector counterparts. This exclusion highlights a deep-seated inequality within the healthcare system, where the labour of rural health workers is undervalued and their safety and well-being are neglected.

ASHA workers and Anganwadi workers, who are exclusively women, operate under some of the most challenging conditions imaginable. ASHA workers, for instance, are often responsible for covering large geographic areas, traveling on foot to visit households, educate families on health practices, and provide crucial services such as immunizations, prenatal care, and family planning. These tasks are physically demanding, and ASHA workers frequently face long hours without adequate rest or compensation. In some regions, they are expected to work for less than the minimum wage, a paltry sum considering the importance and intensity of their work. Anganwadi workers, who run rural childcare centres and play a pivotal role in early childhood development, face similar hardships. They manage not only the educational needs of children but also their nutritional and health needs, often without adequate infrastructure or support.

The vulnerability of these workers is further exacerbated by the lack of formal employment status. ASHA and Anganwadi workers are often classified as “honorary” or “voluntary” workers, which means they do not receive the same benefits as formal employees, such as health insurance, pensions, or job security. This classification leaves them in a precarious position, where they are expected to perform essential public health functions without the protections that should accompany such responsibilities. In addition, they are frequently exposed to violence and harassment, both from the communities they serve and from within the healthcare system itself. Instances of ASHA workers being attacked or threatened while conducting COVID-19 tracing or vaccination drives have been reported across several states, including Uttar Pradesh, Bihar, and Maharashtra. Similarly, Anganwadi workers often face neglect and abuse from families who do not fully understand or appreciate their role, yet they continue to work under these difficult conditions with little acknowledgment.

When it comes to the violence that Anganwadi workers and ASHA workers face, the data is scarce. However, even the minimal data shows that there is a severe problem. A 2016 mixed-method study involving 396 ASHA workers from rural Northern Karnataka found that 94% of participants had experienced violent incidents in the preceding six months. Similarly, a study conducted in Kashmir during the 2010 unrest, which focused on 35 ambulance drivers, revealed that 89% of those interviewed had faced more than one incident of physical harm, 54% had suffered physical assault, and 83% had experienced job-related psychological trauma. Despite the presence of a significant number of ASHA workers, Anganwadi workers and other informal medical workers and aides in India, there is a glaring lack of comprehensive studies investigating the violence they face. The scarcity of data highlights the profound gap in understanding and addressing the risks these essential workers’ encounter. These studies also provide that the violence that these workers face stems from failures at multiple levels. Grassroots and mobile workers, who operate outside of health facilities, lack any form of security, while those stationed at health facilities receive only minimal protection. Owning to a lack of research on this issue, more recent figures could not be quoted.

Despite these overwhelming challenges, ASHA and Anganwadi workers have been resolute in their fight for better working conditions and fair treatment. Over the years, they have organized numerous protests, strikes, and campaigns to demand higher wages, job security, and formal recognition of their roles. In 2020, thousands of ASHA workers went on strike across the country, demanding a fixed monthly salary of ₹10,000 and better protective equipment during the COVID-19 pandemic. Anganwadi workers have similarly taken to the streets, protesting against the inadequate wages and lack of support from the government. Their struggles have led to some victories, such as wage increases in certain states and greater visibility of their demands in public discourse. However, these gains are often piecemeal and do not address the systemic issues that continue to marginalize these workers.

The exclusion of ASHA and Anganwadi workers from the protections and accolades afforded to doctors and other medical professionals indulged in the formal sector is indicative of a broader systemic inequality within India’s healthcare system. While doctors and hospitals that are urban and in the formal sector receive government attention and resources, the women who provide essential healthcare in rural areas are left to fend for themselves. This disparity not only undermines the health and well-being of ASHA and Anganwadi workers but also threatens the overall effectiveness of India’s public health efforts. For the healthcare system to function equitably and efficiently, it is imperative that these workers receive the recognition, protection, and compensation they deserve.

In addition to this, the exclusion of informal sanitation workers from the protections and recognition given to other healthcare professionals further underscores the deep inequities within India’s labour force. These workers, often operating in hazardous conditions with little to no safety equipment, are responsible for some of the most crucial yet dangerous tasks in maintaining public health. They handle the cleaning of sewers, public toilets, and waste disposal sites, tasks that expose them to harmful pathogens, toxic substances, and life-threatening situations daily. Despite their critical role in preventing disease outbreaks and ensuring public hygiene, they remain invisible in the broader narrative of healthcare protection and support.

Informal sanitation workers hail from the most marginalised communities and are trapped in a cycle of poverty and discrimination. They work without proper training, protective gear, or job security, making them extremely vulnerable to injuries, infections, and even death. The risks they take are immense; it is not uncommon for sanitation workers to suffocate or drown in poorly ventilated and hazardous environments such as septic tanks and sewers. One keeps hearing of there being numerous reports of sanitation workers dying due to asphyxiation while cleaning septic tanks, a task often performed manually in the absence of mechanized alternatives. Despite these dangers, they receive minimal compensation and are often denied basic rights like healthcare, insurance, and pensions. Their exclusion from national safety protocols and labour protections is a stark reminder of the systemic neglect faced by the most vulnerable workers in India’s public health infrastructure.

As India a as country continues to address the safety and well-being of medical professionals, we must also confront and correct the disparities that leave rural health workers vulnerable and marginalized. If our efforts to enhance safety and protection focus solely on more visible or privileged segments of the healthcare workforce, we risk perpetuating existing inequalities and leaving behind those who are most in need. Ensuring the protection and empowerment of ASHA workers, Anganwadi workers and informal sanitation workers is not just a moral obligation; it is crucial for the success of India’s public health system. Their work is indispensable, and their contributions should be recognized and valued as such. The time has come for a comprehensive approach that ensures their rights, safety, and dignity, aligning the nation’s healthcare system with its constitutional commitment to equality and justice for all.  For true progress, our reforms must extend beyond just some more visible and central urban centres and formal sectors to encompass semi-urban, non-formal and rural healthcare workers, such as ASHA and Anganwadi workers, and informal sanitation staff. By acknowledging and addressing the unique challenges faced by these essential yet overlooked groups, we can create a more inclusive and equitable system that genuinely safeguards all those who dedicate their lives to public health. Only through such comprehensive and compassionate measures can we hope to achieve a truly effective and just response to violence against healthcare workers.

[1] Despite long standing demands for being recognised as government workers, ASHAs are not instead classified as holding an “honorary/volunteer” position. They serve populations of approximately 1,000 in rural areas and 2,000 in urban settings.

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In response to the question posed by INC Lok Sabha MP from Rajasthan, Ummeda Ram Beniwal, on the lack of healthcare facilities and resources, affecting patients in India, the Central Government has cited the Rural Health Statistics 2022, which suggests that massive health infrastructure gaps need to be covered in rural areas. The Minister of State for Health and Family Affairs, Anupriya Patel referred to the Rural Health Statistics 2022 data in her reply to the query put forth by Beniwal on August 9 concerning the lack of health infrastructure in the country. The data given reveals that as of July 1, 2022, rural areas face a shortfall of 48060 Sub-Centres as against the requirement of 1,93,310 such centres, with the present number of Sub-Centres being at 1,57,935.

Similarly, rural India has a shortage of 9,742 Primary Health Centres (PHCs) against its required strength of 31,640 PHCs, with 24,935 PHCs presently in use. The number of Community Health Centres (CHCs) currently in use stands at 5480 against the required strength of 7894 such centres, with a shortfall of 2852 CHCs in total.

The parliamentary answer by the MoS Anupriya Patel explained that “All India Shortfall is derived by adding State-wise figures of shortfall ignoring the existing surplus in some of the states.” However, state-wise data regarding the shortage was not included in the response. Importantly, the figures provided here does not include shortage of such centres in urban areas, thus revealing the magnitude of the issue.

Patel further informed the Lok Sabha about the Union Government’s efforts at improving health infrastructure and human resource shortage, noting that the Health Ministry provides “technical and financial support including support for recruitment of health human resource (Specialists Doctors and other health workers), to the States/UTs to strengthen the public healthcare system, based on the proposals received in the form of Programme Implementation Plans (PIPs) under National Health Mission.”

She also said that under the Fifteenth Finance Commission (FC-XV) and PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) various initiatives have been undertaken, with “a total of 12,606 units of building-less sub-health centre, 881 units of building-less Primary Health Centre and 125 units of building-less Community Health Centre” being provisioned for the FY 2021-22 to 2023-24.

The response further stated that “Under PM-ABHIM, provisions have been made for construction/strengthening of 730 Integrated Public Health Labs (IPHLs), 3382 Block Public Health Units (BPHU), 602 Critical Care Blocks (CCBs) and 7,808 units of building-less sub-health centre-Ayushman Arogya Mandir during the scheme period FY 2021-22 to 2025-26.”

Notably, some states, including Mizoram, Nagaland, and Meghalaya have pushed back over renaming of Ayushman centres as ‘mandirs’ questioning the imposition of dominant religious nomenclature.

The parliamentary response on the subject dated August 9 can be found here:

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It wanted the government to “immediately give ration cards to 8 crore migrant/unorganised sector workers as directed by the Supreme Court.”

The Right to Food Campaign is deeply disturbed by reports of the immense distress and problems being faced by people across the country on account of the government undertaking E-KYC verification of all 81 crore people who have ration cards and are entitled to receive foodgrains under the National Food Security Act (NFSA).

From different states, the campaign is receiving reports of people rushing back to their villages because they are being informed that failure to get EKYC of the whole family will result in stoppage of ration.

At a time when crores of people have been left out of the food security net on account of the government’s failure to carry out the census of 2021, it is inexplicable that the energy and resources of the government are being spent on creating further hinderance for existing ration cardholders rather than issuing ration cards to all those excluded from the NFSA.

As per ground reports, SMSes have been received by ration cardholders or they are being informed over the phone to immediately go to the nearest ration shop with their whole family to comply with E-KYC requirements through authentication via the POS machines. Ration shopkeepers are informing cardholders that failure to get E-KYC will result in denial of food grains. Even national media has been carrying news that failure to comply with EKYC will result in stoppage of free rations.

Rolling out an authentication exercise in this manner, without providing clear and official information to people about the framework within which the EKYC is being done, the need for EKYC, the timeline and consequences is creating intense distress and anxiety among people. The requirement for the whole family to be present at the ration shop has resulted in the most marginalised sections including migrant workers, elderly and those with disabilities being the most affected and likely to be left out of the EKYC.

Further, the campaign is extremely shocked to note that ration shopkeepers have been empowered to carry out the EKYC process thereby allowing them to exercise power and discretion over it. The ration shopkeeper has absolutely no role in issuance and cancellation of ration cards as that is the prerogative of the Food Department.

The shopkeepers role is limited to distribution of foodgrains to cardholders. This is a key separation of the roles as it is critical to empower people to seek accountability from shopkeepers in the distribution of grains without fear of facing backlash in the form of cancellation of ration cards.

Allowing shopkeepers to carry out EKYC is skewing the power balance and will undermine the capacity of people in raising problems and concerns about irregularities in ration distribution.

Dipa Sinha of the RTF campaign said it is clear that right to adequate and nutritious food is not getting the priority it should. The government’s intentions are clear even if one looks at the coverage and budget allocation. The total coverage of NFSA  still being determined by census 2011 leading to exclusion of crores of people.

If the government’s own population projections are used then as of the 2024 figures, 13 crore additional people should have also been provided ration cards under the NFSA. Instead of addressing this large gap, including through increased budgetary allocation, we find the current budget has slashed the food security budget by Rs. 5,000 crore.

Further, the unleashing of the EKYC in this manner, seems to be a conspiracy to cancel ration cards of people. We have seen how in the name of verification and authentication, even in the past crores of legible people, especially those who are the most marginalised get thrown out of the social security net.

Unemployment and unprecedented inflation has made people very vulnerable and many more people need access to rations. Rations and foodgrains are a legal, constitutional right and not some revdi or dole by the government, as it is sought to be projected these days.

Anjali Bhardwaj of the RTF campaign said that anxiety and distress among people is also happening because of the unclear communication by the government. Pointing to the SMS sent by the Food Department in Delhi (pasted at the end of this document), she noted that no proper information is being provided to people regarding the rules, time-frame, necessity and process of EKYC.

This coupled with news stories that foodgrains on the ration card will be discontinued if EKYC is not done, has led to this situation where people are spending thousands of rupees to rush to the ration shops, especially migrant workers who are travelling to their home state to do the EKYC process.  She spoke of the ongoing case in the Supreme Court in which since 2021 the SC has been giving directions on increasing coverage under NFSA.

In June 2021, the Supreme Court (in xxx) directed the central government to re-determine coverage taking into account the increase in population while the coverage remains stagnant as per 2011 census numbers. Upon the central government stating that re-determination of coverage is not possible in the absence of the census and the census is indefinitely postponed.

The unleashing of the EKYC seems to be a conspiracy to cancel ration cards of people, throw out most marginalised out of the social security net

In 2022, the SC directed the government to consider the population projections figures to increase coverage and finally in April 2023, the SC gave explicit directions that 8 crore people who are registered on the E-shram portal must be immediately issued ration cards. The court has clarified that this should be done irrespective of the quotas defined in the NFSA and the central government must release additional rations to states.

In July 2024, the Court took serious note of the slow pace at which states are carrying out the exercise of verifying and issuing ration cards and directed that all states must complete the work within 4 weeks failing which the court would initiate proceedings against concerned officials.

Annie Raja of the RTF Campaign said that a government which claims to be pro women is creating unprecedented havoc in their lives by forcing them to run around for even their most basic entitlement of ration. What is the purpose of this EKYC? Will they cancel ration cards of those who are unable to comply?

This is going to be a huge blow for ordinary people. By cancelling ration cards who does the government want to benefit? The government is denying people their right to live with dignity- such high unemployment, and budget for NREGA is also wholly inadequate. Now even right to food is in crisis.

Is this the government taking revenge for their reduced numbers in the elections?

Several people spoke of the problems they are facing on account of the EKYC issue.

Sunita hails from UP and is staying on rent in a slum settlement near Malviya Nagar with her family. She has a ration card issued by the government of UP, and she received a call from the ration shopkeeper asking her to come quickly to get her EKYC done. Worried that her ration card may get cancelled she, her husband and 4 children spent around Rs. 6,000 making the round trip from Delhi to UP by bus in order to do the EKYC.

Only Sunita, her husband and one child are listed on the ration card and therefore they get only 15 kgs of grain per month. During the EKYC process the shopkeeper informed her that authentication of her only child listed on the ration card failed as the aadhaar is outdated! She was advised to get the aadhaar updated and try again at a later date. She spent more than 15 days in the village trying to get the aadhaar updated, but was unsuccessful as they were told there are some server and connectivity issues. Other than the verbal communication from the shopkeeper, she has not received any official communication from the department and is unsure of the next steps. Sunita’s husband works as a daily wager and had to missed several days of work due to the unexpected emergency travel.

Munish Devi is currently living on rent in Jagdamba Camp. She is a widow and works as a domestic worker. She is getting calls from her village in Sambhal district, Uttar Pradesh asking her to come for EKYC but she is unable to afford the trip and is worried that she will not get leave. Her family members in the village have been told that if EKYC is not done, Munish and her childrens names will be struck off.

Sumaira, a domestic worker, spent ₹ 8,000 to travel to her village in UP with 7 members of the family for the EKYC process. They ended staying for 15 days and losing their wages as the EKYC of one child was not successful and they had to wait to get it updated.

Sangeeta shared that her husband is bed ridden and there is no way to take him to Ghaziabad for EKYC. She went to the ration shop and failed to get her own EKYC done as it was too crowded.

Similar issues are coming across states- wherein inter state and intra state people are rushing for the EKYC process. From UP there are reports of ration shopkeepers are charging between Rs. 50-200 per person for the updation of EKYC.

The campaign demands that the government immediately halt the EKYC process to prevent further distress among ration cardholders. Further, the government must immediately issue ration cards to all those left out of the purview of the NFSA on account of the failure of the government to carry out the census of 2021.

Click here for NGOs and individuals endorsing the statement 

Courtesy: CounterView

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There are two others who are worth mentioning Sri Sri Ravishankar, who rampaged the Yamuna for his gala event. He was also associated with Anna Hazare’s RSS supported movement. He is in the news generally for subtly supporting Hindu nationalist politics. And then there is Baba Ramdev. He began his career as a Yoga Guru with great success and then made transition to business World with the brand of Patanjali. This firm, producing and marketing Ayurveda products has brought Baba in the line of front ranking business tycoons, with huge assets. He and his close associate Acharya Balkishan have built up a massive empire, un-challenged till lately. All his Ayurveda products were publicized with great fanfare and a large section of media went gaga for his achievements.

The academic qualifications of Acharya and Baba duo are not much known. Currently there are many Ayurveda Medical Colleges, but it is doubtful if they have any degree from these. On the pretext that they are posing an indigenous challenge to the multinational corporations, many of their methods probably went unchallenged.

Matters came to head during Covid 19. On one hand the ruling government made hefty donations for the Pune based Bharat Biotech, Covaccine. On the other hand, within a month of the outbreak of Pandemic; Baba came up with the claim that they have developed a medicine for treatment and prevention of the disease, ‘Coronil’. The claim was that it has the approval of WHO. When challenged by the Ayush ministry, they corrected themselves to say that it has been developed on the guidelines of WHO. Ayush ministry distanced itself from the claims of Baba. The Combo pack of Coronil was introduced with great fanfare in presence of two Cabinet ministers, Dr. Harshvardhan and Nitin Gadkari. Dr. Harshvardhan himself is a trained medical doctor. There is currently a blind praise of ancient systems.

Baba claimed that the medicine has been tested on 100 patients of mild to moderate severity and the Corona test became negative in a few days. He had tied up with a few doctors for the testing of medicine. The protocol of introducing the medicines in modern medicine is preceded by biochemical analysis, animal testing and clinical double blind trial of adequate size samples. This was not followed.

Overawed with his commercial success, he not only accepted the praise from most of the Godi media, he took a step further to call Allopathic as a stupid science. Irked by this the Indian Medical Association (IMA) filed a case against him, which was heard recently. First he apologized to IMA for insulting the modern medicine. Just to recall when he sat on a hunger strike against corruption, he claimed that he has a ‘Yoga body’ and he can withstand the fast for a long time. Within a few days his condition worsened and was admitted to an allopathic hospital. Similarly a year ago Acharya Balkishan was seriously ill and had to be admitted to the ICU of an allopathic hospital.

After Court’ warning, his firm continued misleading advertisements. Court summoned him. He apologized profusely. Court refused to accept his apology and has asked him to mend his ways and come back again.

The details of the whole episode apart, how come such faith based knowledge and use of medications based on that have been rising for so long, what an arrogance to downgrade the modern system of Medicine? One concedes there is lots of empirical wisdom in some traditional medicines and even in Grandma’s medicines. The point however that is the modern system of medicine is based on evidence and peer review. The knowledge is ruthlessly subjected to review and criticism. And this is what leads to improvement leading to something close to what is useful.

The faith based knowledge, and thereby treatment systems are above criticism. Many Babas have their own system of treatment. The protocol of medical systems is evolved by adapting to better systems. The likes of Ramdev take the advantage of Holiness, to be above criticism and make many statements as they like. He had proclaimed that he has treatment for Cancer, Aids and what have you. He even claimed that Homosexuality is a disease and he can cure it!

So far he has the protection of ‘system’ and that gave him the arrogance to downgrade the allopath and make irrational claims about ‘his’ system. And why are such Babas having gala time with their faith based claims?

Last few decades have seen the rise of politics in the name of religion. This also harps on the ancient Indian knowledge systems. Taking these in a critical way is what science and rationalists will demand. This is what was demanded by the likes of Dr. Dabholkar, Govind Pansare, M M Kalburgi and Gauri Lankesh. They were done away for raising rational understanding. This is a period when rational thinking and methods are being undermined in the glare of ‘faith based knowledge’. Even in our educational curriculum in the name of ‘Indian Knowledge systems’ the faith based things will form part of curriculum.

Baba Ramdev is a symptom of the society gripped by faith-blind faith combo. The Supreme Court has done well to put a small stop to this ascending ‘Baba’ trend in the field of medicine.

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“The entire country is taken for a ride! You wait for two years when the Acts says this (misleading advertisements) is prohibited,” Justice Ahsanuddin Amanullah told Additional Solicitor General KM Nataraj, and ordered the Centre to file an affidavit explaining the steps it has taken to ensure compliance.

The apex court had, in November 2023, had warned Patanjali that it would be fined Rs 1 crore if a false claim is made that its products can “cure” certain diseases. During the hearing today, Justices Hima Kohli and A Amanullah criticised Patanjali Ayurved for releasing advertisements despite previous court orders issued last year. While referring to their previous warning to Patanjali, the bench said, “Despite our warning, you are saying your products are better than chemical-based medicines.”

The bench decided to issue notices for contempt of court orders to the two people featured in the advertisements, Baba Ramdev and Acharya Balakrishnan.

The Supreme Court (SC) also sharply reprimanded the union government on Tuesday, in connection with the Patanjali Ayurved “misleading and false” advertisement case, urging the Centre representatives to address the issue of deceptive medical advertisements. Expressing displeasure and dissatisfaction, the top court remarked, “The government is sitting with its eyes closed,” highlighting the need for prompt action in tackling misleading advertising practices.

On August 23, 2022, the Supreme Court issued notices to the Union Health Ministry, Ministry of Ayush, and Patanjali Ayurved following a plea by the Indian Medical Association (IMA). The IMA alleged a smear campaign by Ramdev, the founder of Patanjali, against both the vaccination drive and modern medicine(s).

Coming down sharply on Patanjali today, Justice Ahsanuddin Amanullah said, “You had the courage and guts to come up with this advertisement after the order of this Court! And then you come up with this advertisement. Permanent relief, what do you mean by permanent relief? Is it a cure? We are going to pass a very, very strict order.”

The court issued the ban order while hearing a plea of the Indian Medical Association (IMA), alleging a smear campaign by Ramdev, founder of Patanjali, against the vaccination drive and modern medicines.

On November 21 last year, the counsel representing the company had assured the apex court that henceforth there shall not be any violation of law, especially relating to advertising or branding of products, and no casual statements claiming medicinal efficacy of Patanjali products or against any system of medicine will be released to the media in any form.

The apex court had then cautioned the company, co-founded by Ramdev and dealing in herbal products, against making “false” and “misleading” claims in advertisements about its medicines as cure of several diseases.

“All such false and misleading advertisements of Patanjali Ayurved have to stop immediately. The Court will take any such infraction very seriously, and the Court will also consider imposing costs to the extent of Rs. 1 crores on every product regarding which a false claim is made that it can “cure” a particular disease,” Justice Amanullah orally said.

Senior advocate PS Patwalia, representing the Indian Medical Association, highlighted a press conference held by Baba Ramdev. He said that Patanjali Ayurved had published advertisements in violation of the law, claiming to cure various ailments, including diabetes and asthma.

The advocate also mentioned a defamation case filed by Patanjali Ayurved against the Advertising Council.

On this, the top court stated that there can’t be any defence of advertisements showing cures for illnesses including diabetes and blood pressure. “What do you mean by permanent relief to the diseases? It means only two things – either death or cure,” the SC said, asking Patanjali Ayurved to show how they discharged their duties to tackle misleading advertisements.

During today’s brief hearing, the bench directed Patanjali Ayurved to refrain from publishing misleading claims and advertisements against modern medical systems.

Furthermore, the court also hinted at the possibility of imposing hefty fines, suggesting a penalty of Rs 1 crore for each product promoting false claims of curing specific diseases.

The Supreme Court again reiterated its call for the Centre to devise a solution to the pervasive issue of misleading medical advertisements. It specifically highlighted concerns about claims made by certain medications to provide a complete cure for various ailments.

The ongoing legal battle shows the importance of ensuring accuracy and transparency in advertising practices, particularly in the healthcare sector, to safeguard public health and prevent misinformation. This matter became especially important following the coronavirus pandemic.

The IMA Writ Petition

The writ petition was filed by the IMA, raising concerns over what the association terms as a “continuous, systematic, and unabated spread of misinformation” regarding allopathy and the modern system of medicine. The petition has also asserted that Patanjali’s misleading advertisements disparage allopathy and make false claims about curing certain diseases. The plea referred to a half-page advertisement published on July 10, 2022, titled “MISCONCEPTIONS SPREAD BY ALLOPATHY: SAVE

The IMA, therefore, contended that while every commercial entity has the right to promote its products, the unverified claims made by Patanjali are in direct violation of laws such as the Drugs & Other Magic Remedies Act, 1954, and the Consumer Protection Act, 2019.

Moreover, the writ petition also highlighted previous instances where Swami Ramdev, associated with Patanjali, made controversial statements, including calling allopathy a “stupid and bankrupt science” and making unfounded claims about the deaths of people due to allopathic medicines during the second wave of the COVID-19 pandemic.

The IMA also accused Patanjali of spreading false rumours about COVID-19 vaccines and contributing to vaccine hesitancy. Swami Ramdev’s alleged dismissal, mockery and derision of citizens searching for oxygen cylinders during the second wave are also cited in the petition. The petition emphasized that despite the Ministry of AYUSH signing a Memorandum of Understanding (MoU) with the ASCI for monitoring misleading advertisements of AYUSH drugs, Patanjali has continued its alleged disregard for the law, violating the mandate with impunity. It may be noted that during the earlier proceedings, the Court clarified that it did not wish to make the issue an “Allopathy v. Ayurveda” debate but wanted to find a real solution to the problem of misleading medical advertisements.

(With inputs from PTI, Siasat, Business Today, Business Standard and LiveLaw)

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However, the Government of Odisha continues to adhere to the failed policies of the neoliberal project by categorizing children based on severe, acute, and moderate malnutrition. Such a policy is an extension of the policies pursued by the Congress Party and BJP at the center, which dismantled the universal Public Distribution System (PDS) of food. The malnutrition of children is a consequence of the dismantling of the distribution of food under the universal PDS. The universal PDS was dismantled and replaced with revamped PDS and targeted PDS in the name of making it more effective. In reality, the neoliberal onslaught on universal PDS led to the rise of starvation and malnutrition-related deaths in the state. The universal PDS was a policy designed to support the production and distribution of food that could be available and accessible to all, irrespective of their background. It was intended to control food prices in the market and manage market linkages and leakages of food grain from the Food Corporation of India in the distribution process. The dismantling of food security under the universal PDS resulted in rising food prices, a lack of accessibility and availability of food for all. It also led to the rise of a food market dominated by corporations like Reliance.

The Government of Odisha is jeopardizing children’s food and malnutrition security by categorizing them as severe, acute, and moderate malnourished. The universalization of health and food security is the only way to eliminate the shameful hunger and malnutrition-related deaths in the state. This can be achieved if the BJD-led government abandons the failed policies of the neoliberal project pursued by the Congress Party and BJP at the center.

The Odisha government is developing multiple policies that accelerate the privatization of health in the state.

The gods and goddesses in Odisha receive more funds for the rehabilitation of their abodes with amenities, while Odia children suffer from malnutrition deaths and receive less funding from the government. This is a disturbing trend in governance where the welfare of gods is deemed more important than that of Odia children, who are the future of the state. The health infrastructure is in a dilapidated condition, yet the Government of Odisha continues to develop health policies and projects that transfer public funds to private hospitals, accelerating the business of sickness. The universalization of public health is crucial for developing healthy citizens who can contribute to the well-being of the state, society, and families in Odisha. Unfortunately, the state government promotes short-term populist health policies that undermine public health and favor private healthcare in the state.

The Biju Swasthya Kalyan Yojana, launched on 15th August 2018, represents a policy of transferring public wealth to private hospitals and healthcare providers in the name of universal health coverage in the state. This is a temporary response to the acute public health crisis in the state. It is neither sustainable nor capable of resolving the long-term health issues. The development of public health infrastructure, the establishment of medical and pharmaceutical colleges, hospitals, and improving the accessibility and availability of local hospitals and medical professionals are essential for addressing the public health crisis in the state.

The practice of private healthcare has proven unsuccessful worldwide in meeting people’s healthcare needs. Therefore, the expansion of public healthcare infrastructure in the state is the only alternative that can serve people during all forms of health crises. The Government of Odisha must ensure a sufficient health budget to develop a technologically advanced healthcare system that serves all, irrespective of their purchasing power and backgrounds. Health is not a commodity, and the business of illness must come to an end. Privatization is not a public policy but a project for profit-making by depleting the public treasury and citizens’ pockets.

The Articles such as 21, 23, 24, 38, 39, 41, and 42 under the Indian Constitution directly and indirectly deal with public health and human welfare. The right to health is fundamental to the right to life under the Indian Constitution. The Government of Odisha needs to ensure health for all in both letter and spirit by enhancing all health policies and promoting public health. Healthy citizens are crucial for the development of a prosperous and peaceful state, where human dignity is not undermined for the sake of populist religious politics. Modern states are built on healthy citizens, not merely on the abodes of gods and goddesses.

Bhabani Shankar Nayak, University of Glasgow, UK

Courtesy: CounterCurrent

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Phulo Devi was elected as a member of the Rajya Sabha from Chhattisgarh as a member of the Indian Nation Congress in the year 2020. These questions were presented to Dr. Mansukh Mandaviya, currently serving as the minister of Health and Family Welfare and is a Rajya Sabha member from Gujarat.

Notably, infant mortality is the death of an infant before their first birthday, i.e. the infant mortality rate is the number of infant deaths for every 1,000 live births. As per the data provided, India stands at an infant mortality rate for SC community of 40.7. The highest infant mortality rate amongst the SC is in that state of Uttar Pradesh, presenting at a rate of 57.8. The data further shows the lowest infant mortality rate amongst the SC community to be in in Jammu and Kashmir with a rate of 13.8.

It is crucial to note that the data provided by the union is incomplete as information regarding 9 states, namely Arunachal Pradesh, Goa, Kerala, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura, was either is not available or had been taken in the form of an unweighted mean. Hence, the data provided in the response by the government could not be deemed to be accurate as the infant mortality rate for 9 out of 30 states is not accurate.

In regards to the infant mortality rate for STs, India’s rate is 41.6. The state of Chhattisgarh has a rate of infant mortality rate of 58, the highest amongst the ST community. On the other hand, the lowest infant mortality rate amongst the ST community was reported from the north-east state of Manipur, with a rate of 23.2. Similar as before, the said data on infant mortality rate for STs did not provide accurate information for a total of 14 states/Union Territories.

Data had also been provided on child mortality rate prevailing in both the SC and ST community. It is to be noted that child mortality is the death of a child before reaching the age of 5 years, i.e., the child mortality rate is the number of child deaths for every 1,000 live births. The data table provides that the child mortality rate for SC and ST stands at 8.6 and 9.0 respectively.

For child mortality rate for the SC community, the highest was 13.8 in the state of Jharkhand, while the lowest was the rate of 1.5 in West Bengal. Here too, the information regarding nine states was missing. It is important to point out that these nine states are the same states for which there is no information or inaccurate information regarding the infant mortality rate amongst the Scheduled Castes.

Based on the data, the highest child mortality rate amongst the Scheduled Tribes was in Madhya Pradesh at 13.9. Meanwhile, the lowest child mortality rate was in West Bengal with 0 deaths. Here, information regarding 13 states was not found.

The data provided in the response by the union government was based on the state-wise figures of NFHS-5 (2019-21).

The table is as follows:

It can be deduced that while significant strides have been made through initiatives like the National Health Policy 2017 and the National Health Mission (NHM) to enhance accessibility, affordability, and quality healthcare for all, there remains considerable room for improvement for the SC and ST community. As highlighted above, gaps persist in achieving true universal health coverage and addressing the diverse needs of the population, particularly the marginalized and economically disadvantaged groups. Further concerted action and innovative strategies are essential to bridge these gaps and ensure that no individual faces financial hardship or exclusion from essential healthcare services. Continued commitment to the principles of equity, affordability, universality, and quality care, along with sustained collaborative efforts between the government, healthcare providers, and communities, will be pivotal in advancing towards comprehensive and inclusive healthcare for all.

The complete answer can be read here:

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The same is reflected in the 2030 Agenda for Sustainable Development Goals under target 3.7: by 2030, ensure universal access to sexual and reproductive health-care services, family planning information and education, and the integration of reproductive health into national strategies and programmes.

Conventionally, the role of contraception is attributed to only ensuring the rights of adults to decide freely and responsibly on the number and spacing of their children. The World Health Organization (WHO) emphasizes three roles of family planning: assistance in timing, spacing, and limiting of births.

The denotation is that family planning helps the couple or partners to plan a birth at the right time when they are ready, assists them in planning adequate space between marriage and the first birth and between two births, and supports limiting the desired number of children.

Along with the WHO, several individual researchers have further stressed the role of family planning in the prevention of reproductive tract infections (RTIs) and sexually transmitted diseases (STDs). However, with reduced birth rates, global and local public and private donor spending on contraception research and development, supplies, and related health care is shrinking significantly.

Unmet need for family planning

Despite India reaching replacement-level birth rates (i.e., on an average of two children per woman), the ‘unmet need for family planning’ (defined as fecund and sexually active women who don’t want any more children or want to delay the next child but do not have access to contraception) is still high in women.

Population scientists report that a substantial share of the decline in birth rates is attributable to a rise in age at marriage and access to abortions. The latest National Family Health Survey (2019–21) suggests a considerable state-wise variation in the unmet need for family planning.

Figure 1 shows the highest and lowest unmet needs noted in Meghalaya (27%) and Andhra Pradesh (4.7%), respectively. In the larger states, such as Bihar and Uttar Pradesh, the unmet need for family planning is very high. It indicates that a large number of populations in these states want to use family planning but don’t have access to it.

Unfinished agenda for family planning

The agenda for family planning is not yet finished. Specifically, the agenda of family planning does not end with the decline in birth rates and reaching the replacement level of fertility. The agenda was to enhance access to and use of contraceptives with a rights-based approach and expand choices and safety.

Gender equity in contraceptive choices and use is a critical concern where contraceptive use and its side-effect burden is disproportionately borne by women. Except for male condoms, men’s role in other types of contraceptive use has reduced significantly. Male sterilization has been disappearing in India. Further, the research and development in the manufacturing of contraception is heavily skewed toward female contraception rather than male contraception.

Figure 1: Unmet need for family planning among the women aged 15–49 years across the states and Union territories in India, National Family Health Survey, 2019–21:

The new agenda: Family planning for happiness and prosperity

The new agenda for family planning relies on its role in promoting happiness and prosperity, besides population stabilization and enhancing women’s and human rights. With increasing access to education, postponement of marriages, and an increase in life expectancy, there are new emerging concerns that include contraceptive knowledge, supplies and coverage for unconventional target groups such as adolescents and older adults.

India also has one of the highest adolescent pregnancies in married populations, while we don’t have much evidence on contraception use, pregnancies and abortions in unmarried populations and older adults owing to a lack of data collection rather than their nonexistence.

However, the emergency contraceptive and abortion pill sales data give some hint that there is a considerable hidden burden in India as well. Access to contraception knowledge and coverage for older adults to ensure their sexual rights is also not on the mainstream policy agenda. With increasing life spans in the populations, sexual health and the concerns and rights of older adults also assume importance.

Concluding remarks

Unintended births have a greater chance of being undernourished, receiving less care and education, and having a higher chance of mortality. Couples with unintended births, sexual and reproductive tract infections, or contraceptive-led side effects have a greater chance of having work-family conflicts, intimate partner violence, and lower socio-economic status.

Unmarried partners with accidental pregnancies and sexual tract infections have a lower chance of acquiring greater human capital, skills, and successful labor markets and also have a greater chance of suffering from mental health issues.

Promotion of contraception choices, knowledge, use, and safety for all eligible and desired individuals is critical for expanding happiness, well-being, and prosperity in the country through quality human capital creation, greater labor market participations and avoiding undesired public spending.

It does not only ensure population stabilization but also prevents mistimed pregnancies, education and job market drop-outs, and reduces health risks. It helps build gender and social equity by reducing unwanted motherhood penalties for women, especially those from deprived social groups.

In particular, promoting healthy communication between partners and eliminating stigma around family planning to improve reproductive and sexual health outcomes have demonstrated an impact on making equitable and joint decisions to reach fertility intentions, sexual, emotional and mental health and achieve desired socio-economic outcomes for individuals, families, and society.

Finally, public spending on research for developing gender-sensitive contraceptive method choices to involve more men, increase supply and services, and provide information is essential to achieving family planning-led happiness and prosperity for the country.

*Srinivas Goli is associate professor, International Institute for Population Sciences (IIPS), Mumbai, India. Md Juel Rana is Assistant Professor, Govind Ballabh Pant Social Science Institute, Prayagraj. Declaimer: Opinions expressed are solely the authors’ personal views and do not reflect the opinions and beliefs of the affiliated organizations.

Courtesy: CounterView

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At a press conference held at the Press Club of India in the national capital on Monday, IDPD general secretary Shakeel Ur Rahman said that hill patients commute 150 km to Kohima and Dimapur in Nagaland and nearing cities in Assam to avail treatment as the movement of goods and people between the Valley and hills is severely affected.

“Our team visited the relief camps at the Khuman Lamkpak Sports Complex hostel (Imphal district) and IT relief camps under Sapormeina PHC (Kangpokpi district) in hill areas. We could not carry medicines as our local contacts told us that the mistrust among communities would make the journey difficult,” he said.

The ordeal of patients increases due to the Internet shutdown, said Rahman, a paediatrician by profession.

“We can help patients through telemedicine and train doctors in performing peritoneal dialysis (for renal failure) and other skills, like using AMBU bags in cases of Respiratory Distress Syndrome among children,and counsel mothers on breastfeeding. The shutdown has ended such possibilities,” he said.

“We also found the referral systems for serious patients at the relief camps in hilly areas unsatisfactory. It was beyond shock to find that the Kangpokpi District Hospital has neither an operation theatre nor a blood storage facility,” he added.

Besides, the state has “an acute shortage of specialists, other doctors and health workers. A vast majority of specialists doctors and all the medical colleges are in the Imphal district (three medical colleges) and Churachandpur district (one medical college)”.

Referring to the absence of vaccination among children, Rahman said that there is no special vaccination drive against measles. “Measles vaccine immunisation drive in children above nine months along with Vitamin A oral suspension is imperative for relief camps, according to the Sphere Project of the United Nations High Commissioner for Refugees (UNHCR).”

IDPD president Arun Mitra, an ENT doctor, said that nodal officers for relief camps too corroborated the reports that no green leafy vegetables/eggs/meat/fish has ever been supplied to the people. Only the local community, civil society organisations and a few individuals sometimes provide vegetables.

“Anodal officer said that the people at the camps get one egg each per day every 13 days. Green vegetables are never supplied. Rice, dal, potatoes and cooking oil constitute the bulk of the ration. The absence of green leafy vegetables and animal proteins in children’s diet in the last four months might lead to night blindness, which is caused by Vitamin A deficiency,” he said.

Mitra added that the condition of patients with chronic diseases like renal failure and diabetes is poor. “Two patients with kidney failure requested us for dialysis machines.”

Moreover, children get repeated nightmares. “Many request their parents to return home. The elderly are too anxious about the safety of their families,” he said.

Mitra demanded “robust referral systems after triage from primary health centres to higher relief centres within Manipur and neighbouring states at the earliest”.

“Restoring the Internet is a must to achieve this objective. Similarly, fabricated operation theatres should be made operational at the district and subdistrict levels immediately. Blood storage units should be set up around relief camps after cluster formation,” he further demanded.

Courtesy: Newsclick

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