Authored By: Pratyasha Rath
Kiit School of Law
INTRODUCTION
India is a diverse country which includes population, region, language, culture, and geography and so on. Though there have been many developments done in healthcare system, there still exist a significant gap in the quality of healthcare between urban and rural areas These gaps include inadequate healthcare facilities, shortage of healthcare professionals and poor healthcare facilities. 833 million Indians live in Rural areas according to the 2011 census, which is more than two-third of the total population. It is quite concerning if the majority is suffering from such deficiencies. The right to health in India has now turn more than just a dream that can exist in reality; it is a duty enshrined in the Constitution of India, which came into effect in 1950, with various clauses coming together to make it a fundamental right. The Supreme Court has recognized health as a fundamental right under Article 14, 21 but mostly under Article 21 of the Constitution. However, despite this solid jurisprudence and recognition, India’s public health care delivery system is very concerning. The constitutional right to healthcare remains unmet due to chronic underfunding, acute scarcity of trained medical staff, dilapidated infrastructure, entrenched inequalities between access in urban and rural areas and pervasive corruption. Such a legal study of these systemic issues requires an understanding of the legal framework as well as enforcement. So there need to be a dual approach dealing with structural and implementation aspects.
A-THE LEGAL OBLIGATIONS TO ALLOCATE RESOURCES AND UNDERFUNDING.
At 1.2–1.5% of GDP, India’s public expenditure on health has always been low compared to the WHO’s recommended public expenditure on health of 5% of GDP and the target set in the National Health Policy 2017 of 2.5% of GDP. Such considerations of the budget are traditionally the territory of the executive, but Indian courts can intervene where there is failure to allocate resources that translates into failure to provide life-saving treatment.
In State of Punjab v Mohinder Singh Chawla (1997)[1], the Supreme Court confirmed that the right to health is a part of the right to life and the State has the duty to provide health facilities to its citizens. The Court’s reasoning suggests it should not merely be shielded from constitutional review by invoking the political question doctrine because of budgetary frugality when that frugality leads to avoidable deaths.
B-THE RIGHT TO NON-DISCRIMINATION IS ONE OF THE BASIC HUMAN RIGHT
Geography, caste, gender and economic status are all significant factors in the level of access to public health services in India. Access to even primary healthcare is harder to get in tribal/rural communities. The lack of Sub-Health Centers, Primary Health Centers and Community Health Centers in areas which are remote , amounts to not just an administrative failure but also poses legal issues in light of Article 14 and 21 of the Constitution which guarantee equal enjoyment of protection and the right to life, regardless of their geographical location .Judicial precedents over five decades have consistently given verdict that the right to health is a fundamental right , yet after so many affirmations the gap between the legal recognition and ground-level implementation in rural areas has been wider.
C-THE RIGHT TO HEALTH IN RURAL CONTEXTS
ARTICLE 21
There is only one constitutional guarantee to the right to health in India, namely, Article 21 of the Constitution, which provides that ‘no person shall be deprived of his life or personal liberty except according to the procedure established by law. Over the years, the Supreme Court, through conscious judicial interpretation has endowed Article 21 with a broad and substantive interpretation which includes the right to live with human dignity, the right to a clean environment and most importantly, the right to health and medical care.
The 1996 decision in Paschim Banga Khet Mazdoor Samity v. State of West Bengal[2] continues to provide the clearest statement as to the State’s duty to provide emergency medical care. In the case, the injured employee of a train accident was denied treatment at various government hospitals because of the lack of beds. The Supreme Court ruled that the delay in providing timely medical treatment in government hospitals amounted to denial of the right to life guaranteed under Article 21 of the Constitution, and ordered the State to urgently take steps to augment medical facilities, especially in emergency situations. The decision has far-reaching implications for health care facilities in rural areas, where there are almost invariably no emergency services. In later judgement the court held that the state cannot deny to rural citizens by invoking resource constraints.
Directive Principles of State Policy
Though DPSP not directly enforceable in court of law but the Supreme Court consider them as fundamental in the governance of the country. Several Directive Principles are directly relevant to rural health care:
- Article 39(e) directs the State to ensure that the health and strength of workers — men and women — and the tender age of children are not abused.
- Article 41 requires the State to make effective provisions for securing the right to public assistance in cases of sickness and disablement.
- Article 42 directs the State to make provision for securing just and humane conditions of work and maternity relief.
- Article 47 imposes upon the State the primary duty of raising the level of nutrition and the standard of living of its people and the improvement of public health.
In particular, Article 47 is a central provision that deals with public health. As interpreted by the courts, both the Union government and State governments have a legally binding duty to promote the quality, access and relative availability of health care in the rural areas and continuously improve it.
The International Human Rights obligations
The International Covenant on Economic, Social and Cultural Rights (ICESCR), Article 12 of which, gives everyone the right to enjoy the highest attainable standard of physical and mental health, to which India is a signatory. The UN Committee on Economic, Social and Cultural Rights, mentions the four “AAAQ” characteristics of health facilities, goods and services: availability, accessibility, acceptability, and quality.
The Supreme Court has, on several occasions, considered whether there are international human rights obligations that are relevant to the interpretation of provisions of its domestic constitution, notably Article 21. In Vishaka v. State of Rajasthan (1997)[3], the Court took the help of international conventions for constitutional interpretation. By that approach, India’s obligations under ICESCR are to progressively fulfil the right to health in rural areas without discrimination, which is in addition to its constitutional obligations.
D-The Human Resource Crisis: Legal Dimension
Constitutional validity of compulsory rural service.
The constitutionality of compulsory rural service has been a topic of debate. Despite decades of policy initiatives to remedy the lack of healthcare providers in rural areas, that gap has persisted and several states have passed laws requiring compulsory rural service as a prerequisite for their medical school admission process or for their award of medical degrees. In Karnataka, Maharashtra, and other places, such requirements are put into place at different times. There have been many cases challenging the constitutionality of mandatory rural service commitments.
The Court’s decision does not give constitutional backing to compulsory rural service schemes, but it said that compulsory rural service schemes must not be implemented in an arbitrary manner.
Although their constitutionality has been confirmed, the programmes of forced rural labour have not been successful in practice. Rural posting of doctors is often resulted in frequent seeking of job transfers to other units, or even resignation from government service because of the lack of career progression, professional support, and personal comfort. But a purely legalistic solution to the human resource problem is not enough, and should be coupled with incentive programmes, building capacities, and better living and working conditions.
AYUSH Practitioners and the Regulatory Controversy
In the wake of scarcity of allopathic medical professionals in the rural areas, consecutive governments have granted AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) practitioners performing multiple primary health-care roles such as immunisation, first aid and referral services etc. This policy is pragmatic, yet involves complex legal considerations regarding what constitutes ‘authorised practice’ for AYUSH practitioners, liability for unintended consequences of their practice and the quality of training provided for practitioners to perform expanded functions.
The Indian Medical Association has been opposing the growth of AYUSH positions from the beginning, saying it is quackery and harms the rural people. There have been instances when several high courts have been approached for addressing conflicts between the health practitioners of AYUSH with the allopathic establishment. In Indian Medical Association v State of Maharashtra (2025)[4], the Bombay High Court struck down the practice of modern medicine by practitioners of AYUSH without any additional training but recognised the need for a regulated multi-practitioner approach to address the shortfall of healthcare in the rural area
E-GRIEVANCE REDRESSAL AND ACCESS TO JUSTICE IN RURAL HEALTH
Structural Barriers to Legal Redressal
Even if there are some legal provisions and rights for rural patients, their practical use is inconsiderable without effective and convenient ways of redressing grievances in an affordable manner. Geographic remoteness from courts and consumer forums, high costs of litigation, lack of legal aid services in remote areas, lack of legal literacy, reliance on the same public health system that one would want to come into conflict with, and power imbalances that discourage complaints against local health officials and providers are all structural barriers that rural patients may encounter when seeking legal remedies.
The Legal Services Authorities Act 1987 provides for free legal services to people living in rural areas and to the poor and weaker sections of society. District Legal Services Authorities (DLSAs) have the authority to set up legal aid camps, carry out Lok Adalat and offer legal aid on health-related issues. However, the capacity and geographical scope of DLSAs in distant rural areas are still very limited.
Public Interest Litigation and its limitations in rural context
PIL has become an effective instrument for systemic reform of rural health care, but the rural context poses some inherent constraints on PIL. A petitioner who is literate, knowledgeable about his legal rights, and financially resourceful is usually required to pursue PIL over a longer period of time. The communities most adversely impacted by the failure of health care in rural areas are those that are least able to afford and access to PIL facilities without the support of someone else. The most affected communities by the failure of these health care facilities in rural areas are the ones that are least able to access the PIL facilities without the assistance of another.
Despite these shortcomings, PILs have given outcomes in the field of rural health care. The final watchdog over the implementation of the midday meal scheme by the Supreme Court, Writ Petitions from the NRHM are some examples of PIL as a vehicle for rural health rights. In the absence of individual rights-holders, civil society organisations, especially those in tribal and rural areas, have partnered with legal experts to uncover systemic flaws and launched strategic litigation.
Consumer Forums and the Rural Access Problem
Consumer forums established under Consumer Protection Act, 2019 offer health care complaints an affordable and easily available mechanism. In rural areas of India, on the contrary, District Consumer Disputes Redressal Commissions, the first tier of the Consumer Forum, are situated in District Headquarters, where the rural complainants need to travel long distances, hire advocates, and have to deal with the institutional procedure. The e-filing provisions in the 2019 Act may provide some advantage in practice, but it is only useful and effective in the areas where there is digital connectivity and digital literacy.
Conclusion
Indian rural healthcare system is afflicted with deep-rooted, structural and legal problems. They are not one-off atrocities committed by errant public officials, but a systemic constitutional miscarriage of justice – a failure on the part of the State to protect and defend the right to life, dignity and health of its most vulnerable citizens. The institutional structures that are necessary to put into practice the significant judicial rulings and policy statements are adequate, but lack the political will to do so because they are not sufficiently resourced or effective. The government may have done enough structural development for rural public healthcare but it alone cannot fix all the existing issues altogether. The focus should also be on operational outcome as well the areas need to be classified as normal, difficult and most difficult ones based on some defined criteria. In the difficult areas where there are high persistent staff or healthcare professionals’ vacancies there should be introduction of special incentives such as additional compensatory financial allowances, quality schooling facilities for children, priority for postgraduate seats, staff quarters and a comfort lifestyle.
Law is just the first step to a just and functional rural health care system, but it is not the last. Legal reform needs to be complemented by continued public investment, empowerment of communities, social accountability and a fundamental reframe of the role of the State for the hundreds of millions of Indians who do not have access to currently available health services. It’s a demand of the Constitution. It is a necessity to human dignity. The time for action — and not just talk — is long past.
The rural health care problem in India is, at the bottom line, a moral test needs to be done out of a moral responsibility of the State to fulfil the commitment made in the Constitution. The right to life is guaranteed by the Constitution of a country, with thousands of rural citizens of that country dying every year due to treatable conditions that are preventable; that’s a huge responsibility for the nation to explain and rectify. As we can no longer afford to see the loss of the majority population of the country suffering due to the prevailing complexities in the public healthcare system which is the only source of care and treatment for the survival of the poor and marginalized.
REFERENCE(S):
Primary Sources
- Constitution of India
- National Health Policy by Ministry of Health & Family Welfare Government of India
- International Covenant on Economic, Social and Cultural Rights (ICESCR)
- World Health Organisation
- The Legal Services Authorities Act 1987
- Consumer Protection Act, 2019
- Census of India 2011
Secondary Sources
- The Hindu
- The New England Journal of Medicine On Health Policy Report by John K. Iglehart
- International Journal of Law Management & Humanities-Rural Health Care System in India: A Critical Analysis
- Mohan P, Kumar R. Strengthening primary care in rural India: Lessons from Indian and global evidence and experience. Journal on Family Medical Primary Care 2019;
- Singh MM, Garg US, Arora P. Laws Applicable to Medical Practice and Hospitals in India. Int J Res Foundation Hosp Healthcare Adm 2013
- https://csemonline.net/wp-content/uploads/2019/07/WHY-5-of-GDP-1.pdf
[1] State of Punjab v. Mohinder Singh Chawla, (1997) 2 SCC 83, [Page no.-2 (Indian Kanoon)]
[2] Paschim Banga Khet Mazdoor Samity v. State of W.B., (1996) 4 SCC 37.[ Page No.-5 (Indian Kanoon)]
[3] Vishaka & Ors. v. State of Rajasthan & Ors. (1997) 6 SCC 241
[4] Indian Med. Ass’n, Pune Branch v. State of Maharashtra, WP (St.) No. 23740 of 2025 (Sept. 17, 2025) (Bom.)- [Page no.-6: -para 5 & 6 (Indian Kanoon)]
