Revisiting Mahatma Gandhi`s Decentralization - Health and Rural India

 09 June 2020   |    Sunayana Basu Mallik

Gandhiji said ‘if villages perish, India will perish’. Can India protect its villages from coronavirus pandemic

 

Today’s blowing corona pandemic has awakened our understanding and the manner we process our thoughts and even rigid process driven work formats and routine. It has manifested in several contrasting ways what the government has already done and what government, each representative of people, every individual and families living in India can do. The Government has invoked powers under Constitution of India and several statutes including the Epidemic Act, Indian Penal Code, Disaster Management Act, 2005, Guidelines on Telemedicine and several fiscal statutes in not only observing international and regional standards pertaining to preventing but containing novel corona virus. However it is inspiring to see the majority and the opposition parties, people’s elected representatives, public and social influencers are embarking passionately into what government and institutions can do for people, individuals, countries, regional clusters and districts.

 

The Constitution of India has conferred powers on each institution (Legislature, Judiciary and Executive) and it has laid down valuable guidelines and all pervasive philosophy reiterated by our father of Nation ‘The Mahatma’. Gandhiji’s philosophy of self-sufficient village economy is reflected in Article 40 of the Constitution of India (Gram Swaraj). Gandhiji’s potrait of village economy will remain incomplete without having treatment facility and essential health infrastructure for such people residing in semi urban and rural economies.  

 

Article 40 set out that state shall take steps to organize village panchayats and confer such powers and authority to enable them to function as units of self-government. Several states enacted statutes to establish Panchayat with a view to ensure effective involvement of the Panchayat Raj Institutions in the local administration and development activities. Gandhiji said ‘if villages perish, India will perish’.

 

As ‘novel corona virus’ came as an incidental import entering our country through cross border transport channels using large cities as conduit to enter quieter towns and villages. When millions of people within hundreds of villages were sleeping after eating home made meals, a set of village representatives grossly unaware, ill prepared and suffering from language gap / disadvantage overnight came to understand that a deadly virus has endangered each of their lives.

 

Although the vast and rich economy and produce of the vast Gangetic plains or the fertile areas around Godavari, Krishna and Narmada River are not globally rated or ranked, it is these villages across the country which is indeed the lifeline of India.

Today each of the elected representatives or representatives of people through non-elective process is making efforts to stop this virus from reaching and ravishing rural India. Each of them are mobilizing equipment, resources and creating infrastructure (hospitals, isolation wards, creating diagnostic and testing centers) in the district and taluk level. The concerted action to establish care and treatment centers in semi urban and rural India in these times of emergency is possibly a massive opportunity to improve government aided good quality and reliable healthcare infrastructure in semi urban and rural India. Currently funds are getting allotted for developing such resources and infrastructure. The inertia of combating corona virus in semi urban and rural India can be sustained by permanently creating a good public health care system within such areas. There are detailed surveillance mechanisms being deployed to oversee districts in semi urban and rural India to identify and control corona virus. The process of assimilating technology in acquiring such data and storing, accumulating and analyzing the same is going to bring a large population within the ambit of a formal health surveillance mechanism which can in turn be used subsequently to extend continuous and permanent health care services to such persons. 

 

Further, Article 47 of the Constitution enjoins on the State and contains a Directive Principle of the State Policy and provides that the State shall regard the improvement of public health as amongst its primary duties. ‘Article 47 of the Constitution of India clearly mentions Duty of the State to raise the level of nutrition and the standard of living and to improve public health.’ I would emphasize the word ‘public health’. The Supreme Court (SC) has interpreted the need to safeguard public health from the food adulteration and food safety point of view notably in Centre for Public Interest Litigation Vs UOI cited in MANU/SC/1094/2013. The SC has iterated the penal provision of the Food Safety Act and observed in para 25 ‘It is, therefore, of utmost importance that the provisions of the Acts are properly and effectively implemented so that the State can achieve an appropriate level of human life and health, safeguarding the right to life guaranteed under Article 21 of the Constitution of India.

 

In a recent decision by Supreme Court to extend covid 19 testing mechanisms free of cost to the poor and such sections of people identified by Government is a bench mark for extending one of the core public health infrastructure (identification and diagnosis) to the poor which may cover within its ambits thousand of families living in semi urban and rural India.

 

Comprehensive efforts coming from Government to identify a disease, treat the disease and cure the disease at Taluk or District level may be at present understood to mean combating novel corona virus. But the infrastructure now being created for it and resource mobilized for the same can be harnessed to extend treatment for several curable diseases.

 

‘Public Health’ comes within the ambit of state list as outlined in Constitution of India. The State Government has powers to frame its own rules on public health, sanitation, hospital and dispensaries. This may create a situation that public healthcare system within each state - the quality and manner of diagnostic support, accountability and treatment in such hospitals may significantly vary from one state to another. However the nature and depth of the crisis staring at us may urge us to think if the Union Government (Centre) should establish one minimum benchmark of consistent standard across different states, districts, taluk for public health infrastructure and services which all states should adhere and implement.  

Hear the full Article

The Union Government has valuable powers laid down in concurrent list under the items of ‘economic and social planning (Item 20)’ and ‘social security and insurance (Item 23)’. The Union Government as per (Item 97) in List I has powers to legislate on any matter not enumerated in State List (II) or Concurrent List (III).  Considering the unprecedented and exponential nature of the present pandemic, the Union may opt to enact statutes on any matter not outlined in State or Concurrent List.

 

Additionally, Union government has powers to enact statutes to implement principles agreed in Bilateral and Multilateral Treaties and those stipulated by United Nations including the World Health Organization.

In Hind Swaraj (page 37) on or about 1909, Gandhiji writes

‘The poor villagers are exploited by foreign government and also by their own countrymen— the city-dwellers. They produce the food and go hungry. They produce milk and their children have to go without it. It is disgraceful. Everyone must have a balanced diet, a decent house to live in, facilities for the education of one's children and adequate medical relief.’

After 110 years since then a time has come wherein we question ‘could we the people of India (the state) provide adequate medical relief to our villages?’

 

The creation of a consistent public health care system across different semi urban areas and rural areas will be a herculean task for the Government but a permanent remembrance and execution of Gandhiji’s idea of protecting the villages and its economy. If people living in semi urban India and villages don’t remain in good health there can be no sustainable economy.

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