For India’s 930M rural residents, protecting qualified health workers is ‘national interest’: Gauhati High Court

“In a country of 1.47 billion people, of which about 62.5 per cent to 63 per cent reside in rural areas, bringing the rural population to roughly 922 to 930 million people, it is paramount in the national interest that qualified professionals who are capable of rendering essential health services in terms of the standards specified and/or enumerated by the health department,” the court said on May 29.

Justice Soumitra Saikia said that the right to health is an integral part of the right to life and is a facet of Article 21.

The order added that while it is true that the rural population must be given the best and the highest medical facilities to the extent available, it is equally important to involve local population who may be willing to undergo such training and attain such qualification as laid down by the State and render such services to the rural population as involvement of members of the local rural community will subserve the interest of better health care to such rural communities which are particularly not having access to specialised or higher medical institutions or facilities.

‘Right to health is integral part of right to life’

• The Assam Rural Health Regulatory Authority Act, 2004 was enacted to provide for the establishment of a regulatory authority in the State of Assam to regulate and register the diploma holders in Medicine & Rural Health Care (DMRHC) and their practice of medicine in rural areas and also to regulate opening of Medical Institutes for imparting education and training for the course of diploma in Medicine and Rural Health Care (DMRHC).
• Pursuant to the enactment of this Act, certain regulations were framed, namely the Regulations of the Assam Rural Health Regulatory Authority.
• The regulations prescribed the process of admission into the Diploma in Medicine and Rural Health Care Course in a medical institute in the State of Assam.
• It is settled law that Article 21 of the Constitution of India confers on the citizens of India a fundamental right to life and personal liberty.
• Right to health is an integral part of the right to life and is a facet of Article 21.
• The principle of fairness in action requires that public authorities be held accountable for their representations, since the State has a profound impact on the lives of citizens.
• Good administration requires public authorities to act predictably and honour the promises made or practices established unless there is a good reason not to do so.
• It is evident that the State Government at a relevant point in time had undertaken the process for granting the benefits to the petitioners in terms of the judgment of the Apex Court.
  For reasons not explained, this process, although not concluded, appears to have been abandoned halfway.
• During the hearing, sufficient opportunities were also granted to the Department of Health & Family Welfare to apprise the Court as to the decisions taken or likely to be taken in terms of the meetings which were earlier held by the committee itself.
• However, no specific instructions were placed before the Court about the status of the committee, and/or any conclusive decisions or recommendations were arrived at by the said committee.
• There was no restraint on the courses undergone by the petitioners by the Court or by the State during the pendency of the petition.
• It cannot under any circumstances be understood to be the deficiency or fault of the petitioners in undergoing the courses and not resorting to any other vocational or professional course available.
• That step should be taken to ensure qualified health professionals are made available to such areas in addition to the regular doctors under allopathy, homeopathy, and ayurvedic as considered necessary by the State.

Rise and fall of 2004 Act and legal battle of medical professionals

The case originated from a 2004 state initiative designed to address the shortage of doctors in rural areas. Under the Assam Rural Health Regulatory Authority (ARHRA) Act, students were enrolled in a three-and-a-half-year Diploma course in Medicine and Rural Health Care (DMRHC) at the Medical Institute in Jorhat.

These practitioners were authorised to treat common diseases, prescribe specific drugs, and perform minor surgeries within rural jurisdictions. However, the Indian Medical Association (IMA) challenged the Act, leading the high court to strike it down as unconstitutional in 2014.

The court found the Act in conflict with the Indian Medical Council Act, 1956, as the state had not obtained central permission to start the new medical course. In response to the 2014 ruling, the Assam legislature enacted the Assam Community Health Officer (CHO) and categorised them as paramedicine personnel.

The 609 petitioners moved to the high court, arguing that this re-designation downgraded their status from practitioners to paramedics and restricted their ability to practice medicine as they had been trained to do.

Appearing for the petitioners, Senior Advocate Harin P Raval submitted that there can never be any deprivation of the qualifications which the petitioners earned lawfully during the operation of the ARHRA Act of 2004.

It was submitted that no relief was either paid for or granted against the petitioners. The petitioners were never arrayed as parties in the proceedings before the High Court.