Unconstitutional to prescribe different qualifications for doctors to provide services in rural and urban areas: Supreme Court

Around two decades ago, the Assam Government had introduced the three-year diploma course for strengthening the rural healthcare infrastructure by creating a cadre of barefoot doctors allowed to practice modern medicine, to a certain extent.

Medical Dialogues had earlier reported that while considering the matter, the Supreme Court had objected to the attempt of the State for encroaching into the exclusive domain of the Parliament. The bench had noted, "It is essential that uniform standards are laid down by the Parliament which are adhered to by institutions and medical colleges across the country. To this end, Entry 66 has been formulated with the objective of maintaining uniform standards in research, higher education, and technical education. Hence, state legislatures lack legislative competence in the areas of prescription of minimum standards for medical education, authority to recognise or derecognise an institution, et cetera..."

In this context, the bench also referred to the Directive Principle of State Policy and noted, "The framers of the Constitution, in Article 47 have directed the Union and State Governments to regard the ‘improvement of public health’, as its primary duty. It follows from this directive that the State shall make all possible efforts to ensure equitable access to healthcare services. These efforts must be made to progressively realize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, as acknowledged in international conventions and agreements."

The bench also observed that the even though the State has the right for devising policies for public health and medical education regarding peculiar social and financial conditions, policies that cause an unfair disadvantage towards any class of citizens, ought not be formulated.

“The citizens residing in rural areas have an equal right to access healthcare services by duly qualified staff. Policies for enhancing access to rural healthcare must not short-change. The citizens residing in rural areas are subjected to direct and indirect forms of discrimination on the basis of their place of birth or residence. Any variation in the standards of the qualifications required of medical practitioners who render services in rural areas qua those rendering services in urban and metropolitan areas circumscribe constitutional values of substantive equality and non-discrimination,” observed the bench.