Right to Health and Local Governance: A Constitutional and Administrative Perspective

Abstract

The constitutional imagination of India situates the right to health at the intersection of justiciable fundamental rights, non-justiciable Directive Principles of State Policy (DPSPs), and a complex, multi-level administrative architecture spanning the Union, States, and local self-governments. Although “public health and sanitation” are predominantly State List subjects, the 73rd and 74th Constitutional Amendments constitutionalised decentralized governance, vesting Panchayats and Municipalities with functional responsibilities over primary health, sanitation, and public amenities. Over three decades, decentralization has matured through programmatic missions, fiscal transfers, and judicial innovations around Article 21, transforming the right to health from a welfare aspiration into a rights-claim infused with procedural safeguards, accountability, and measurable standards.

This paper offers a constitutional and administrative analysis of the right to health through the lens of local governance. First, it maps the constitutional scaffolding—Articles 14, 15(3), 15(6), 19(1)(g), 21, 23, and pertinent DPSPs (Arts. 38, 39, 41, 42, 43, 47)—and synthesizes jurisprudence that reads health into the guarantees of life, dignity, equality, and non-arbitrariness. Second, it examines the institutional design of multilevel health governance, including the division of legislative powers (Seventh Schedule), decentralization under the Eleventh and Twelfth Schedules, and the interlocking of programme delivery via National Health Mission (NHM), Ayushman Bharat (PM-JAY and Health & Wellness Centres), and post-pandemic public health infrastructure initiatives. Third, it situates local bodies within administrative law’s grammar—reasonableness, proportionality, legitimate expectation, transparency, and participatory decision-making—showing how these principles discipline discretion in planning, contracting, licensing, and public procurement in health and sanitation.

Drawing comparative insights from Brazil and South Africa, the paper argues for a subsidiarity-anchored model of “rights-based health federalism” where functions, funds, and functionaries (the F-F-F triad) align with local needs, social accountability institutions (VHSNCs, Ward Committees) are empowered, and grievance redress—through ombuds processes and judicial remedies—is streamlined. It concludes with a set of normative and operational recommendations: clarifying statutory mandates for local health authorities; hard-wiring measurable service guarantees; embedding community-led social audits; integrating digital health and data protection with ethical guardrails; and strengthening fiscal devolution through formula-linked health-equity grants. Collectively, these reforms can convert constitutional promise into lived health entitlements, especially for marginalized communities.