The duty of the State to improve public health and the interplay between fundamental rights and directive principles in ensuring affordable public health services.

JUDGMENT :

1. Heard learned Counsel representing the parties and perused the records available before us on this Public Interest Litigation Petition (PIL Petition).

2. This PIL Petition seeks interference of this Court in exercise of its jurisdiction under Article 226 of the Constitution of India with a prayer to issue appropriate directions to the Respondents to ensure completion of a hospital in Kausa- Mumbra locality falling within the municipal limits of the Municipal Corporation of Thane (hereinafter referred to as the Corporation). A prayer has also been made to issue a direction to institute an inquiry into the causes of delay in completing the said hospital project and further into the alleged excess expenditure incurred by the Corporation in the said project and to take requisite action against the Officers responsible for such excess expenditure, which according to the Petitioners, appears to have been incurred without the sanction of law.

3. Having regard to the causes sought to be espoused in this PIL Petition, we shall, first take up the issue surrounding non-completion of the hospital project and the steps which are required to be taken by the Respondents to make it functional so as to cater the public health care needs of the population living in the Kausa-Mumbra locality.

4. A study conducted by the Tata Institute of Social Sciences (hereinafter referred to as the TISS) in the year 2014 into the health conditions of the citizen living in Kausa- Mumbra highlights the urban paradox wherein on one hand, it has areas that reflect economic prosperity while, on the other, it has areas that are characterized by sub-standard housing and non-availability of amenities to serve basic human needs which is detrimental to the well-being of the inhabitants. The study further highlights that urban slum residents of the area exhibit poorer health characteristics which indicates presence of structural conditions that shape inequalities in health and illness affecting the poorer, especially the vulnerable sections of the society such as infants, young children, elderly and women.

5. The study also reveals that the four pillars of health, which include promotive, preventive, curative and rehabilitative services delivered by Health Personnel and their support structures are weak in Kausa-Mumbra. The study concludes as under:

“Health of people in Mumbra-Kausa reflects an impact of variable intensities of joblessness, homelessness, marginalization, morbidity, food insecurity and social disarticulation. All of these are along with lack of access to basic public services. This has led to families having to bear economic burden of accessing private healthcare facilities. It is evident that health risks faced by people of Mumbra-Kausa is associated with economic hardship which lead to further disruption of social fabric and a feeling of uprooting, alienation and psychological trauma.”

6. With the insertion of Part IX-A in the Constitution of India w.e.f. 1st June 1993, the Municipalities or the Urban Local Governance bodies in the country have acquired a constitutional status. Part IX-A not only strengthens the municipalities by raising them to a constitutional status but it also bestows certain responsibilities upon them. Article 243-W mandates the Legislature of a State to vest in the Municipalities, by making law, certain powers, authority and responsibilities which include performance of functions and implementation of schemes as may be entrusted to the Municipalities including those in relation to the matters listed in Twelfth Schedule. One of the functions enlisted in Twelfth Schedule is “Public Health, sanitization conservancy and solid waste management”. Thus, it becomes a constitutional function and duty of every Municipality to implement the schemes entrusted to it including the schemes in relation to the public health as well.

7. It appears that realizing the statutory and constitutional functions entrusted to the Corporation, a decis