PHA-Exchange> PHM India 25th anniiversary PHC celebration

[Claudio]

25th anniversary of 'Health for All' declaration

PHM-India launches 'Right to Health Care' national campaign

Cases of 'denial of health care' presented before Chairperson, National Human Rights Commission

 

Over 250 PHM-India delegates from 16 states spread across the country assembled in Mumbai, for a National workshop (5th Sept. 2003) and National Public Consultation (6th Sept. 2003) on the issue of 'Right to Health Care'. During this unique event, organised by Jan Swasthya Abhiyan (PHM-India) on the 25th anniversary of the 'Health for All' declaration, health activists analysed the justification and content of the Right to Health Care, shared cases where health care had been denied, and chalked out a campaign strategy to make the Right to Health Care a fundamental constitutional right and an operational reality. During these events, which were locally hosted by CEHAT, one of the high points was the session resembling a 'public hearing', involving Justice Anand, Chairperson, National Human Rights Commission, along with ordinary people and grassroots activists who presented cases of 'Denial of health care'.

During the 5th September workshop on Right to Health Care, in the opening plenary session, the content, relevance, justification and broad campaign approach regarding the 'Right to Health Care' was presented by a national PHM-India representative. It was stated that 'our approach is Right to Health, one of our strategies is to establish the Right to Health Care' and 'the movement for Right to Health Care is people's response to neo-liberal health policies'. Following this, there were group discussions on different aspects of health care as a fundamental right -

·        Right to basic (including PHC) health services;

·        Women's right to health care; 

·        Right to essential drugs; 

·        Health care rights of unorganized workers and urban poor; 

·        Health rights of HIV / AIDS affected persons; 

·        Health rights in situations of conflict (such as the recent Gujarat carnage) and displacement.

Leading health activists working on the issue moderated each of these sessions. Similarly, there were short plenary presentations on 'Children's right to health care', 'Right to mental health care', 'Health rights related to the Private medical sector' and 'Health sector employees and the right to health care'. It emerged through these forceful presentations and discussions that the health-care needs of various vulnerable sections have been neglected and a comprehensive strategy to address these is required. 

In a subsequent session with parallel groups, grass root activists narrated in their own language, their tragic stories of gross deficiencies of health care in Primary Health Centres, rural hospitals and urban public health facilities. These structural deficiencies, including lack of basic drugs or vaccines, insufficient staff and inadequate transport facilities had led to their relatives or people from their area to suffer or even lose their lives. In all about 50 such cases were presented, based on careful documentation by PHM-India activists from different states with the help of a standard questionnaire. 

 

On 6th September, the 'National Public Consultation on Right to Health Care' began with a welcome address by Dr. N.H. Antia, Chairperson on PHM-India. Justice Anand, Chairperson, National Human Rights Commission (NHRC) mentioned in his inaugural speech that the Supreme Court has taken a view that health care is a fundamental right. He mentioned the role of NHRC in highlighting this issue by means of organising various workshops and consultations. At the end of his inaugural speech, Justice Anand stated his clear position that "Obligation of the state to take care of primary health is paramount, total and absolute. The State cannot avoid its constitutional obligation on account of financial constraints." 

Subsequently, six testimonies and case studies were presented before Justice Anand, demonstrating how weakened public health services are denying health care to the poor. These highlighted how essential drugs and vaccines are absent in public health institutions, emergency care is not available at sterilization camps and treatment is delayed because doctors are not available and ambulances have not been deployed. Some examples of these testimonies show how people are discriminated against in health care because of poverty (names changed to protect confidentiality) -

·     12 year old, Neeta, from Malakapur in Uttar Pradesh was bitten by a rabid dog. She was taken to the district hospital in Moradabad, but not given appropriate anti-rabies vaccine. She died due to rabies after some period, along with three others from the same village who had similarly been bitten and had been denied the vaccine.

·     Tukaram, a resident of Thane district in Maharashtra was bitten by a snake. He was first taken to Saralgaon PHC, where no treatment was given since Anti Snake Venin was not available. Next he was taken to Murbad rural hospital. Here too Anti Snake Venin was not available and some injections had to be purchased from outside. He was also made to wait in a queue and go through routine administrative procedures. Tukaram died the same day.

·     Suchitra Devi was motivated by the Auxilary Nurse-Midwife to undergo sterilization at a tubectomy camp in Halharmau PHC, in Uttar Pradesh. She was made to sign papers, but not explained their contents, and nature of information. She expired during the operation, although it is a very minor and routine procedure. No emergency care was available at the site of the 'Camp'. All the PHC staff, including the doctor, then, fled the PHC, without informing the relatives of the deceased. Members of her family found her dead body lying on a stretcher outside the operation theatre. 

·     Chotu and his family of three - father, mother and sister - in Kolkata (Calcutta) were all suffering from Tuberculosis. Dr. Biswas referred them to the government hospital for treament of TB, by DOTS (Directly Observed Treatment Short-course). They were refused DOTS treatment because they did not have a ration card, and since their name was not mentioned in the voter's list. When Dr. Biswas met Chotu some time later, his father and little sister had expired.

 

Next, Prof. Satyaranjan Sathe, a national-level constitutional and legal expert, clearly stated his opinion that the government is acting against the constitution by abdicating its responsibility of providing basic health care to people. He also stressed that without increased awareness and civil society pressure, mere judicial, constitutional actions would not realize the aim of health care as a fundamental right.

In his presentation on behalf of PHM-India, Dr. Abhay Shukla of CEHAT emphasised the need for action and possibility of collaboration between NHRC and PHM-India to realise the right to health care. He pointed out that NHRC in its recommendations has clearly recommended that the Right to Health be expressly transformed and declared as a fundamental constitutional right. He suggested that the NHRC organise regional public hearings on this issue, to facilitate a national process of public debate and dialogue with health authorities.

This session concluded with a pledge made by all the participants in presence of Justice Anand-

"On this day, the 6th of September 2003, on the occasion of the 25th Anniversary of the historic 'Health for All by 2000 AD' declaration, we as national representatives of Jan Swasthya Abhiyan, take the following pledge --

We regard the right to the highest attainable standard of health as an inalienable human right. We declare that the Right to Health Care should be made a Fundamental Right in the Indian Constitution, and that this right must be enforced immediately through appropriate legal and executive measures. We pledge to work tirelessly to resist the denial of this right in all forms and at all levels, and to mobilise our fellow countrymen, women and children towards the establishment of the Right to Health Care as an important milestone on the way to the realisation of the dream of 'Health for All."

 

In the concluding strategy planning session, representatives from various states discussed and presented their broad state-level plans of action, including organising district level public hearings on the 'Right to Health Care'. Representatives of various National networks, which are constituents of PHM-India, expressed their involvement in and support for the campaign. Some initial steps in the newly launched campaign are likely to include submission of a national petition on 'Right to Health Care' to the National Human Rights Commission (based on cases of denial of health care), active participation in regional public hearings which may be organised by the NHRC and release of a national 'State of Health Care in India' report on occasion of the PHA anniversary in early December 2003.

 

Abhay Shukla,

National Secretariat, Jan Swasthya Abhiyan (PHM-India)

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