PHA-Exchange> National Public Hearing on Right to Health Care in India

Tue Jan 4 06:49:37 PST 2005

Dear Friends,
As one further step in the Right to Health Care campaign that has been taken up by PHM-India (Jan Swasthya Abhiyan), recently a National Public Hearing on the Right to Health care was organised by the National Human Rights Commission and PHM-India. This hearing was the culmination of a series of five regional public hearings held in all regions of the country, documentation of cases of denial of health care in most states, and conduction of 'people's health tribunals' (Jan Sunwais) in certain states. A brief report of this event is given below.
With regards,
Abhay Shukla,
National secretariat, Jan Swasthya Abhiyan (PHM-India)

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National Public Hearing on Right to Health Care 

Organised by National Human Rights Commission and PHM-India, 16 and 17 Dec. 04, New Delhi

On the 16th and 17th of December 2004, a unique National public hearing on the Right to Health Care was conducted in New Delhi by the National Human Rights Commission (NHRC) and Jan Swasthya Abhiyan (People's Health Movement-India), a national coalition for people's health and health rights. Participants in this hearing included the Union Minister for Health and Family Welfare, Dr. Anbumani Ramadoss; Chairperson of the NHRC, Justice A.S. Anand; Union Secretary for Health and Family Welfare, Mr. P. Hota; State Health Secretaries or Directors of Health Services from 22 states; expert members of the NHRC Core committee on Health; and over one hundred Jan Swasthya Abhiyan (JSA) delegates representing more than 20 states across the country.

This National Public Hearing was organised as the culmination of a series of five Regional public hearings on the Right to Health Care, held during July to November 2004, organised in designated cities and covering the following regions of the country: West (Bhopal), South (Chennai), North (Lucknow), East (Ranchi) and North-east (Guwahati). In these five regional public hearings, senior Government health officials (Health Secretary or Director of Health Services) represented most of the states, while a total of nearly one hundred and fifty cases of health care denial were presented, certain policy level issues were discussed, and after each public hearing, a series of recommendations were issued concerning the State governments participating in each regional hearing. In the coming few months NHRC is expected to investigate some selected cases of health rights violations presented during these regional hearings.

Brief report of the National Public Hearing:

The National Public Hearing on the Right to Health Care was organised at the India Habitat Centre, New Delhi on 16th and 17th December 2004. On 16th December, the inaugural plenary session was followed by Regional sessions / session on Urban health care in two parallel groups, and concluded with a plenary session on National health policy issues and health rights violations. On 17th December, discussions on key areas of health rights violations were conducted in two parallel groups, followed by the concluding plenary session on a National action plan to establish, fulfill and monitor the Right to Health Care. 

A. Inaugural session
Opening the inaugural Session of the Public Hearing, Dr. Ekbal, National convenor of JSA, gave a welcome speech on the behalf of the Jan Swasthya Abhiyan. In his speech he briefly spoke about the emergence of the JSA Right to Health Care Campaign, and also mentioned the considerable efforts by JSA constituent organisations that had gone into preparation for the series of regional Public Hearings. 

Dr. Srinath Reddy, convenor of the NHRC Core committee on Health spoke about the need for sustained efforts at all levels to move towards actual realisation of the Right to Health Care. He also recalled the Regional consultation on Public Health and Human Rights organised by NHRC in collaboration with the Union Health Ministry and WHO in 2001, as one previous initiative to raise the issues of health rights. He candidly pointed out that the situation regarding health rights continued to remain a matter of concern, yet expressed optimism that certain concrete outcomes would emerge from the present process of Public Hearings.

Following this, Dr. Ambumani Ramadoss, the Union Health Minister of India, in his inaugural address spoke of the Government's commitment to delivery of better health care. He briefly spoke about various schemes being run by the Government for bringing about improvement in Health Care delivery at all levels. However he also expressed his opinion that increase in population is seen as one of the priority issues for the new National Government. He also spoke about Private-Public Partnership for implementation of National Health Programmes. He appreciated the efforts made by JSA, and accepted in principle the range of recommendations outlined by NHRC and JSA, to operationalise the Right to Health Care.

Justice Anand, Chairperson, National Human Rights Commission, in his concluding speech spoke about the importance of recognizing the Right to health care as a Fundamental Right. He pointed out how the NHRC has taken up the issue of Health rights as a key issue on its agenda, and appreciated the contribution of JSA in raising this issue. He expressed the expectation that Dr. Ramadoss, as a doctor and environmental activist, would take energetic steps to improve the health care situation in the country.  

On behalf of JSA, N.B. Sarojini gave the vote of thanks, thanking the various Union and State Government officials, NHRC office bearers and JSA representatives who were contributing to making the hearing a success.

B. Regional sessions and session on Urban health care
On the first day of the National Hearing, from the morning session onwards, JSA regional representatives presented reports on key areas of the health rights violation in their respective regions, in two parallel groups. These presentations drew upon the information collected for the previous regional hearings, yet also outlined developments that had taken place after the regional hearings in various states.

In the parallel sessions in Group A, JSA presentations related to Western, Southern and Eastern regions were made by Abhay Shukla, Navin Thomas and T. Sundararaman respectively. This was supplemented by presentations from some of the state JSA convenors. Justice Shri Y. Bhaskar Rao, Member NHRC chaired this session, which was co-chaired by Dr. Ekbal from JSA. In Group B, Amit Sengupta and Tapan Sarma made the JSA presentations for Northern and North-eastern region respectively. Shri P.C. Sharma, Member NHRC chaired this session.

After various regional JSA presentations, participant state health officials, mostly Director of Health Services or Health Secretaries from various states, briefly responded to the issues raised related to their state. In some cases, this was followed by state JSA representatives making strong rejoinders, pointing out the continued violation of health rights in certain states, and even recent measures that had worsened health rights violations. In many instances, the NHRC chairpersons and core committee members strongly endorsed the issues raised by JSA representatives, and called upon the state government officials to take urgent steps to remedy the situation pointed out by JSA.

The final session in Group B focussed on Urban Health Care Rights relating to all the regions, in which Ritu Priya gave an overview of the specificities of the urban context, responsible for health rights violations. Sanjay Nagral and Chander made presentations on Urban Health Care Rights issues in Mumbai and Bangalore respectively, based on the 'Jan Sunwais' that had been organised by JSA in both these major cities. C. Sathyamala and Kamala Ganesh made presentations of studies analysing the serious barriers to accessing health care in Delhi faced particularly by the poor, and by women attempting to access obstetric care. Finally, Rajib Dasgupta presented a set of recommendations related to protection and promotion of urban health rights. 

C. Session on Health Policy Issues and Violation of Health Rights at the National level

The final session on the first day of the hearing was a plenary, in which Amit Sengupta, Alpana Sagar and Abhay Shukla from JSA made a presentation on Health Policy Issues and Violation of Health Rights at the National level. In this presentation, major national policy issues with a bearing on health rights violations, especially the National Health Policy 2002, which has reneged from the previous commitment to Universal access to comprehensive health care, were critically analysed. The failure of the Indian government to live up to its commitments made with respect to relevant sections of international covenants such as CESCR (General Comment 14) and CRC, which mandate the Right to Health for Indian citizens, was also pointed out. Justice Shri Y.Bhaskar Rao Honorable Member NHRC chaired this session and gave his concluding comments on this issue.

D. Sessions on key areas of health rights violations

On the morning of Day two of the hearing, in two parallel groups, eight key areas of health rights violations were discussed. Detailed background papers on all these key issues had been drafted and circulated by JSA resource persons, beforehand. On behalf of JSA, Vandana Prasad and Amitava Guha were rapporteurs respectively for Group A and Group B. 

In Group A the following key health rights issues were discussed -

a)      Women's  Right to Health Care: Smt. Reva Nayyar, Secretary, Women and Child Development chaired this session. 

Manisha Gupte, N.B Sarojini, Sudha Sundararaman and Anuj K made presentations on this issue on behalf of JSA, pointing out the range of violations of women's health rights in India. Manisha Gupte made a presentation on the various State obligations with respect to the right to health care especially relating to women, dealing with how it has been understood in international treaties. Other presentations touched upon the implications of the two-child norm and state population policies as they impacted on women, and inadequacies in the Reproductive and Child Health (RCH) programme. While stressing the need to ensure access to health care services for women, issues of gender based violence and discrimination against women in the field of health care were also highlighted. 

b)      Children's Right to Health Care: Shri. S.S. Brar, Joint Secretary (RCH) Department of Family Welfare chaired this session. On behalf of JSA, Vandana Prasad, Arun Gupta and Devika Singh made presentations on this issue. In their presentations, they effectively touched upon key child health related services requiring substantial action: antenatal care, maternity benefits, special care for under-three children, universalisation and improvement in ICDS and quality school health services. Other issues included the need for convergence between efforts by the Women and Child Development department and the RCH programme; the need for CHW schemes to especially address health of under-three children through home-based interventions, and special interventions to reduce neonatal mortality. Recommendations for immediate action included the need for a comprehensive Child Rights Code and to include a section on Children's health in the National health policy. 

c)      Mental Health Rights

Shri Chaman Lal, Special Rapporteur, NHRC chaired this session. Shri Naidu and Ashish Gupta from JSA made a presentation on the violation of health rights in case of persons with Mental Health problems. This presentation was a compilation of issues related to people with mental illness in India, including gender issues, lack of family support, stigma, discrimination and physical and mental abuse. The paucity of mental health professionals, lack of essential mental health care medications, They gave concrete recommendations for action, ranging from Mental health law reforms, budgetary and legal measures to a social monitoring system. 

d)      Health Rights in situations of conflict and displacement 

Dr. P.K. Dave from the NHRC Expert Group on Emergency Medical Care co-chaired this session. On behalf of JSA, Renu Khanna made a presentation on Health Rights in conflict situations, citing various examples of denial of essential health care in the context of conflict as witnessed during the Gujarat communal carnage. Sahba Husain made a presentation  on the current situation in Kashmir, tracing the human cost of conflict over the years, and the trauma and its social, economic and health implications, particularly for the most vulnerable groups: children, women and youth. Yogini Khanolkar made a presentation on Health Rights violations in situations of displacement, exemplified by the mass displacement witnessed in the Narmada valley.        

In Group B the following presentations were made:
a)      Right to essential drugs

Shri. V.K. Arora, Additional Director General of Health Services chaired this session.

Anant Phadke from JSA made a presentation on this subject, discussing the lack of access to essential drugs as a serious health rights violation and the lack of effective price control on essential drugs leading to irrationally high prices of these drugs. Continued sale of hazardous contraceptives, irrational Fixed Drug Combinations and sale of substandard drugs due to inadequate regulation were other issues raised. The presentation concluded with a critique of the manner in which India is becoming TRIPS compliant, with introduction of product patents and other provisions, which would substantially push up the prices of essential drugs in the coming period.

b)      Health Rights in the context of the Private medical sector

This session was also chaired by Shri. V.K. Arora. On behalf of JSA, Imrana Qadeer made a presentation on this issue, pointing out the range of violations being made by the unregulated private medical sector, which functions with the sole motive of making profits. Lack of quality and rationality of services is often combined with high costs. The manner in which this sector is utilizing large-scale public subsidies, but not actually providing stipulated services to poorer patients came under special scrutiny, with the demand for a national enquiry into all hospitals that have availed of public subsidies and are expected to provide services to the poor.

c) Health rights in the context of HIV-AIDS

This session was chaired by Additional Secretary and Project Director NACO Dr. S.Y. Qureshi and Co-chaired by Dr. N.H. Antia, Chairperson NHRC core group on health.  

Joe Verghese, Anand Grover and Meena Sheshu made presentations related to this issue on behalf of JSA. They touched upon five important areas where violation of Human Rights in the context of HIV infection and AIDS, has been reported in the Health Sector:  access to comprehensive care for PLHAs through the Public health system; Health rights in the context of Prevention of Parent to Child Transmission; Consent and counseling issues related to testing/screening for HIV; Stigma and Discrimination in Health Care settings, and Confidentiality issues. They presented a series of recommendations relating to these areas.

d) Occupational and Environmental Health Rights  

This session was also chaired by Dr. SY Qureshi. 

Madhumita Datta made a presentation on this issue on behalf of JSA.  In her presentation she outlined the range of modern environmental hazards and their health effects, exemplified by the continuing tragedy of Bhopal. She pointed out that ambient environmental conditions have emerged as a significant health risk in urban as well as the rural areas, giving the example of various industrial estates. These environmental hazards are closely related to the occupational health risks faced by workers engaged in hazardous occupations.

These two parallel group sessions were followed by a plenary presentation, in which the key health rights issues emerging from all the parallel sessions were presented by JSA Rapporteurs. This session was chaired by Shri. S.S Brar, Joint Secretary (RCH).

E. Concluding session of the hearing - 'Towards a National Action Plan to Establish, Fulfill and Monitor the Right to Health Care'. 

At the commencement of this session on the afternoon of Day 2, a JSA representative read out a statement specially sent by Prof. Paul Hunt, United Nations Special Rapporteur on the Right to Health. In his statement Paul Hunt congratulated NHRC and JSA for organizing the series of Public Hearings, and encouraged all the participants involved in this process to work to ensure that permanent mechanisms of monitoring and accountability are in place, to support the sustained and continuous protection and promotion of the Right to Health in India.   

This was followed by a brief presentation by Abhay Shukla on behalf of JSA, outlining the likely range of civil society actions in the coming period to establish the Right to Health Care, ranging from surveys and documentation of cases of denial, to monitoring, dialogue and social mobilization. He pointed out the broad inclusive nature of the JSA coalition with the participation of 18 national networks encompassing several hundred organisations across the country.

The highlight of the concluding session was the presentation of a National Action Plan to Operationalise the Right to Heath Care, prepared jointly by NHRC and JSA. This National Action Plan was jointly presented by Y.S.R. Murthy on behalf of NHRC and T. Sundararaman on behalf of JSA. The broader objectives of this National Action Plan were explained as explicit recognition, delineation of content, legal enshrinement, effective operationalisation including adequate resource allocations, and multi-level monitoring with civil society involvement, related to the Right to Health Care. A specific list of the recommendations was given to the Union Government and Union Health Ministry, including enacting of a National Public Health Services Act enshrining health rights of all citizens concerning the public health system, a Clinical Establishments Regulation Act related to the private medical sector, a Health Services Regulatory Authority, enhancement of the Health budget to reach 3% of the GDP and a National Health Services Monitoring Committee with civil society participation. Corresponding and parallel recommendations were made to State Governments, including a range of pro-people health sector reform measures to be carried out at the state level. Certain recommendations were also given to the National Human Rights Commission, State Human Rights Commissions, Jan Swasthya Abhiyan and Civil Society Organisations.

Followed by the presentation on the National Action Plan, Shri. P. Hota, Secretary, Union Ministry for Health and Family Welfare gave his response. While congratulating NHRC and JSA for organizing the Public Hearing, he stated that he agreed with all the recommendations given in the National Action Plan. At the same time he cautioned about the capacity of local bodies to utilise funds effectively, and talked about need to involve professional bodies in this process. He expressed willingness to interact with JSA and civil society organisations, in the effort to improve health services in the future. 

Justice Anand, Chairperson, NHRC gave the concluding remarks of the session. During his speech he read out a number of recent press headlines highlighting widespread denial of health rights and the deficient state of health services. He recounted the case of Hakim Sheikh, who had been denied health care by seven successive public hospitals, providing the basis for the Supreme Court to give a landmark judgment on the Right to timely health care being integrally linked to the fundamental Right to Life. He appreciated the role of JSA in raising the crucial issue of Right to health care, and clearly stated the need to make Health care a Fundamental right in the Indian Constitution.

Finally, Shri Y.S.R. Murthy gave the vote of thanks on the behalf of the NHRC. 

The National hearing was followed by a Press conference addressed by Justice Anand, Chairperson of NHRC and B. Ekbal, Amit Sengupta and Abhay Shukla on behalf of JSA.

Certain aspects of this unprecedented National Public hearing were worth noting. Firstly, the range of presentations by JSA delegates on a wide spectrum of issues relating to health rights, were technically very sound in their analyses and took a well argued, unambiguous stand in favour of public health. On the other hand, the responses from public health officials, including the senior most ones, seemed defensive and at times digressive, while reflecting a more circumspect view regarding the central role of the public health system which they themselves were called upon to represent. Secondly, the information and arguments put forth regarding denial of health care were quite convincing, as evidenced by the strong and clear endorsement of JSA positions made on repeated occasions during the hearing, by practically all the NHRC office bearers. Thirdly, the comprehensive National Action Plan adopted by the NHRC reflected practically all the major suggestions given by JSA, and may be considered a significant milestone in form of broad endorsement of the 'PHM approach' by the major official human rights body of the country. And finally, the scale of national coordination, spectrum of intellectual inputs, and shared consensus while encompassing a range of perspectives, exhibited by Jan Swasthya Abhiyan (PHM-India) during the hearing reflected its collective capacity to represent the voice of the Indian people on a vital concern: that health and health care be realised as human rights.

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