PHA-Exchange> Sri Lankan People's Charter for Health

[Claudio]

 Greetings from Colombo.  At the request of the People's Movement for Rights
of Patients, I prepared a draft "Sri Lankan People's Charter for Health".
This is appended below. Can the network partners send their  views and
comments to me to help us finalize the draft?
> Bala

> Dr K Balasubramaniam
> Advisor and Coordinator
> Health Action International Asia - Pacific
> E-mail: bala at haiap.org

Sri Lankan Peoples' Health Charter

Dr K Balasubramaniam



Preamble



  a.. One of the most fundamental human rights is the assumption that each
person matters and everyone deserves to be treated with dignity.  This is
the tenet from which all other human rights follow.  Another is that those
who are most vulnerable deserve special protection.
  b.. The recognition of the inherent dignity and equal and inalienable
rights of every citizen is the foundation of freedom, justice and peace in
Sri Lanka.
  c.. Emergence of Sri Lanka as a country in which all its citizens shall
enjoy freedom of speech and freedom from fear and want is the highest
aspiration of the common people.
  d.. Sri Lankans reaffirm their faith in fundamental human rights, in the
dignity and worth of the human person and in equal rights for men and women.
They are determined to promote social progress and better standards of life
in larger freedom.
  e.. Health, a fundamental right, is a social, political and economic
issue.
  f.. While Health is a fundamental human right indispensable for the
exercise of all other rights, health and ill-health are themselves the
outcome of social, economic and political influences.  Without sustained
improvements in socio-economic conditions and consequent improvements in
standards of living, optimum health for all is unlikely to be achieved and
maintained.
  g.. Inequality, poverty, exploitation, violence and injustice are at the
root of ill health.
  h.. Every one has the right of access to preventive healthcare and the
right to benefit from medical treatment under the conditions established by
national laws and practices.
  i.. Every one has the right to a standard of living adequate for the well
being of himself/herself and of his/her family, including food, clothing,
housing, medical care, necessary social services and the right to social
security in the event of unemployment, sickness, disability, widowhood, old
age or other lack of livelihood in circumstances beyond his/her control.
  j.. The right to health embraces a wide range of socio-economic factors
that promote conditions in which people can lead a healthy life and extends
to the underlying determinants of health including food and nutrition
housing, access to safe and potable water and adequate sanitation, safe and
healthy working conditions, and a healthy environment.
  k.. Poverty is the deadliest disease
  l.. Hunger is the commonest cause of death
  m.. These clearly demonstrate that the Ministry of Health and the
Department of Health Services alone cannot ensure the right to health, but
points to the non-exhaustive examples of the obligations of other government
Ministries and Departments.
  a.. The right to health in all its forms and at all levels described above
contains the following interrelated and essential elements.


  1.. Availability
Well functioning public health and healthcare facilities, goods and services
as well as programmes have to be available in sufficient quantities within
the government institutions.





  2.. Accessibility


Health facilities, goods and services have to be accessible to every one
without discrimination.  Accessibility has four overlapping dimensions.



i.                     Non-discrimination

Health facilities, goods and services must be accessible to all, especially
the most vulnerable or marginalized sections of the population.

ii.                   Physical accessibility

Health facilities, goods and services must be within safe physical reach of
all sections of the population, especially the vulnerable or marginalized
groups.

iii.                  Acceptability

All health facilities, goods and services must be respectful of medical
ethics and culturally appropriate.

iv.                 Quality

Health facilities, goods and services must be scientifically and medically
appropriate and of good quality.

·        People have the right and duty to participate individually and
collectively in planning and implementation of healthcare.



The roll of the State



·        The state has the responsibility for the health of its entire
people.  This can be fulfilled only by provision of appropriate and adequate
health and social measures.

·        Health for all Sri Lankans can be achieved only when the right to
health is protected by the laws of the country and enshrined in the
constitution.

·        The realization of the right to health can be achieved by
formulation and implementation of national health policies based on the
concepts of Primary Health Care as outlined in the Alma Ata Declaration on
Primary Health Care as the key to Health for All.  Sri Lanka, along with
other Members States of the World Health Organization, adopted the Alma Ata
Declaration at the International Conference on Primary Health Care in
September 1978.  This conference reaffirmed that health was a fundamental
human right.  The WHO member states, including Sri Lanka, gave a solemn
promise to the world community that they would introduce national health
policies based on Primary Health Care in their respective countries.

·        The constraints faced by the government due to the limits of
available resources is acknowledged.  However, there are minimum core
obligations of the government.  These include at least the following:



a.                   Ensure the right of access to health facilities, goods
and services on a non-discriminatory basis, especially for vulnerable or
marginalized groups;

b.                  Ensure access to the minimum essential food which is
nutritionally adequate and safe, to ensure freedom from hunger to everyone;

c.                   Ensure access to basic shelter, housing and sanitation,
and an adequate supply of safe and potable water;

d.                  Provide essential drugs as, from time to time, defined
under the WHO Action Programme on Essential Drugs;

e.                  Ensure equitable distribution of all health facilities,
goods and services;

f.                     Adopt and implement a national public health strategy
and plan of action, on the basis of epidemiological evidence, addressing the
health concerns of the whole population; the strategy and plan of action
shall be devised, and periodically reviewed, on the basis of a participatory
and transparent process; they shall include methods, such as right to health
indicators and benchmarks, by which progress can be closely monitored and
evaluated; the process by which the strategy and plan of action are devised,
as well as their content, shall give particular attention to all vulnerable
or marginalized groups.

g.                  Ensure reproductive, maternal and child healthcare.

h.                   Provide immunizations against the major infectious
diseases occurring in the community.

i.                     Take measures to prevent, treat and control epidemic
and endemic diseases.

j.                     Provide education and access to information
concerning the main health problems in the community, including methods of
preventing and controlling them.

k.                   Provide appropriate training for health personnel
including education on health and human rights.



Finally, the obligation of the State to fulfill the various requirements for
the Right to Health of all obliges the State to enshrine the Right to Health
in the constitution and adopt appropriate legislative, administrative,
budgetary and judicial measures towards the full realization of the right to
health.