PHA-Exchange> Food for challenging a conventional thought (2)

[claudio at hcmc.netnam.vn]

Human Rights reader 158


Exploring a critical, systemic approach to health rights
Summary of a paper by Abhay Shukla * (part 2 of 4)

The issue of prime mover on health rights 

Health which concerns ‘everybody’, might be in the danger of being the 
particular concern of ‘nobody’.

12. Unlike many other issues (like workers rights, women’s rights, rights of 
indigenous people), there is no single ‘core constituency’ for health rights. 
Patients are usually unable to take-on the role of championing health care 
rights single-handedly. HR is really an `OFF and ON' priority for people --
which is OFF much of the time. 

13. [Due to the hierarchical conception of how patients should relate to them, 
doctors and other caregivers would be shocked if patients began demanding 
rights in an assertive manner and asked questions of them as equals. Hence 
they are also often not suited to be the prime movers for health rights]. 
So, who can be the prime movers for health rights?
14. Both patients and doctors/caregivers have limitations; the latter, if 
nothing else, because they benefit economically from the present set-up. The 
question then is: Who can lead the struggle for health rights? 
15. The most plausible answer is: a broad coalition will be required to carry 
forward the struggle for the right to health. 

16. The following key constituencies, it is purported, will have to join 
together:
•	mass organisations of the socially, economically, or politically 
disadvantaged,
•	individual professionals working in the health sector (even if a 
minority), 
•	health sector NGOs, 
•	associations or groups of health professionals, and 
•	other groups, such as consumer organisations, development 
organisations, peoples’ science groups, environmental groups, women’s 
organisations. 

17. Basically, both the sufferers and the everyday witnesses of the denial of 
needed health care will have to accrue the necessary social power to make 
access to health care a political issue and to bring about the changes 
required for the fulfilment of the RTH.

18. The contents of the right to health care – some basic elements to start 
with
i. Right to a set of basic public health services
•	Adequate physical infrastructure,
•	adequate skilled humanpower, 
•	availability of all basic medications and medical supplies, and 
•	availability of the complete range of specific PHC services.

In short, the movement to establish the right to health care aims to 
substantially strengthen, reorient and make accountable the public health 
system.
ii. Right to monitoring and accountability mechanisms
•	A people's monitoring system of public health services, 
•	community monitoring of health services with regular public hearings, 
and 
•	formal redressal mechanisms. 
iii. Right to patient information and redressal in both the public and the 
private sectors
•	Treatment- and diagnosis-related information must be made available to 
every patient, 
•	likely risks of the different treatments to be publicly displayed, and
•	information about available complaint mechanisms to be part of the 
information given.
iv. Right to minimum standards and emergency medical care in both the public 
and the private sectors
•	Clear norms for universal emergency care need to be laid down 
including this type of care in the private health sector, and
•	mandate minimum standards for various types of health care 
establishments both in the public and in the private sector. 
v. Right to essential drugs 
•	Availability of all basic medications free of cost,
•	a National Essential Drugs Policy ensuring the production and 
availability of an entire range of essential drugs at affordable prices

19. Further possible contents of the right to health care 
•	Recognition of certain guaranteed health services as an actual 
entitlement of all citizens.  
[We cannot proceed with the right to health care argument beyond a point 
without addressing the task of restructuring, strengthening and reorienting 
the entire health system including both public and private health services so 
as to ensure universal access to appropriate, quality health care as an 
entitlement]. 
•	Making health care a fundamental right at the constitutional level. 
•	Universal social health insurance (to be considered in the larger 
context). 
•	Consumer monitoring of quality and of access to services. 
•	Significantly higher public expenditure on health services (starting 
with about 3% of the GDP directed towards public health care, then 
progressively raised to a level of 5% combined with changed budgetary 
priorities and higher overall allocation for the public health sector). 
[Strong and sustained pressure from various sections of civil society is 
needed for this to become a reality].   
(contd).

Claudio Schuftan, Ho Chi Minh City
claudio at hcmc.netnam.vn 
________________________________
*: Adapted from Abhay Shukla’s “A compiled review of the rights approach to 
health and health care”, submitted for publication to ‘Beyond the Circle’, 
India, 2007. This summary includes adaptations of certain quotations from 
other authors, references for which can be found in the full article.




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