PHA-Exchange> Food for challenging a conventional thought (3)

[claudio at hcmc.netnam.vn]

Human Rights Reader 159

Exploring a critical, systemic approach to health rights

Summary of a paper by Abhay Shukla * (part 3 of 4)

Health rights of social groups with special health needs 

20. Any system of rights is relevant only if it benefits the most vulnerable 
or deprived. The argument is not for a proliferation of special programmes for 
these groups grafted onto a weak health system, but rather integrating special 
services for them into a strengthened health care system.

21. We are talking here of the  right to health care of women, of children, 
the health rights of HIV-AIDS affected persons, of persons with mental health 
problems, of differently abled persons, of unorganised sector workers, of 
urban deprived communities, and of the health rights of people in conflict 
situations, of people displaced, of migrants, of ethnic minorities.

User fees as a violation of health rights

22. User fees tend to infringe on the health rights of the poor by reducing 
their utilisation of health services; ‘exclusion mechanisms’ (waivers) for the 
poor have long shown they do not work.  Exemption mechanisms do not actually 
benefit the poor, but are often cornered by other locally more powerful 
groups. [The same is true for the so often recommended targeting of 
interventions to the poorest of the poor].
In short, user fees are seen as a regressive form of health care financing. 
Public-private partnerships (PPPs): A significant erosion of health rights
23. Ample evidence exists of the often poor and irrational quality of private 
services. Private practitioners frequently prescribe irrational drugs and 
diagnostic tests. Hence the insistence on an effective public regulation of 
the sector.

24. From a health rights perspective, ‘franchising’ and 
particularly  ‘outsourcing’ of public health care functions, are to definitely 
be considered a regressive step as well. Handing over major functions to the 
private sector may actually be a way of diluting the responsibility of the 
public health system. Any such dilution will have adverse consequences for 
poor people’s health rights. 

25. The challenge before the Health for All movement now is to simultaneously 
present a people’s response/alternative to the large scale health system 
reorganisation, as well as to challenge all privatisation-oriented measures 
while continuing to press for the fulfilment of universal access to health.

26. The right to guaranteed services will only remain on paper if not 
persistently demanded and operationalised. People’s organisations need to 
watch the reorganisation process --supporting its positive aspects while 
critiquing the negative ones and posing alternatives at various levels as 
necessary. For example, drawing on the Indian experience, a People’s Rural 
Health Watch can be conceived of. 

27. In our efforts to reform the system, we have to avoid two extremes 
regarding restructuring measures: Avoid a blanket rejection which might lead 
us into isolated passivity and an inability to influence this process; and 
avoid the danger of cooption and absorption into the dominant health system; 
we have to keep continuously critiquing and exposing its various negative 
aspects.

28. As said, in this struggle for the RTH, we need to target not only the 
local, but also the higher level decision makers. The only way to effectively 
challenge the overall thrust of health policies -- and pressing for the 
substantial strengthening of health care in the public sector while 
confronting the privatization agenda-- is by influencing the central political 
decision-making process. This includes concerted attempts to dialogue with 
political parties. We have to push for key positive changes and block 
retrogressive steps --both of the preceding by appropriately intervening in 
the political space.

29. As also said, along with our critiques, it is a must that we develop and 
present well thought-out alternative plans. Such ‘People’s Health Plans’ could 
be developed over a period of time. They would be a logical and practically 
elaborated sequel to the existing People’s Charter for Health of the People’s 
Health Movement (www.phmovement.org ). 

30. Moving from an initial situation of ‘talking-among-ourselves’ to ‘talking-
to-implementing-officials’ (in the form of direct dialogues and of public 
hearings) will confront us with the need to --from a position of greater power-
- talk to the political decision makers. Moving from a critique of the current 
health system deficiencies to a broad vision of an alternative (in the said 
People’s Health Plan), we will respond to the need of posing comprehensive and 
detailed alternative demands and strategies. Building upon such a more 
democratic focus on the health-system-to-be, will also require that we develop 
parallel effective and practical strategies to address the key social 
determinants of health (i.e., water, food, housing, a safe environment, 
etc.).  
(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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