National Public Hearing on Right to Health Care
Organised by NHRC and People’s Health Movement (JSA),
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 (JSA), 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 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.
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.
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.
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 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.
Statement by Paul Hunt, UN Special Rapporteur on the Right
to Health