'Right to Health Care: Moving from Idea to Reality', was a two-day seminar at the Asian Social Forum, Hyderabad arranged by CEHAT (Centre for Enquiry into Health and Allied Themes) in partnership with the National Centre for Advocacy Studies, Pune and the Global Health Council, U.S.A. The seminar took place under the larger theme of 'Social Infrastructure, Planning and Cooperation'. It was a part of the series of events arranged under the aegis of the Jan Swasthya Abhiyan. The Jan Swasthya Abhiyan is a national level platform of health and social organizations working on health issues with a rights based approach. The seminar took the opportunity to emphasise that access to quality health care is not only a human need, a right of citizenship and a public good, but it is also a pre-requisite to good health, which is essential to achieve and enjoy fruits of equitable development. While the 'Right to Health' would be the ultimate aim, the Right to Health Care could be a first step, a tangible and feasible demand. Making this right functional in the existing Legal and Constitutional framework, looking at International Experiences regarding Universal Access to Health Care, working out an Operational and Financial framework required to realize it and last but certainly not the least, Campaign Strategies that need to be adopted - were the topics around which presentations and discussions at the seminar were centered. The seminar was attended by about 200 participants.

The Asian Social Forum- The Asian Social Forum was convened in Hyderabad from 2^nd to 7^th January 2003. This forum was a prelude to the World Social Forum, which took place in Brazil in late January. The Forum was a response of the growing international movement critiquing the neo-liberal economic policies and capitalist globalisation being imposed on most countries. It was convened in expression of the WSF principle of offering space for free discourse, debate, interaction in the process of mutual learning, informed debate, and participatory formulation of alternative models with the worth and viability to address the challenges of development with justice. About 10,000 people attended the Forum and gave the slogan 'Another World is Possible!' The 'Right to Health Care Seminar' and the various events organized by the Jan Swasthya Abhiyan re-iterated that 'Health For All too is possible'.

The necessity to demand the Right to Health Care- Dr. Abhay Shukla, Co-ordinator, SATHI Cell, CEHAT facilitated the seminar. He spoke of the dismal health scenario in India which makes articulating the right to health care a necessity. India is known to have poor health indicators in the global context, even in comparison with many other developing countries. The per capita public health expenditure in India is abysmally low at Rs. 21 per person, among the lowest in the world. For the vast majority, the key barriers to good health are not the lack of technology but poverty and health system inequity. He stated that the objective of this seminar was to serve as platform for academics and activists, to come together and plan a strategy to realize universal availability of basic health care.

Legal and Constitutional Framework for the Right to Health Care -The theme on the first day of the seminar was 'Legal and Constitutional Framework for the Right to Health Care and relevant International Experiences'. The presenters who talked on the legal aspects were Jean Dreze (Professor of Economics, Delhi School of Economics), Colin Gonsalves (Advocate, Supreme Court and India Centre for Human Rights and Law), John Samuel (Director, National Centre for Advocacy studies) and Brian Lobo (Advocate and activist of a people's organization, Kashtakari Sanghatana).

It was reiterated that even without any specific amendments, the case for basic health care to be provided to all citizens as their right is strong. The 'Right to Life' (Article 21) enshrined in the constitution, as well as the directive principles regarding Nutrition, Standard of living and Health (Article 47), and various Supreme Court Judgments in favour of emergency and occupational health care, illustrate this. The 93^rd amendment in the constitution accepting Education as a fundamental right, has strengthened the case of basic social services to be accepted as people's right. The International Covenant on Economic, Social and Cultural Rights, in its Article 12 clearly recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and creation of conditions which would assure to all medical service and medical attention in the event of sickness. The Alma Ata declaration of 'Health for all by 2000' signed in 1978 is yet another declaration which the government endorses. Even so, it was agreed that adequate financial allocation, political will, awareness of this right among people and strong political mobilization will be required to realize this right.

Apart from this the possibility of conducting a study like the PROBE study, which had an important part to play in Education being declared a fundamental right, on the availability and utilization of basic health care services at the grass roots level, was discussed. Dr. Shrinath Reddy, National Human Rights Commission (Health Committee) and Professor of Cardiology, AIIMS, New Delhi spoke on the next day about the active role of the health committee in NHRC to uphold the citizen's right to health care. Some other novel experiences at the village level like the communitisation of law in Nagaland, where the village health committees control the making of health plans as well as their functioning and financing, and village level monitoring of health care services in Dahanu taluka of Thane district were also related. It was stressed that “Rights are toothless wonders without support of law or finance”. Therefore the 'Right to Health Care' should be accompanied by the Right to Information, Right to Participation and Right to Monitor. There is need for strong political mobilization to ensure the implementation of these rights.

International Experiences- Sadhana Hall (Director, Global Partnerships Department, Global Health Council, USA) and Dr. A.H.M. Nouman (Chairperson, PHM Bangladesh Circle) spoke about international experiences in providing Universal Access to Basic Health Care.

Experiences in four countries- Costa Rica, Canada, South Africa and Bangladesh were shared. Costa Rica and South Africa both spend upto 9% of their GDP on health care, in spite of not being rich countries. Costa Rica has the best health outcomes of any country in Latin America. South African health care system faces the formidable challenge of the HIV-AIDS epidemic, with almost one in nine persons affected by year 2000. Given the short time span, which South Africa had in which to develop the National Health System, it had done good progress. On the other hand the much-acclaimed Canadian Health System, is facing skyrocketing costs and plummeting satisfaction levels. Canada has been advised, not to regress from the accomplishments of the Medicare system toward a hybrid privatized system. For Bangladesh too poverty reduction and Village Health Worker Programs seem to be the most effective tools to improve health and access to health care. India can draw valuable lessons from the experiences of these countries.
        
Operational and Financial Framework- Ravi Duggal (Co-ordinator, CEHAT), Dr. H. Sudarshan (Chairperson, Task Force on Health of Karnataka Government) and Father Sebastian (Director, Catholic Health Association of India) spoke in this session

The core content of the Right to Health Care, Organising and Managing the Universal Healthcare System, Projection of Resource Requirements and Financing the Health Care System through mechanisms such as Social Insurance were discussed. Dr. H. Sudarshan spoke about his experiences as the chairperson of the Task Force on Health of Karnataka Government. The task force has demonstrated that Health Sector Reforms can take place if necessary political will is present. Corruption in the health sector has been identified as the greatest obstacle for the availability of services to all in an equitable manner. The task force is currently involved in weeding out corruption. The role of the NGO sector in Health, towards operationalising the Right to Health Care was discussed.

Campaign Strategy, The way ahead- Sarojini (Convenor, Medico Friend Circle, Women's Health Activist and Member of SAMA), Dr. Ravi Narayan (Advisor, Community Health Cell, Bangalore) and Dr. T. Sundararaman (Professor of Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry) have all been active in the People's Health Assembly process and represent the Jan Swasthya Abhiyan. They spoke about the campaign strategies that could be employed to realize universal access to Health Care. Dr. Zafarulla Chaudhary chaired the session.

It transpired that involvement of the communities is the key to success when we look at experiences in other campaigns. Two successful women's health issues which have already received attention are 'Say no to hazardous contraceptives' and 'The Supreme Court case against sex selective abortion'. It was emphasized that making alliances with other movements like the Narmada Bachao Andolan is important because health cannot be segregated from larger development issues.

It was proposed that strengthening the public health system and making it more effective with community basing of health programmes, could be an effective strategy towards gaining the 'Right to Health Care'. There should be a health worker in every village, who will help entitlements of health care services to reach the community. Giving the health worker such a meaning and context will help build a major mobilization of people for this right.

The need for Political Commitment across the political spectrum, Election Manifestoes to carry this programme and Constitutional mandate if the 'Right to Health Care' were to be realized were emphasized.

Dr. Zafarulla Chaudhury concluded the session by reminding the gathering that strong opposition, especially from the medical profession is only to be expected in this process. Our strategy to combat would be to invite them to come with us, failing which the only course of action would be to go against them.

Action Plan for the Future- It is planned to form a group of representatives of organizations and individuals who attended the seminar in order to follow up on the strategy to realize the 'Right to health Care'. Some activities that are tentatively being discussed are- A study to assess the availability and utilization of basic health services at the grass roots level, putting forth viable operational and financial mechanisms to make the right functional, and filing a Public Interest Litigation to bring such a right into reality are among a few activities thought of. Systematic efforts would have to be made to include the issue in the election manifestos and generate political will.