Healthcare as a right

May 09, 2019

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BY initiating a debate on the recognition of citizens’ right to health, the National Commission on Human Rights (NCHR) has rendered an invaluable service to the state and the people of Pakistan.

The low priority accorded to health in the country’s basic law has been assailed in public debates for decades. The Constitution refers to health in a most limited sense. Medical relief is the last facility (after food, clothing, housing and education) mentioned in Article 38 under the unenforceable ‘Principles of Policy’, to be provided only to those citizens who cannot earn their livelihood on account of infirmity, sickness or unemployment.

Hence, people’s right to health has been considered much too radical an idea to be broached seriously. However, after the transfer of the right to education from ‘Principles of Policy’ to ‘Fundamental Rights’ and ratification of the International Covenant on Economic, Social and Cultural Rights, activists believe they can start calling for healthcare as a right.

The low priority accorded to health in the country’s basic law has been assailed in public debates for decades.

The NCHR presented its case by releasing its report Right to Health in Pakistan in Karachi last week. Prepared by the Sindh office of the NCHR after three years of research and consultation in partnership with the Pakistan Association for Mental Health and the Aga Khan University, the report discusses Pakistan’s health programme in the context of international efforts to promote the right to health.

After taking note of the social determinants of health in the constitutions of 36 states and surveying the situation in Pakistan, the report makes many recommendations that merit the urgent attention of the government.

The state has been asked:

• to include in the Constitution the WHO “definition of health as physical, mental and social well-being and not merely the absence of disease and infirmity”;

• to recognise health as the right of all citizens without any discrimination;

• to provide free/affordable health services for all citizens;

• to create an authority for regularly reviewing enforcement of the right to health;

• to allocate at least five per cent of GDP or GNP for health;

• to eliminate social injustice and violence.

The report proposes the insertion of Article 9-A in the fundamental rights chapter of the Constitution in the following form:

Article 9-A. Right to Health

a) The state shall guarantee every citizen’s access to the basic necessities of life, including food, clothing, housing, clean environment and quality healthcare.

b) Every citizen shall have the right to the highest attainable standard of physical and mental health.

c) The state shall by law extend to non-nationals the rights under (a) and (b) to the extent possible.

The study also recommends that the health system of Pakistan shall:

• monitor reduction in inequalities between the affluent and indigent sections of society.

• ensure access to quality care according to WHO standards, diagnosis and treatment services of international standards, maintain special focus on sexual and reproductive health, rehabilitation of the disabled, and violence against women and girls.

As for public health, the report recommends designing of population-based programmes for disease prevention and health promotion, with special focus on (a) availability of water, food, transport, housing and sanitation; (b) prevention of violence and traffic injuries; (c) health education for all; (d) environment, food security and safe water; and (e) hospital waste management.

As regards healthcare financing, the study recommends that the state should guarantee healthcare to all citizens on a need basis and not on their ability to pay; all out-of-pocket expenditures at health facilities should be eliminated. Further, the state must bring healthcare under the Consumer Rights Protection Act to promote accountability of the private sector.

One of the highlights of the report is that it concentrates not only on curative services, but also on the social determinants of health, such as availability of nutritious food, healthy environment, and freedom from violence, servitude and fear.

The authors of the report, led by the widely respected social activist Kausar S. Khan, admit that their work is “perhaps a bit ambitious as it embraces various elements into one fold”, but a study on health issues in the broadest possible context was certainly overdue. The authors are right in conceding “that though this may be the first-ever report on the right to health in Pakistan, it is definitely not a definitive report. It should be taken as a commencement of our concern for the right to health”.

Although the study does take notice of the prime minister’s programme there is need to consider whether the Sehat Insaf card scheme enforced in Khyber Pakhtunkhwa (and now being introduced in Punjab), apparently one of the good initiatives of the PTI leadership, could lead to the creation of a national health cover.

What this scheme, a kind of health insurance, does is that it relieves patients, who are already receiving medical relief at major public hospitals, of the burden of out-of-pocket payments. But these hospitals are unable to cope with the pressure of patients, and the lack of adequately trained support staff has created crises at several hospitals. The situation could be eased by opening dispensaries in cities and towns under local governments. Further, the national health cover could be expanded by extending the social security system to all employees in both the public and private sectors.

The report offers health planners, researchers, media persons and concerned citizens a rich stock of information about what Pakistan and the world has been doing about the right to health for 70 years. The efforts include WHO campaigns, UN treaties, the Constitution, health-related laws and policies in Pakistan, mental health in Pakistan, healthcare financing, social security and pension systems in the country, the Prime Minister’s National Health Scheme, the Pakistan Medical Association’s position, and various political parties’ pledges related to health. This information should be valid for many years.

Published in Dawn, May 9th, 2019