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[afro-nets] Food for challenging a conventional thought (2)

  • From: "Claudio Schuftan" <claudio@hcmc.netnam.vn>
  • Date: Mon, 23 Apr 2007 01:16:46 +0700

Food for challenging a conventional thought (2)

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
? 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 fulfillment 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].

Claudio Schuftan, Ho Chi Minh City
*: 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.