Objectives for a national action plan
Specific actions under the Action Plan
Abstract
The Indian People’s Health Movement mobilized constituencies in several Indian states to organize public hearings on the Right to Health Care. The Indian Human Rights Commission was then invited to join the process and endorsed the idea of formulating an Indian Action Plan to Operationalize the Right to Health Care. The document was approved in a national assembly and is now being presented to an Indian Parliament hearing. The version presented here has been adapted for use outside the Indian context, but preserves the full spirit of the original document. It is felt this document should be shared widely worldwide as an example to others on how to to organize to come up with similar national plans.
Objectives for a national action plan
(The objectives here under pertain mostly to duty-bearers at different levels, but also to claim-holders)
1. Explicit recognition of the Right-to-Health-Care to be enjoyed by all citizens. (Recognised by all concerned parties, i.e., central and provincial governments, HR commission, civil society, citizenry and all health sector staff.
2. Definition of an Essential-Health-Services-and-Supplies-Package whose timely and full delivery is to be assured as a right at the different levels of the public health system.
3. Definition of the Citizens’-Health-Rights-related-to-the-private-health-sector including a Charter-of-Patients’-Rights.
4. Legal enshrinement of the Right-to-Health-Care by enacting a Health Services Act, that includes Public-Health-Services-Rules and Clinical-Establishment-Regulations to regulate both the public and private health sector.
5. Operationalisation of the Right-to-Health-Care by formulating a broad timetable of activities by central and provincial governments consisting of the essential steps required to ensure availability of and access to quality health services by all citizens (this, necessary to operationalise the Right to Health Care). [This may include a basic set of Health Sector Reform measures indispensable for a universal and equitable access to quality health care, and guidelines regarding the budgetary provisions to be made available for their effective operationalisation].
6. Institutionalistion of mechanisms-for-joint-monitoring at district, provincial and national levels involving Health Departments and civil society representatives and including the specifics on regularity of monitoring activities and of the powers of monitoring committees. [In parallel with this, an institutionalised space needs to be created for regular civil society inputs towards a more consultative planning process; measures taken should also be combined with vigilance mechanisms to take prompt action regarding, for example, illegal charging of patients, unauthorized private practice, corruption relating to drugs and supplies].
7. Enforceable-redressal-mechanisms to be put in place at district, provincial and national levels to address all complaints of denial-of or abuses-in the provision of health care.
Specific actions under the Action Plan
A. Government and Ministry of Health actions (as prime duty- bearers):
A1. Enactment of a National-Public-Health-Services-Act that recognizes and delineates the Health Rights of citizens (claim holders), the duties of the Public health system, the public health obligations of private health care providers (duty bearers) and the specifying broad legal and organisational mechanisms to operationalise these rights. [The Act is to make the actions under this Action Plan mandatory, and is to make more accountable/justiciable the denial of health care. It will also include special sections recognising and legally protecting the health rights of various sectors of the population with special health needs, i.e., women, children, persons affected by HIV-AIDS, persons with mental health problems, disabled persons, persons in conflict situations, persons facing displacement, workers in various hazardous occupations including unorganised and migrant workers].
A2. Definition of packages-of-essential-health-services at different levels (village/dispensary/community health center/district and provincial hospital) to be made public to all citizens as their right.
A3. Substantial increase-in-central-budgetary-provisions-for-public-health [to be increased to 2-3% of the GDP in the next three to four years].
A4. Setting up a Central-Council-on-the-Right-to-Health to develop a consensus among various state agencies and civil society towards operationalising the Right to Health Care across the country.
A5. Enacting a National-Clinical-Establishments-Regulation-Act that ensures citizen’s health rights concerning the private health sector and includes the right to emergency services, as well as ensuring minimum quality of care standards, adherence to standard treatment protocols and ceilings on diagnostic tests and essential health services prices.
A6. Issuing of a Health-Services-and-Drugs-Price-Control-Order, as well as the formulation of a Charter-of-Patients-Rights.
A7. Setting up a Health-Services-Regulatory-Authority that will broadly define and sanction what constitutes rational and ethical practice, as well as set and monitor quality standards and prices of services. [This is not to be a representative body of doctors alone, but is to include representatives of health care providers, public health experts, legal experts, representatives of consumers, health and human rights groups and elected public representatives].
A8. Issuing of National-Operational-Guidelines-on-Essential-Drugs that specify: a) the right of all citizens to access good quality essential drugs at all levels in the public and private health system; b) the promotion of generic drugs over brand name drugs; c) the inclusion of all essential drugs under the Drug Price Control Order; and, d) the elimination of irrational formulations and combinations. [The Government is also to take steps to publish and consolidate a National Drug Formulary based on the morbidity pattern of the people in the country].
A9. Taking measures to integrate-national-health-programmes-with-the-Primary-Health-Care-system in a way that decentralizes planning, decision-making and implementation. [Focus to be shifted from bio-medical and individual-based measures to social-, ecological- and community-based measures that will, among other, include the compulsory health impact assessment of all development projects, as well as a decentralized and effective compulsory surveillance system of notification of prevalent diseases by all health care providers, including private practitioners].
A10. Reversal of all coercive-population-control-measures that violate basic human rights, are not effective in stabilising population, and draw away significant resources and energies of the health system from public health priorities. [Steps to be taken to eliminate and prevent all forms of coercive population control measures which target the most vulnerable and marginalized sectors of society].
A11. Setting up by the Ministry of Health of a-functioning-national-mechanism-of-health-services-monitoring that periodically reviews the implementation of health rights and the respective underlying structural and policy issues responsible for health rights violations. [Health sector civil society organizations to be involved].
A12. Preparation of a National-Accident-Policy with the establishment of appropriate accident and trauma services in all district government and private hospitals.
A13. Taking concrete steps to eliminate-spurious-drugs-and-sub-standard-medical-devices.
A14. Assuring-universal-access-to-mental-health-care.
A15. Enactment of a Public-Health-Protection-Act that defines the norms for nutritional security, drinking water quality, sanitary facilities and other key underlying determinants of health. [Such an act will complement the existing acts regarding environmental protection and working conditions to ensure that citizens enjoy the full range of conditions necessary for the preservation of health, along with the right to access good quality health services].
A16. Instituting a Health-Rights-Redressal-Mechanism at national and provincial level to investigate and take action in a timely manner in cases of denial of health care.
A17. Introduction of a set of Health-Sector-Reform-measures that will ensure the health rights of all through the strengthening of public health systems, and by making private care more accountable and equitable. [The minimum aspects of a Health Sector Reform framework that will strengthen public health systems must be laid down as an essential precondition to securing health rights of all and must include provisions to guarantee free health care to those who cannot afford it].
A18. Taking the necessary steps to effectively-decentralize-health-services-management [both in terms of decision-making and of decentralized budgets].
A19. Ensuring full-availability-of-essential-drugs in the public health system with transparent drug procurement and efficient drug distribution procedures and adequate budgetary outlays. The new drug policy should also promote fair drug prices and their rational use in the private sector. [Copies of the drug formulary and prices will be displayed in all government facilities and (with an approved mark-up) in private health facilities. Regular updating of the formulary should be ensured and mechanisms be set up for users to table complaints].
A20. Development and wide distribution of treatment-protocols-for-common-diseases to health professionals in the public and private sectors.
A21. Adoption of a nationwide-community-health-worker programme with adequate provisioning and support, so as to reach out to the most marginalised rural and urban areas, providing basic primary care and strengthening community level mechanisms for preventive, promotive and curative care.
A22. Adoption of a detailed essential-secondary-care-services-plan that includes emergency care services.
A23. Public-identification/notification-of-medically-underserved-areas together with ad-hoc-plans-to-close-these-gaps in a time bound manner.
A24. Adoption of an integrated-human-resource-development-plan to ensure adequate availability of health humanpower including the most peripheral levels.
A25. Adoption of transparent-non-discriminatory-health-workforce-management-policies, especially on transfers and postings, so that health personnel are fairly treated when working in rural areas, and so that specialists are sent to serve in secondary care facilities according to public interest.
A26. Adoption of improved-vigilance-mechanisms to respond to and limit corruption, negligence and different forms of harassment within both the public and private health systems.
A27. Implementing relevant actions-on-food-and-nutrition-security, nutrition-surveillance, early-childhood-development-and-school-feeding-programmes to address food and nutrition insecurity and malnutrition, which are a major cause of ill-health.
All the above will be taken as a base minimum by provincial governments, and modified to match the specific health situation in each province. To this effect, these governments will also increase their health budget over the next three to four years to levels needed to respect the right to health care of its citizens. Corresponding monitoring mechanisms with civil society involvement will be set up in all districts to monitor rural health services, as well as in towns and cities to monitor urban health services.
B. National Human Rights Commission actions
(If none exists yet, setting one up is in-itself a priority for civil society)
Both as a duty-bearer and as a conduit for claim-holders, the NHRC will:
B1. Oversee the monitoring of health rights at the national level by initiating and facilitating proactive monitoring activities and by appointing Special Rapporteurs on Health Rights in each province.
B2. Review all laws/statutes relating to public health from a human rights perspective to make appropriate recommendations for the Government to make commensurate, human rights-compliant amendments.
B3. Oversee the implementation of redressal measures being implemented in a timely manner.
C. Civil society organizations actions
(Mostly as a conduit of claim-holders)
C1. Work for the widest possible awareness-raising on health rights as set out in this Action Plan and work on an empowering ‘health rights literacy’ with all sectors of health rights claim holders of the country – especially the currently more marginalized.
C2. Act as a watchdog on the progressive implementation of the elements of this Action Plan and denounce all procrastination by the respective duty bearers in this respect.
Abhay Shukla and Claudio Schuftan
abhayshukla1@gmail.com
schuftan@gmail.com
(*): Adapted from the National Public Hearing on the Right to Health Care organised by the National Human Rights Commission & JSA (People’s Health Movement, India) in New Delhi, 16-17 December 2004.