National Inquiry on Health Rights Series of Public Hearings - Regional and National

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National Inquiry on Health Rights Series of
Public Hearings - Regional and National

• To be organised by
• Jan Swasthya Abhiyan (JSA)
• in collaboration with
• National Human Rights Commission (NHRC)

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Why should WE organise a SERIES OF PUBLIC
HEARINGS on Health rights in 2015-16?
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Why did Health rights actions and Health Rights
campaign emerge in 2000s?

• Serious deterioration in public health services
  and stagnant or declining public health budgets
  since mid 1990s
• Sharp rise in costs of unregulated private
  medical care

• Growing popular resistance to negative effects
  of neoliberal globalisation - privatisation

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Formation of Jan Swasthya Abhiyan in 2000
2000 health activists from 19 states across India
organised a National health assembly to launch
the peoples health movement.
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Looking back for thinking forwardCollaboration
between NHRC and JSA for series of Public
hearings on Health rights in 2004

• NHRC collaborated with Jan Swasthya Abhiyan to
  conduct a series of Public hearings on Health
  rights, as a national inquiry process in year
  2004. Presenting Health as a classical
  social-economic right which can become
  justiciable
• Failure of state to provide health care
  presented not just as weakness of implementation,
  but as Human rights violations
• NHRC hearings on Health rights attracted large
  scale public support and popular participation,
  media coverage

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Political context of Health movement over last
one and half decades
NDA 2 2014 - ???
NHRC JSA Hearings II
UPA 2 2009-2014
UPA 1 2004-2009
NDA 1 1999-2004
NHRC JSA Hearings I
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A decade later (2005-2015) . What is the
situation?

• Some strengthening of Public health services with
  NRHM - but now under threat due to recent budget
  cuts
• Healthcare has increasingly become a commodity,
• Healthcare a massive, unregulated Industry !

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Two contending logics in the Health sector
Profit logic
Rights based logic
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Why include the Private Medical Sector in a Human
rights based inquiry?

• The Human rights rationale Patients
  rights are Human rights state obligation to
  protect
• ii. The Market failure rationale Realisation of
  Rights requires Regulation
• iii. The Health systems rationale Public health
  services are constrained due to unregulated
  Private medical sector major public subsidies to
  private sector
• iv. The Ethical imperative ethical duties of
  doctors translate into basic rights of patients

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Need for Health rights approach to activate
Medical councils

• Medical Council of India (MCI) and State Medical
  Councils (SMCs) have legal mandate to ensure
  ethical conduct by doctors, including patients
  rights
• However, SMCs have not taken up ethical issues
  seriously and proactively (Maharashtra Medical
  Council 2005-2015 756 complaints, 80 pending,
  only 3 short term punishments)
• There are a few exceptions like Punjab Medical
  Council
• Need to demand expansion, people-oriented
  restructuring and social accountability of
  medical councils

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Need for Health rights approach to activate
Public authorities concerning Private medical
sector

• Public authorities concerned with regulation of
  private hospitals need to address Patients rights
  while operationalising regulation
• Need to demand appropriate Clinical
  establishments acts in various states to ensure
  socially accountable, patient oriented regulation
• Private hospitals receiving significant public
  subsidies and PPPs must be held to account
  similar to publicly supported bodies the logic
  of privatisation needs to be challenged

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Areas of rights violations related to the
private medical sector
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A. Denial of patients rights in the private
medical sector, which have some legal
justification today

•  Denial of Emergency medical care in hospital, on
  the grounds that emergency treatment would be
  started only after payment is made by patient /
  caregivers
• Patient / caregivers not provided basic
  information related to nature of treatment and
  related costs in a private hospital
• Patient is not given records / reports on demand
  during period of hospitalization
• Denial of right to second opinion patient or
  caregivers not allowed to consult another doctor
  / specialist during period of hospitalisation

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• Denial of right to informed consent proper
  information not provided before operation or
  other invasive procedure
• Not respecting patients privacy, or not keeping
  confidential the identity of the patient.
• The dead body of a deceased patient is not handed
  over to the relatives, until the full payment of
  all expenses has been made to the hospital.
  Similarly, newborn baby of a recently delivered
  mother is not handed over to the mother, until
  the full hospital expenses have been paid.
• Patient is coerced into buying medicines from a
  specific medical store in the hospital premises
• Patients rights denied during a clinical trial
  proper informed consent not taken, full
  information about trial not provided, treatment
  for trial side effects not given, insurance
  coverage related to trial not provided etc.
• Patient from economically weaker section denied
  treatment in a Charitable / Trust hospital

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B. Information that needs to be collected from
sources besides patient testimonies

• All doctors are supposed to display their
  professional rates (MCI Code of Ethics), however
  very few doctors do so. This can be documented by
  visiting some clinics / hospitals.
• Doctors are not supposed to take gifts or
  sponsorships from pharmaceutical companies (MCI
  Code of Ethics). They are also not supposed to
  sponsor such products. Naturally, the massive
  amounts that drug companies spend on doctors are
  recovered through charging very high drug prices
  from patients. However information about this
  could be provided by Medical representative
  associations or other internal sources.

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• Doctors are not supposed to give or take
  commissions in any form, in their relationships
  with other doctors (MCI Code of Ethics). Again,
  information on this is difficult to obtain except
  from certain ethical doctors who may have been
  offered but have refused such commissions in the
  past.
• Doctors are supposed to prescribe medicines by
  generic names as far as possible, which would
  lead to reduction in the cost to patients (MCI
  Code of Ethics). However, as we know, this does
  not happen usually. To document that this is not
  taking place, we could collect say 100
  prescriptions by private doctors, which do not
  mention the generic name of the drug.

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C. Some major problems faced by patients in
private hospitals, which are not included in the
above categories

• Medical negligence leading to bodily damage, and
  in some cases even death of the patient
• Gross over-charging and arbitrary charging of
  patients,
• Irrational and unnecessary procedures including
  medication, investigation, operation or other
  treatment
• It is doubtful if presenting information on
  these areas to NHRC would be followed by any
  specific action from their end, and
• It may not be productive to ask people to present
  testimonies on these areas to NHRC.
• However these issues could be raised in a general
  manner, demanding for CEA

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The movement for health rights and health system
change must be part of the wider struggle for
social change