CURTAIN RAISER
NHRC National Conference on Health Care as a Human Right
Dated: 31st October, 2013
Every human being is entitled to enjoyment of the highest attainable standard of health conducive to living a life of dignity. Health does not mean mere absence of disease but physical, mental, psychological and emotional well-being of an individual. This right is indispensable for the exercise of other human rights. It is the duty of the State to promote, protect and preserve the health of all individuals and also ensure the sustenance of human entitlements, such as nutrition, freedom from want and food security among others. The Constitution of India upholds 'right to health' as a Fundamental Right under Article 21. Article 47 of the Constitution further places a duty on the State to raise the level of nutrition and the standard of living and to improve public health.
2. The human right to health is recognized in Article 25 of the Universal Declaration of Human Rights (UDHR) and in numerous other international instruments. Prime among them being the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) , the 1965 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) , the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the 1989 Convention on the Rights of the Child (CRC) .
3. India has undertaken several measures to promote human rights based approach with regard to health and nutrition in its Five Year Plans, policies and programmes. Notable among them is the Integrated Child Development Services Scheme (ICDS), the Mid Day Meal Scheme (MDMS) and the expansive network of Sub-Centres, Primary Health Care Centres and Community Health Care Centres across the country. However, despite adopting a multi-pronged approach towards strengthening availability, affordability and accessibility to health care services, several challenges continue to remain. Availability of skilled human resources in terms of Doctors, Nurses and Auxiliary Nurse and Midwifes (ANMs) remains a key constraint. Rural and Tribal areas are very poorly served. Against the global average of 14.2, the physician density of India per 10,000 population stands poorly at 6.5. India's nursing and midwifery density of 10 per 10,000 population is not even half the global average of 28.1. The worst indicator of health care in India comes with the density of hospital beds per 10,000 population which stands at 9 against the global average of 30. The doctor-population ratio in rural areas is 3:10,000, while it is 13:10,000 in urban areas. Besides, just 26 per cent Doctors work in rural areas, serving 72 per cent of the population.
4. Quality of health care services varies considerably in both the public and private sector. Many practitioners in the private sector are actually not qualified Doctors. Regulatory standards for public and private hospitals are not adequately defined and, in any case, are ineffectively enforced. The lack of extensive and adequately funded public health services pushes large numbers to incur heavy out-of-pocket expenditures on services availed in public and private sector hospitals.
5. The total expenditure on health care in India, taking public, private and household out-of-pocket (OoP) expenditure was about 4.1 per cent of GDP in 2008-2009 . However, the public expenditure on health was only about 27 per cent of the total in 2008-2009 , which is very low by any standard. Public expenditure on Core Health (both plan and non-plan and taking the Centre and States together) was about 0.93 per cent of GDP in 2007-2008. It was increased to about 1.04 per cent during 2011-2012. It needs to increase much more. Afghanistan, for instance, spends 7.6 per cent of its GDP on healthcare, Bhutan 5.2 per cent, Haiti 6.9 per cent, Iraq 8.4 per cent, Nepal 5.5 per cent, Rwanda 10.5 per cent, Sudan 6.3 per cent while the United States spends 17.6 per cent, Canada 11.3 per cent, the United Kingdom 9.6 per cent and Australia 8.7 per cent.
6. Despite efforts through the flagship programmes of National Rural Health Mission, India's child sex ratio for 0 to 6 age group has declined from 927 in 2001 to 914 in 2011. The country has not been able to reduce its maternal mortality ratio (MMR) to 100 per 1,00,000 live births nor reduce its infant mortality rate (IMR) to 28 per 1,000 live births. India has also not been able to reduce its total fertility rate to 2.1. The reason for this primarily has been early marriage, close spacing of births and lack of skilled contraceptive services. The last three were the Eleventh Plan monitorable goals. Progress on goals relating to reduction in malnutrition among children in 0-3 group and anemia among women and girls cannot be assessed for want of updated data, but localized surveys indicate that the status has not improved.
7. According to the latest World Bank Development indicators, only 15 countries outside sub-Saharan Africa had a gross national income per capita lower than India's in 2011, including Afghanistan, Bangladesh, Burma, Pakistan, Nepal, Haiti, Yemen, Tajikistan and Uzbekistan, among others. However, India's rank even among these 16 poor countries is an abysmal 10th or even worse on various social indicators. Its rank in this group is 10th for child mortality, 11th for female literacy and mean years of schooling, 13th for access to improved sanitation and DPT immunization, and in terms of the proportion of underweight children, it shares the last rank together with Yemen.
8. India's Economic Survey, 2013 points to the fact that even though the country's spending on health has increased by 13 per cent, it nonetheless has the lowest public health spending as a proportion of its GDP.
9. According to a report by the IMS Institute for Healthcare Informatics titled "Understanding Healthcare Access in India", rural areas remain significantly underdeveloped in terms of health infrastructure, with about half the people in India and over three-fifths of those who live in rural areas forced to travel beyond 5 kms to reach the nearest healthcare centre. It clearly shows that physical accessibility of public and private healthcare facilities is a major challenge in rural areas. The report also shows that availability of healthcare services is skewed towards urban centres with these residents, who make up only 28 per cent of the country's population, enjoying access to 66 per cent of India's available hospital beds, while the remaining 72 per cent, who live in rural areas, have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses and pharmacists, is highly concentrated in urban areas and the private sector.
10. There is clearly something amiss in India's 'path to development'. While India is doing spectacularly better than other South Asian countries in terms of per capita income, it is failing behind every other South Asian country (with the exception of Pakistan) in terms of many social indicators.
11. In order to take stock of the existing health situation in the country and to make a meaningful intervention for an improvement in the same, the National Human Rights Commission has now decided to organize a two-day 'National Conference on Health Care as a Human Right' on 5th - 6th November 2013 at India International Centre, New Delhi. The main objectives of the Conference will be to -
(i) discuss ways in which the public health system could be strengthened from the perspective of human rights, especially with regard to accessibility, affordability and quality of health care,
(ii) discuss ways in which the problems of health relating to women and children could be addressed,
(iii) discuss issues relating to occupational health like silicosis etc. and ways to ensure the rights of workers involved, and
(iv) discuss measures for improving health care in terms of clean drinking water, hygiene and sanitation.
12. The Commission has invited Dr. Devi Prasad Shetty, Chairman, Narayana Hrudalaya Hospital, Bengaluru to deliver the keynote address in the inaugural session. His keynote address will be on 'Dissociating Health Care from Affluence'.
13. After the inaugural, the Conference will be focusing on four substantive sessions, which would be followed by working group discussions. These sessions are -
" Availability, Accessibility, Quality and Affordability of Health Care Services in India - Need for Universal Health Care
" Women and Child Health - Important Issues
" Clean Drinking Water, Hygiene and Sanitation : A Step Towards Better Health Care
" Occupational Health and Safety
14. For each of these sessions, the Commission has invited health professionals from diverse fields working in the country. Other than this, it has invited experts from Sri Lanka and Bangladesh as their experiences are worth emulating. It has also requested State Secretaries of Himachal Pradesh, Kerala, Tamil Nadu, Bihar and Uttar Pradesh to make presentations on essential aspects of health care. Some of the prominent speakers are Prof. K. S. Reddy and Dr. S. Sudarshan, Chairman and Member of NHRC Core Advisory Group on Health; Dr. K. K. Talwar, Chairman, Max Healthcare, Delhi; Dr. S. K. Thakur, Consultant, Gastroenterology, Moolchand Medcity, Delhi and Dr. G. Sahu from Tata Institute of Social Sciences, Mumbai.
15. The participants to this Conference are public health experts, policy makers and health scientists, legal experts, representatives of NGOs working in the health sector, representatives of civil society, including consumer groups, technical institutions, international organizations, representatives of Ministries/Departments of Health and Family Welfare, Women & Child Development, Panchayati Raj Institutions, Consumer Affairs, Drinking Water & Sanitation and National and State Commissions.
16. The need today is to go 'back to basics' and promote 'good health at low cost' along with focus on prevention by way of immunization, sanitation, public hygiene, waste disposal, disease surveillance, health education, food safety regulation and so on. Expanded collective action in these areas is urgently required, taking into consideration India's poor experience in fields like immunization and sanitation. There is a need not only for better health delivery, through institutional change, but also for devoting much more resources, as a proportion of the GDP, to public expenditure on health. This has to go hand in hand with the cultivation of greater efficiency and accountability in public services - a subject on which there are many lessons already in India in States like Tamil Nadu, Kerala and Himachal Pradesh.
17. Last but not the least, issues of health and health care must become the focus of political discourse in the country.
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Every human being is entitled to enjoyment of the highest attainable standard of health conducive to living a life of dignity. Health does not mean mere absence of disease but physical, mental, psychological and emotional well-being of an individual. This right is indispensable for the exercise of other human rights. It is the duty of the State to promote, protect and preserve the health of all individuals and also ensure the sustenance of human entitlements, such as nutrition, freedom from want and food security among others. The Constitution of India upholds 'right to health' as a Fundamental Right under Article 21. Article 47 of the Constitution further places a duty on the State to raise the level of nutrition and the standard of living and to improve public health.
2. The human right to health is recognized in Article 25 of the Universal Declaration of Human Rights (UDHR) and in numerous other international instruments. Prime among them being the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) , the 1965 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) , the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the 1989 Convention on the Rights of the Child (CRC) .
3. India has undertaken several measures to promote human rights based approach with regard to health and nutrition in its Five Year Plans, policies and programmes. Notable among them is the Integrated Child Development Services Scheme (ICDS), the Mid Day Meal Scheme (MDMS) and the expansive network of Sub-Centres, Primary Health Care Centres and Community Health Care Centres across the country. However, despite adopting a multi-pronged approach towards strengthening availability, affordability and accessibility to health care services, several challenges continue to remain. Availability of skilled human resources in terms of Doctors, Nurses and Auxiliary Nurse and Midwifes (ANMs) remains a key constraint. Rural and Tribal areas are very poorly served. Against the global average of 14.2, the physician density of India per 10,000 population stands poorly at 6.5. India's nursing and midwifery density of 10 per 10,000 population is not even half the global average of 28.1. The worst indicator of health care in India comes with the density of hospital beds per 10,000 population which stands at 9 against the global average of 30. The doctor-population ratio in rural areas is 3:10,000, while it is 13:10,000 in urban areas. Besides, just 26 per cent Doctors work in rural areas, serving 72 per cent of the population.
4. Quality of health care services varies considerably in both the public and private sector. Many practitioners in the private sector are actually not qualified Doctors. Regulatory standards for public and private hospitals are not adequately defined and, in any case, are ineffectively enforced. The lack of extensive and adequately funded public health services pushes large numbers to incur heavy out-of-pocket expenditures on services availed in public and private sector hospitals.
5. The total expenditure on health care in India, taking public, private and household out-of-pocket (OoP) expenditure was about 4.1 per cent of GDP in 2008-2009 . However, the public expenditure on health was only about 27 per cent of the total in 2008-2009 , which is very low by any standard. Public expenditure on Core Health (both plan and non-plan and taking the Centre and States together) was about 0.93 per cent of GDP in 2007-2008. It was increased to about 1.04 per cent during 2011-2012. It needs to increase much more. Afghanistan, for instance, spends 7.6 per cent of its GDP on healthcare, Bhutan 5.2 per cent, Haiti 6.9 per cent, Iraq 8.4 per cent, Nepal 5.5 per cent, Rwanda 10.5 per cent, Sudan 6.3 per cent while the United States spends 17.6 per cent, Canada 11.3 per cent, the United Kingdom 9.6 per cent and Australia 8.7 per cent.
6. Despite efforts through the flagship programmes of National Rural Health Mission, India's child sex ratio for 0 to 6 age group has declined from 927 in 2001 to 914 in 2011. The country has not been able to reduce its maternal mortality ratio (MMR) to 100 per 1,00,000 live births nor reduce its infant mortality rate (IMR) to 28 per 1,000 live births. India has also not been able to reduce its total fertility rate to 2.1. The reason for this primarily has been early marriage, close spacing of births and lack of skilled contraceptive services. The last three were the Eleventh Plan monitorable goals. Progress on goals relating to reduction in malnutrition among children in 0-3 group and anemia among women and girls cannot be assessed for want of updated data, but localized surveys indicate that the status has not improved.
7. According to the latest World Bank Development indicators, only 15 countries outside sub-Saharan Africa had a gross national income per capita lower than India's in 2011, including Afghanistan, Bangladesh, Burma, Pakistan, Nepal, Haiti, Yemen, Tajikistan and Uzbekistan, among others. However, India's rank even among these 16 poor countries is an abysmal 10th or even worse on various social indicators. Its rank in this group is 10th for child mortality, 11th for female literacy and mean years of schooling, 13th for access to improved sanitation and DPT immunization, and in terms of the proportion of underweight children, it shares the last rank together with Yemen.
8. India's Economic Survey, 2013 points to the fact that even though the country's spending on health has increased by 13 per cent, it nonetheless has the lowest public health spending as a proportion of its GDP.
9. According to a report by the IMS Institute for Healthcare Informatics titled "Understanding Healthcare Access in India", rural areas remain significantly underdeveloped in terms of health infrastructure, with about half the people in India and over three-fifths of those who live in rural areas forced to travel beyond 5 kms to reach the nearest healthcare centre. It clearly shows that physical accessibility of public and private healthcare facilities is a major challenge in rural areas. The report also shows that availability of healthcare services is skewed towards urban centres with these residents, who make up only 28 per cent of the country's population, enjoying access to 66 per cent of India's available hospital beds, while the remaining 72 per cent, who live in rural areas, have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses and pharmacists, is highly concentrated in urban areas and the private sector.
10. There is clearly something amiss in India's 'path to development'. While India is doing spectacularly better than other South Asian countries in terms of per capita income, it is failing behind every other South Asian country (with the exception of Pakistan) in terms of many social indicators.
11. In order to take stock of the existing health situation in the country and to make a meaningful intervention for an improvement in the same, the National Human Rights Commission has now decided to organize a two-day 'National Conference on Health Care as a Human Right' on 5th - 6th November 2013 at India International Centre, New Delhi. The main objectives of the Conference will be to -
(i) discuss ways in which the public health system could be strengthened from the perspective of human rights, especially with regard to accessibility, affordability and quality of health care,
(ii) discuss ways in which the problems of health relating to women and children could be addressed,
(iii) discuss issues relating to occupational health like silicosis etc. and ways to ensure the rights of workers involved, and
(iv) discuss measures for improving health care in terms of clean drinking water, hygiene and sanitation.
12. The Commission has invited Dr. Devi Prasad Shetty, Chairman, Narayana Hrudalaya Hospital, Bengaluru to deliver the keynote address in the inaugural session. His keynote address will be on 'Dissociating Health Care from Affluence'.
13. After the inaugural, the Conference will be focusing on four substantive sessions, which would be followed by working group discussions. These sessions are -
" Availability, Accessibility, Quality and Affordability of Health Care Services in India - Need for Universal Health Care
" Women and Child Health - Important Issues
" Clean Drinking Water, Hygiene and Sanitation : A Step Towards Better Health Care
" Occupational Health and Safety
14. For each of these sessions, the Commission has invited health professionals from diverse fields working in the country. Other than this, it has invited experts from Sri Lanka and Bangladesh as their experiences are worth emulating. It has also requested State Secretaries of Himachal Pradesh, Kerala, Tamil Nadu, Bihar and Uttar Pradesh to make presentations on essential aspects of health care. Some of the prominent speakers are Prof. K. S. Reddy and Dr. S. Sudarshan, Chairman and Member of NHRC Core Advisory Group on Health; Dr. K. K. Talwar, Chairman, Max Healthcare, Delhi; Dr. S. K. Thakur, Consultant, Gastroenterology, Moolchand Medcity, Delhi and Dr. G. Sahu from Tata Institute of Social Sciences, Mumbai.
15. The participants to this Conference are public health experts, policy makers and health scientists, legal experts, representatives of NGOs working in the health sector, representatives of civil society, including consumer groups, technical institutions, international organizations, representatives of Ministries/Departments of Health and Family Welfare, Women & Child Development, Panchayati Raj Institutions, Consumer Affairs, Drinking Water & Sanitation and National and State Commissions.
16. The need today is to go 'back to basics' and promote 'good health at low cost' along with focus on prevention by way of immunization, sanitation, public hygiene, waste disposal, disease surveillance, health education, food safety regulation and so on. Expanded collective action in these areas is urgently required, taking into consideration India's poor experience in fields like immunization and sanitation. There is a need not only for better health delivery, through institutional change, but also for devoting much more resources, as a proportion of the GDP, to public expenditure on health. This has to go hand in hand with the cultivation of greater efficiency and accountability in public services - a subject on which there are many lessons already in India in States like Tamil Nadu, Kerala and Himachal Pradesh.
17. Last but not the least, issues of health and health care must become the focus of political discourse in the country.
*****