“Orientation/training to HRTC network on Right to Health and Identifying right to health violations/issues”
As human beings, our health and the health of those we care about is a matter of public concern. Regardless of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and essential asset. Ill health, on the other hand, can keep us from going to school or to work, from attending to our family responsibilities or from participating fully in the activities of our community. The right to health is a fundamental part of our human rights and of our understanding of a life in dignity. The World Health Organization (WHO) states that the highest attainable standard of health is a fundamental right of every human being. The right to health includes access to timely, acceptable, affordable health care of appropriate quality. According to WHO, the right to health means that governments must generate conditions in which everyone can be as healthy as possible. The WHO states that the right to health extends not only to timely and appropriate health care but also to the underlying determinants of health. These include access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health.
Global approach on right to health: The evolution towards defining health as a social issue led to the founding of the World Health Organization (WHO) in 1946. With the emergence of health as a public issue, the conception of health changed. WHO developed and disseminated the understanding of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It defined an integrated approach linking together all the factors related to human well-being, including physical and social surroundings conducive to good health.With the establishment of WHO, for the first time the right to health was recognized internationally. The WHO Constitution affirms that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Over time, this recognition was restated, in a wide array of formulations, in several international and regional human rights instruments, which include:
- Universal Declaration of Human Rights (art. 25)
- American Declaration on the Rights and Duties of Man (art. 33)
- European Social Charter (art. 11)
- International Covenant on Economic, Social and Cultural Rights (art. 12)
- African Charter on Human and Peoples’ Rights (art. 16)
Alma Ata Declaration: Universal recognition of the right to health was further confirmed in the 1978 Declaration of Alma-Ata on Primary Health Care, in which different states pledged to progressively develop comprehensive health care systems to ensure effective and equitable distribution of resources for maintaining health. The Declaration affirms the crucial role of primary health care, which addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly. It stresses that access to primary health care is the key to attaining a level of health that will permit all individuals to lead a socially and economically productive life and to contributing to the realization of the highest attainable standard of health.
People’s Health Movement (PHM):At the Alma-Ata conference in 1978, health ministers from 134 countries, in association with the WHO and UNICEF, set a goal of achieving “Health for All by the year 2000” and identified primary health care as the mean to achieve it. However in response to continued and deepened health inequalities, on 8 December 2000, 1453 delegates from 92 countries met at Savar, Bangladesh for the first People’s Health Assembly which led to the founding of the People’s Health Movement and the drafting of the People’s Charter for Health. PHM currently has bases in more than 70 countries that include both individuals and well established circles with their own governance structures. It has chapters in South Asia (India, Bangladesh, Sri Lanka), Africa, Pacific, South America, Central America, North America, Europe and several other countries.
Millennium Development Goals: To improve the health of the people mainly of developing nations, the Millennium Project was commissioned by the United Nations Secretary-General in 2000to develop a concrete action plan for the world to achieve the Millennium Development Goals (MDGs) and to reverse the existent poverty, hunger and disease affecting billions of people. At the Millennium Summit in September 2000 the largest gathering of world leaders in history adopted the UN Millennium Declaration, committing their nations to new global targets with a deadline of 2015. The MDGs have been a milestone in global and national development efforts. While significant improvement in maternal and children health have been achieved, further efforts and a strong global partnership for development are needed to accelerate progress and reach the goals by 2015. The outcome document of the 2010 High level Plenary Meeting of the General Assembly on the MDGs requested the Secretary General to initiate thinking on a post-2015 development agenda.
Post-2015 process (Sustainable development goals):One of the main outcomes of the Rio+20 Conference was the agreement by member States to launch a process to develop a set of Sustainable Development Goals (SDGs). The United Nations is in the process of defining a post 2015 development agenda. The agenda will be launched at a Summit in September 2015, which is the target date for realizing the MDGs. SDGs have been planned to improve the development goals which could not been achieved during 15 years MDG period (2000-2015) by most of the developing countries. The post 2015 development agenda plans to address Sustainable Wellbeing for All (Poverty eradication, health, education, nutrition, security etc), Healthy Lives at All Stages(Child survival, maternal survival, MDG6, adolescent health, NCD burden reduction), Universal Health Coverage (Health promotion, prevention, treatment, financial risk protection). United Nations have played an important role in exercising key health indicators to be included in the SDGs. Similarly civil society has also played a key role in discussinghealth goals. In Nepal, RECPHEC has coordinated the meeting for discussion and suggestions on key health indicators including social determinants. This document has been submitted to UN in 2014.
Right to health in Nepal:
- Long term health plans: A 15 year long term health plan (1976-1992) was implemented in 1976 to promote physical, mental and social health of the people; producing health sector manpower to make health services available to all the people, reducing the mortality rate and uplifting the average life expectancy. The policies of the LTHP included providing basic health services at the village level for the majority of the population and checking population growth to promote national development. The priorities included developing these basic health services, popularizing family planning and maternal and child welfare services and producing health manpower.
The second long term health plan (1997-2017) has focused on the preparation of periodic and annual plans, guidelines and formulation of strategy, programmes and plan of action based on national health needs and priority and coordination among governmental, non-governmental and donor agencies. Self dependence, gender awareness, decentralization, effective and efficient organization and management, full people’s participation, partnership among government, NGOs and private sectors, are the policies adopted by this long term plan. The strategies adopted in the second long term plan in order to improve the delivery of health services and develop an effective strategy planning approach; are strengthening health services delivery, decentralization within the health sector, improving the public private NGO mix and strengthening sectoral management.
- National Health policy 1991: With the success of People’s Movement in 1990, the elected government adapted National Health Policy was adapted in 1991 to bring about improvement in the health conditions of the people of Nepal. The primary objective of the National health policy is to extend the primary health care system to the rural population so that they benefit from modern medical facilities and trained health care providers. In this policy priority is given to preventive, primitive and curative health services that directly help reduce infant and mortality rates. Services are to be provided in an integrated manner throughout the health system to sub health posts at the local level. It has aimed to make available curative health services at all health institutions including central, regional, and zonal and district hospitals, PHCC, HP and SHP. Besides it has focused on mobile teams to provide specialist services to remote areas. This policy encourages to the Ayurvedic and other traditional health services such as Unani, Homeopathy and Naturopathy. The policy seeks community participation at all levels of health care through the participation of FCHVs, TBA and leaders of local social organizations.
- 2005/2006 -Interim Constitution: The constitution is the fundamental law of Nepal. In 1990 Nepal adopted its fifth and first fully democratic constitution. Although there were many good features about that constitution, it failed to satisfy the demands of many Nepali people. Nepal is governed under the Interim Constitution of Nepal, 2007.It replaced the constitution of the Kingdom of Nepal 1990. The interim constitution was drafted to facilitate and manage the Nepali constitutional transformation process that started with the massive people’s movement against the monarchy in 2006. An important aspect of the Interim Constitution, which gives it its interim nature, is that it provides for the setting up of the Constituent Assembly and the preparation of the new Constitution. Under the terms of the interim constitution the new constitution was to be promulgated by May 2010, but due to disagreement between political parties the new constitution has not been drafted and came into practice. Hence the country still rules under the Interim Constitution of 2007.
- Free health service: The provision of free essential health care services is a central strategy of the government of Nepal for improving the health of all the Nepalese people and meeting the health goals. The implementation of free basic health services is guided by DoHS’s free health service programme implementation guidelines. Citizens are able to access District Hospitals (DH) and Primary Health Care Centers (PHCC) for free outpatient care, emergency, in patient services without having to pay for registration. The government has been providing 40 essential drugs for free to all district hospitals, 35 from primary health posts and 25 from health posts. Government has decided to provide medicine of 12 non communicable diseases in the list of essential drugs for free of cost. These drugs are for high blood pressure, diabetes, chronic gastric problems and mental disease.
- National health insurance policy: The interim constitution of Nepal 2007 provides for free basic health care as a fundamental right of citizens. Although access to health care services has gradually improved, universal coverage has yet to be achieved and out of pocket expenditure by individuals is high. A national health insurance programme is in process to ensure universal health coverage by capturing the unregulated out of pocket spending and facilitating the effective, efficient and accountable management of available resources. The national health insurance policy 2013 was prepared to give guidance to the implementation of a national health insurance programme in Nepal.
Rationale of the programme:
Although in Nepal the government has made commitment to fulfill people’s basic health rights the implementation of the activities is yet not to the mark. Women face discrimination in the family, society, and state. Many districts are remote, making access to health services and information are very limited. The level of women’s health and education is particularly low. There is little knowledge on preventive measures of various health and nutritional problems. Also women’s health issues remain inappropriately addressed in the national health policy and programs. Therefore, it is necessary to provide primary health care facilities and to make communities aware of their basic rights to health. It is vital that women have access to and control over healthcare services from a women’s rights perspective.
There is little participation of local communities in health facility management. Although there are policies to engage local government in health facility management, in absence of elected local body, the participation of local government is also limited to the government staff.The health facility management committee is not functioning effectively in S/HP, and thus requires participation of community for resource generation to management, and monitoring service delivery (for example: availability, accessibility and quality of health). Regarding monitoring current free health provision/declaration is not sufficient to ensure universal access of health services with desired quality, though there is encouraging initiation from government. Despite the policy scope and visible improvement in few indicators, access, affordability and sufficiency to health services provided by health facilities remains a key issue particularly for the marginalized groups.
The following program is, therefore, planned to educate district coordinators of HRTC networks on the aspect of right to health. The orientation/training program will deliver key message on bringing right to health issues at district level, community level as well as advocate at VDC level regarding budget allocation for health, conducting social audit, public hearing at district level and VDC level respectively.
Goal of the project:“Strengthening Marginalised Communities in Accessing their Right to Health”
Objective of the training:
To give training on Right to Health to coordinators of 10 HRTC district and 3 outreach district and to share information on Right to Health from government as well as civil society perspective.
The resource person will provide orientation training on the state or non state sector efforts on Right to Health and orient on how people in the district can advocate regarding health issues.
- Participants had information on right to health.
- Participants were able to hold discussions on right to health issues at district level
No. of participants: 26 (2 from each district) + RECPHEC staff
Names of districts:
- HRTC districts: Dhankuta, Jhapa, Kavre, Dhanusha, Sarlahi, Tanahu, Rupandehi, Kapilvastu, Kanchanpur, Surkhet
- Outreach districts: Udaypur, Saptari, Gorkha