Guarantee health

An article by SAF Nepal Chairperson Dr. Rita Thapa

I am neither a political commentator nor a human rights activist; but as a lifelong advocate of health for all, I am seriously concerned to read The Kathmandu Post’s report of Sept. 9 on the preliminary draft submitted by the Fundamental Rights Committee of the Constituent Assembly (CA). As reported, there seems to be a few but serious flaws, especially the use of the restrictive phrase “as determined by law” to define fundamental rights. Supreme Court advocate Chandakant Gyawali has rightly and in time pointed out these visible flaws.
I believe that not only would such a qualifying phrase restrict the citizens’ fundamental rights to the whims of the government in power, it would also defy the spirit of new Nepal to write a new constitution of the people, for the people and by the people. The Interim Constitution of Nepal has also enshrined health as a basic human right “as determined by law”. Such a restrictive response has failed to serve the needy citizens’ health interest any better than before. The continuing deaths and disabilities due to the diarrhoea epidemic in Jajarkot and other adjoining districts are a case in point.

Why the right to health is inalienable?

The health of all the citizens is central to human dignity, prosperity and security. Recent evidence shows that every rupee invested in human health brings back six rupees in return. Universal coverage of health care should, thus, become a priority basic human rights agenda as well as a priority of socio-economic development and poverty reduction programmes.

What constitutes the basic right to health? 

Article 25 of the Universal Declaration of Human Rights, 1948, to which Nepal is a signatory, states that everyone has the right to a standard of living adequate for the health and wellbeing of oneself and of his/her family including food, clothing, housing and medical care and necessary social security. It has further emphasized that motherhood and childhood are entitled to special care and assistance; all children regardless of whether born out of wedlock shall enjoy the same social protection.
It becomes clear from the above that the people’s right to health is universal and cannot be realized in the absence of other basic rights. While the media has rightly credited the prime minister for rescuing Kamala from death, there are countless numbers of Kamalas, especially in rural and remote areas, in need of such lifesaving care while going through the natural life giving process - birthing.

Safeguarding citizens’ right to health

We have to understand that health or health risks are not determined by biological factors alone. They are also determined by the people’s living, working and economic conditions, their access to good health care, gender roles, environment, potable water, unpolluted air, sanitation, human-animal excreta disposal; socio-cultural beliefs, education, recreation, lifestyle and behaviours. For example, practicing safe sex could prevent HIV transmission and the practice of washing the hands with soap and water could prevent not only diarrhoea causing diseases but also swine flu. Similarly, improved provision of health care for children may improve their educational performance and chances for better employment. More responsive policies and programmes related to roads, driving licenses and vehicles might have prevented the recent tragic Sun Koshi bus accident that took the lives of 22 healthy people.

Although the policies and programmes relating to the aforementioned factors are located in different sectors, they influence each other’s goals and objectives. Ensuring the people’s right to health should, thus, go hand in hand with other basic rights. Accordingly, such interactive interrelationships of human rights to health must be constitutionally recognized and constitutional provisions made accordingly.

In summary, the universal right to health could be defined as follows in the new constitution.

First, the new constitution should make the state responsible for guaranteeing that every citizen, regardless of their socio-economic status, sex, ethnicity or geographical location, will have equal access to a holistic package of health promoting, disease preventing and disease treating information, education and services in a way that are enforceable by the courts. There should not be any restrictive phrase with regard to the basic right to health.

Second, the new constitution should make a special provision to ensure that every woman’s right to have equal access to skilled care for enabling her to decide freely and responsibly the number and spacing of her children, to go safely through wanted pregnancy and childbirth, preferably at community based birthing centres staffed by skilled health workers, and ensuring best possible chances of having a healthy baby.

Third, realizing that the right to health is a shared responsibility, the new constitution must make adequate provisions to incorporate health-friendly policies in all the related sectors as appropriate to their respective programme objectives.
Fourth, the state should be responsible for establishing a nationwide social and community-based health insurance scheme through public-private partnership so that health care costs become more sustainable and the mode of payment is more humane.

Lastly, constitutional provisions should guarantee total devolution of power to the local government with full autonomy and control over the local as well as the national and international resources available for health, including scholarships for training a skilled health workforce.

(The author is a member of the High Level Health Policy Advisory Committee, MOPH, and a former WHO staffer.)

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