Viewing health as an inalienable right

"We recognise health as an inalienable human right that every individual can justly claim. So long as wide health inequalities exist in our country and access to essential health care is not universally assured, we would fall short in both economic planning and in our moral obligation to all citizens." These sentiments were expressed not by an activist demanding the Right to Health but by Prime Minister Manmohan Singh. He was delivering the convocation address at the All-India Institute for Medical Sciences in New Delhi last week.

Dr. Singh went on to add that he believed the bulk of the provision of basic health services and medical care, specially for the poor, would continue to remain in the public domain in the near future. "Private care," he added, "cannot be the immediate answer to the needs of those who do not have basic purchasing power."

The Prime Minister's sentiments now need to be reflected in the allocation for health in our budget. Currently, India spends only 0.9 per cent of its GDP on health care in the public sector. The majority of the people are forced to turn to private health systems that are often beyond their reach. For the poor, the choice is sometimes between treatment or death. That is a choice no citizen should be forced to make.

For women, the right to health is even more important as for a variety of reasons both choice and access are often denied to them. This was one of the dominant themes at the recent International Women and Health Meeting (IWHM) in New Delhi that brought together over 600 people, mostly women, from over 60 countries. Ironically, even as the Prime Minister's sentiments on the same subjects were being reported, there was hardly a whisper of the deliberations at the IWHM in the media based in the capital.

In fact, Dr. Singh would have endorsed the views of the women at the meeting as they presented evidence of the consequences of the denial of health care to women. The impact of war, conflict and violence, in particular, was a major focus as several delegates came from nations that were still caught in conflict situations or had only recently emerged from the battering of a major war or upheaval.

One of the most moving testimonies at the IWHM was from Chantal Mukhodoli of Rwanda. While the media noted and reported the violence against women in places such as Afghanistan and earlier in Bosnia, the 1994 genocide in Rwanda went virtually unreported. "During the 100 days of genocide in 1994, the world and the United Nations let us down," said Chantal. "It was hell to find ways to survive." But survive she did even though she now has to live with the fact that she is HIV positive. This, however, has not deterred her. She campaigns for an end to discrimination against HIV-positive people and advocates testing by everyone irrespective of their sexual history.

According to U.N. estimates, around 250,000 women were raped in Rwanda in 1994. A survey of 1,125 Rwandan women conducted by the organisation Chantal is associated with revealed that 66 per cent of them had been raped and 80 per cent were still going through severe psychological trauma. Many such women were forced to marry the men who had raped them. If they wanted to escape, their only choice was prostitution. The children born to these women are called "bad memory children." As the rapists were from "the other" tribe, these women and their children got little support from their own community. Chantal narrated in a deadpan voice horrors that left the audience gasping. She said women who had tested HIV positive, or who were disabled after the war, or who suffered psychological problems were abandoned by their families. The biggest killer today, she said, was HIV/AIDS. An estimated 400,000 children in the country have lost one or both parents to AIDS. In such a situation the right to health and the ability to survive cannot be separated.

But women face others forms of violence daily. Much of this is within the home. Some of it is external, the result of developmental policies that displace them, impoverish them and their families, that increase their burden of work, that force them into low-paying hazardous jobs. Even the better-paying jobs, such as those in the Special Economic Zones, come with a price tag for women's health.

A striking presentation by Padmini Swaminathan from the Madras Institute of Development Studies (MIDS) illustrated how the social impact of policies is as important as the social content. She recounted that even though women benefited in terms of income from jobs in the SEZs, they suffered great stress because of the relentless nature of the work and rules that strictly monitored the time they took to eat their lunch or even to go to the toilet.

The idea of a right to health should foreground policy debates on health care. It would mean recognising that apart from access and affordability, women also need to be guaranteed choice, particularly in matters of reproductive health. That non-discrimination is essential for effective health intervention in the face of the growing incidence of HIV/AIDS in India. That livelihoods are as important as health infrastructure.

Both the content of our health care services and the amount invested in them would change drastically if, indeed, the government accepted the Prime Minister's views on the right to health.