The media is rife with stories these days about the 27th Amendment coming soon.
Taking this once more as an opportunity to highlight the significance of health in national development, I, in my humble capacity, have started another advocacy campaign at all levels that I can so as to sensitise the stakeholders engaged in the process. The provision of health is a universally agreed human right, constitutionally catered for in all functioning governance systems, democratic or undemocratic.
The WHO Council on the Economics of Health for All states that around 140 countries worldwide recognise health as a human right in their constitutions. Pakistan has been a member of the WHO since its inception. Being a member, it subscribes to the constitution of the organisation, which places “Health as a fundamental human right without any discrimination of race, religion, political belief and economic or social condition”.
Pakistan has also ratified the International Covenant on Economic, Social and Cultural Rights. Article 12 of the ICESCR recognises the right of citizens to enjoy the highest attainable standard of physical and mental health. Despite all this, we have a unique distinction that, whatever our political path and whichever political party or military is in power, health and essential human services have been ignored, much like the ‘governance’ factor.
A cursory study of the Constitution of Pakistan reveals that the section on fundamental human rights, listed in Articles 9 to 28, in the chapter on Fundamental Rights in Part II of the constitution, does not specifically mention the right to health, which is counterintuitive. The constitution also mentions healthcare in Chapter 2 of Part II, but the Principles of Policy are not enforceable provisions.
In section (d) of Article 38, the constitution says, “The state shall… provide basic necessities of life, such as food, clothing, housing, education and medical relief, for all such citizens… on account of infirmity, sickness and unemployment” – leaving much to be desired. To address this inadequacy in the constitutional scheme, we initiated an advocacy campaign in October 2024, concurrent with the 26th Amendment, and lobbied for the need to incorporate health as a fundamental right in that amendment. Although all the political forces I could manage to persuade were convinced of its need and agreed that it would be taken care of, it didn’t materialise when the draft was submitted to the assembly.
Despite my vigorous advocacy, both in the office as Minister of Health and outside, our GDP allocation to health has yet to increase from one per cent, in contrast to at least five per cent in the developed world.
The campaign for framing health as a constitutional right is being made on the grounds of principles of constitutional interpretation, including direct and meaningful enforcement, symbolic importance and greater efficacy. Numerous health challenges and structural inequalities lie at the heart of Pakistan’s healthcare crisis, particularly affecting the marginalised and vulnerable.
Inadequate health awareness, coupled with limited access to quality services and poverty, contributes to a vicious cycle of preventable and communicable diseases, such as tuberculosis, Hepatitis, Malaria, cardiovascular diseases, diabetes, cancers and malnutrition.
An uncontrolled population explosion is a ticking bomb that further exacerbates the health and socio-economic status of the population.
There exist gross inequalities in the provision, utilisation and affordability of healthcare services. The concentration of healthcare facilities and resources in urban centres disproportionately favours higher-income urban populations. This leaves rural and remote areas underserved, limiting healthcare options for the less privileged, and leads to overcrowding, strained resources and suboptimal healthcare delivery. Class inequality also results in disparities in the quality of healthcare received.
Low literacy rates and awareness of health and preventive measures among marginalised populations hinder their ability to make informed healthcare decisions and seek appropriate treatment.
Socioeconomic disparities also exacerbate the lack of access to adequate nutrition, resulting in higher rates of malnutrition and related health issues among lower-income groups. It is now high time that the state and all key players in this ecosystem realise that mere words and slogans will not suffice; we must showcase something concrete if the public is to be won back. We either swim together or sink together.
The right to health, once recognised as a fundamental constitutional right, would bind the state to provide comprehensive and universal provision. We can then more forcefully advocate with the government to allocate at least five per cent of the budget to the healthcare sector.
Making healthcare freely accessible and affordable for all is a right and not a privilege. Universal access to quality healthcare must be ensured according to people’s aspirations and needs, not their ability to pay.
It is ironic that, though circumstances and conditions related to the health of the citizens have been captured in the constitution, health has been missed by a logic best known to the political leadership and constitutional experts. The importance of its inclusion in the constitution as a fundamental human right would ensure its enforceability and render the state accountable for failing this responsibility.
The not-so-good health status of the country in many health domains – infectious, non-communicable disease burden – makes a strong case in its favour alone, denying which is tantamount to disenfranchising its citizens from seeking health justice.
The constitution was amended many times since its inception, but sadly, every time, health has been ignored. Let’s hope that at least this time we succeed.
I implore upon both the treasury and opposition parties, lawyers, media, academia, civil society, health professionals, religious clout and other stakeholders to use their leverage in incorporating ‘health as inalienable fundamental human right’ in the forthcoming amendment under Article l9-A of the constitution along with equal provision of essential nutrition, immunisation, protection, water and sanitation services to all citizens without any discrimination.
The writer is a former federal health minister of Pakistan. He tweets/posts @DrNadeemjan and can be reached at: nadeemjan77@hotmail.com
