No right to health

Health has still not been assigned the fundamental human right status in Pakistan

Mohammad Jahangir finally breathed his last on a January mid-night this year after over a dozen dialysis sessions in one year at public sector hospitals in the Twin Cities.

Revisiting the painful memories of his father, his only son, Mohammad Ibrahim, says “his feet, legs and nails had turned black a few days before his death as blood circulation in his body was affected”.

Coming from a low-income background, Ibrahim knocked at the doors of every public and private sector hospital to save his father’s life.

Jahangir’s misfortune began when doctors started administering painkiller injections to reduce pain in his leg, which had a tumour.

Late diagnoses resulted an amputation in 2016 and eventual kidney failure in 2019.

“I used to lift my ailing father on my shoulders to take him to the cab to go to the hospital for dialysis. At the hospital, we had to wait for four to eight hours for our turn because my father was not registered as a scheduled patient,” says Ibrahim.

According to Ibrahim, his father received medical treatment at several Twin Cities’ hospitals for four years. These included Pakistan Institute of Medical Sciences (PIMS), Holy Family Hospital, Civil Hospital, Rawalpindi Institute of Cardiology (RIC) and Rehman Foundation.

The average cost of a session at a government-run hospital was Rs 4,000; the expenses reached Rs 7,000 at a private-sector hospital.

Ibrahim believes proper health protection is a fundamental human right that his father did not get.

Seventy-three years have passed since the country’s inception, but Pakistan’s constitution has not declared health a fundamental human right of its citizens.

Although the World Health Organization (WHO) has declared health a fundamental human right for the member states, Pakistan is amongst the countries that have not upgraded its status beyond the Principles of Policy.

According to the latest Pakistan Economic Survey (2019-2020), the country’s health spending is 1.1 percent of its GDP. The WHO recommends that countries spend 5 percent of their GDP on health.

Dr Zafar Mirza, the former special assistant to prime minister on health, says that around 130 countries have declared health as a fundamental human right. Pakistan is not one of those.

He says there is a difference between treating health as a fundamental human right and providing medical aid.

“Medical aid covers the emergency or disaster situations while health as a fundamental human right provides comprehensive protection and promotion.”

Dr Mirza says that a sound health care system should provide five kinds of health services: preventive, curative, promotive, rehabilitative and palliative. These services should not remain limited to curing the disease but must take care of overall health.

“State becomes responsible in providing health protection to its citizens when it declares health a fundamental human right,” says Mirza.

Advocate Hamid Khan, a senior lawyer and jurist, says health is still not a fundamental human right in Pakistan. It has only been addressed under the Principles of Policy.

“Allocation of resources is one of the reasons behind not adding the health subject under the umbrella of fundamental human rights,” says Khan.

According to Khan, other than resources, hurdles in implementation, political and public awareness are also significant challenges in making health a fundamental human right.

“Declaring health a fundamental human right increases the state’s responsibility. It will then have to build more hospitals, healthcare units and emergencies to facilitate its citizens.“

He notes that Iran has declared health a fundamental human right, and provides health services at the grassroots level to the public.

“Once the constitution is suitably amended there is a need for implementation. The state has declared education a fundamental human right but is still struggling in implementing its policy on it,” Khan points out.

According to Dr Raza Zaidi, a consultant at the Ministry of National Health Services Regulation and Coordination (NHSR&C), declaring health a fundamental human right will pave the way for the availability of essential health services for citizens.

He says while making health a human right may not immediately improve governance, health would become a ommitment of the state.

Dr Zaidi adds that health as a subject in the constitution has dealt with in the preamble so far. Its upgrade as a human right will provide back-up support to the health system.

Advocate Anees Jillani, a human rights activist, believes that making health a fundamental right will not make much difference either.

“In Pakistan, recognition of rights as fundamental has not made a difference in the past,” he says.

Jillani says that the government lacks commitment in this regard. The elite, including the rulers, can seek treatment abroad, so they do not care about what is available to the ordinary itizen.

He says most of the resources allocated for health are spent on specialised fields and not on prevention or day-to-day care of the ordinary citizen.

Parliamentary Secretary the Ministry of NHSR&C, Nausheen Hamid, says that health is broadly recognized as a fundamental right in Pakistan. She says its declaration as a fundamental human right requires a constitutional amendment which might take some time.

She also says a constitutional amendment would not cover the gaps in the healthcare system. We need to build a reliable infrastructure of health systems across the country.

Dr Hamid adds that the government has introduced some reforms in the health sector is working to provide healthcare facilities to the public.

“We are heading toward Universal Health Coverage (UHC) in the country for all citizens, which will be a big step towards providing relief to the public in the health sector,” she says.

Once the system is fully developed, she says, the constitutional amendment will be easy and effective.

The writer is a journalist and ICFJ fellow based in Islamabad

No right to health: Health still not assigned fundamental human right status in Pakistan