PRIVATE MEDICAL / HOSPITAL LEGISLATION
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- Title
- PRIVATE MEDICAL / HOSPITAL LEGISLATION
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eod c±se&5? daasaFfoaedaa dacisadoio e jao&dad edaa
tsdedd eao±>© food daaad cdaadjde sao&Fd dododu,zaadcaxriddde.
23. dddd dodo tna^doba.- (1) oFsrai sadA ddoFn
*
doeorte' '
(dSoiada) eSFiodda, 1976
(1976 d oFJOFfou eddodda 75) d?
dx-aeau SdddrtofdeaAd.
(2) EOrt Sadddiio’ffdCait^,-
(a) sdddrbaod e&Ddadod t?a daaduad ciro^df ^d4 edaoa
nydja^cad ato^d? gdadria. d? ea^oddod doasaa trodaodrW
eacdcj, daadoaAd edzoa oydaa A d aoda zpaadddda, j
(a) wdddnoaod saDcuodad docdrt doafodrSnaA adaa
dOtodra=a4A
eadoddaaj 2aa,dodaarb^d04 daaod dOdcad
dodo
eadcdadaaS gs^dcdpad a^ecdodo darirarfnaA zaas
<^dod ao_
ddortood^cb d>3o eod etirrteri
)od™lj^oo
*
rjo2
*ja
A»oaac
caa^dO^saarjA d^d^Dtod dodri^ d?
*3 dOtoad^ca&odad ?5abodra
doodad eodfdsaA, ojsart^ saadn ddFcrr5’ doeori^ (a&abda)
tsadoddo, 1976 =4 adcaA aoda ddort, Eadddd^ ddaa^da
edd4adoda aadduaAd.
adec±>=d),
adodndjaodrt d?
daoad^rid drt enaddod o^dadd.
(I) saadA djd^ecda dodrid daadd sarto daadaoia edaadda
dada ddciaad ;
(ii)
daad4aa a^aead dado d<?eo±> do&eeFaa ddadcda ddrf ;
(ill) add rbradai^ri'Jrt doiaod^dod saadA d,d6(da dodrtdri^
dAFfoBdaa^da dado saadA dd^fod dodrivo Az^oa, d^3=sa,
ojada, ot^drteb, aaadd dugddrt^a, daaosad^ri^rt doiaoa^d
rtaroadldri^da aaOdadod erid^dadaajda ;
(iv) d,dc5aaoda saadA d^Secb dodcdad^ add dd.=jc±>
dudnaA
dada_C ^dd dedrterroA eda aadod
rJ
'
Jdoe."3 dddcdoda
Q
<
tzM^cOQ.ri>t^)cU0 J
(v) aaadA dd^ecd dodri^ daar^naou ;
caausuj co<j\d cdat^oaddja ^ddj tidd^
&X>d0cua£5o djaddu-do dodo t?Ou3 t^dFaadda
eaacdodod traduodri^ eacixD, d-a5ddnaA d-adaan edr
dOdwdada.
SSEjFi—aCwH
en>dfs!ri<£> eSj^o eadrarte dj<^=
(\n) eBddada dada ddadari^ znaeoddnaA dodrfeb.'
,^dd
dsadcaAd.
edpod
dOrsadaadu dada edadoA= sadaardodcdada dd
ddfcdao.
out)- a
19
KARNATAKA LEGISLATIVE ASSEMBLY
(EIGHTY EIGHTH SESSION)
IK.AK,
Karnataka
P-rivate
Medical
Institutions
legislation - 1998 (
\
v/<. <■ ■■■ ■
" a(1998 Legislative Act No. 15)
(Regulation)
To regulate and control Private Medical Institutions and to
create (conceive) (order) a legislation to its related or
its associated (incidental) matters.
Keeping
Medical
profession
in
mind
to
prescribe
minimum
quality of service to regularise Private Medical Institutionthrough legislation having Public interest (in mind)
During fortynineth year of Indian Republic Karnataka State
legislative assembly enacted as follows:
I.
Brief name commencement and application
This Act shall be called as Karnataka
Institutions (Regulation) Act 1998.
Private
Medical
This will
come
into
effect
from the
date
notified
(appointed) by State Government through Act.
And notify
different dates for different (sub section) of Act.
Ik
This Act will
Institutions., ,,
be
II.
DEFINITIONS
otherwise required
applicable
i ~■
In
this
to
all
convenient
Private
(opportune
Medical
)
Act
(a) 'Recognition1 means Recognition given under 5th section
(b)
'recognito^y Authority' means Authority Constituted
under 4th chapter.
(c) 'Appeal Enquiry Authority' means authority nominated by
the State Government for the purposes of this Act.
(d) Appointed Date means appointed date
section (chapter) of Section (chapter) (1)
under
S tfrt c - c>
/to KWOK,
Sub
2
(e)
'Bangalore Metropolitan Area' means defined in Bangalore
Development Authority Act 1976 (1976 Karnataka Act 12)
(f)
'Clinical Laboratory' means generally
(i) Biological, Pathological
Chemical or other test,
study
conducted or
Radiation,
(examination)
Microseopic,
or analysis
(ii) An Institution which prepares culture, serum, vaccine or
other pathological or Histo pathological products preparation
during diagnosis or treatment.
(g)
'Department' means Health & Family Welfare department and
Indian Systems of Medicine department accordingly.
(h) Medical Professional means Homeopathy practitioners under
Act 1961 (1961 Karnataka Act 35) Ayurveda, Naturopathy, Sidda,
Unani
and
Yoga
practitioners
Registration
and
Medical
Practitioners
1961
(1962
Karnagtaka
Act---------- 9)
Medical Registration Act, 1961 (1961 Karnataka Act---------- 34)
Central Council of Indian Medicine Act, 1970 (1970 Central Act
48) Homeopathy Central Council Act 1978 (1978 Central Act 59)
Medical Council act 1956 (1956 Central Act 102)
Practitioners registered under Medical System in which the
practitioner studied one Medical Practitioner and (1948 Central
Act 10) One Dentist registered under Dental Doctors Act 1948.
(i) Local
Section 8.
Study:
Committee means
nominated
Committee
under
(j) Related to Private Medical Institution A 'Manager' means,
whether he is called by any other name or designation, a
persons who is Manager of a Private Medical Institution or who
is in charge or handling person.
(k) 'Maternity Home' means generally for the purpose of
delivery and care at the time of Child birth or before delivery
after care purposes an Institution to admit women or keep them
or for both purposes and also for sterlisation treatment or
medical termination of pregnancy includes institution which
admits and keep them.
3
(1)
means a hospital or a clinic with
'Medical Institution1
bed facility, nursing home, clinical laboratory, pathology
centre, Maternity home, Blood Bank, Radiation centre, Scanning
Centre, Physiotherapy centre and Disease check up for public,
diagnosis and prevention or rehabilitation treatment facility
Institutions that provides any such facility called by any
name,
But in this a Medical .Practitioner who does his
practice, but a clinic withodt bed facility not included.
(m)
'Medical treatment'
means Allopathy or Ayurveda,
Unani,
Homeopathy,
Yoga,
Nature
cure
and
Sidda
through
other
recognised Medical system any disease prevention, treatment or
any other systematic diagnosis and treatment done to improve
health condition of all individual this includes accupuncture
and Accupressure also.
(n) 'Nursing Home' means Physical & Mental (body & mind's)
disease
any
institution,
including maternity home which
observes having disease, (Physical & Mental) (body & mind's)
suffering or ailing from weakness,
cares
and treatment
generally admits and with the purpose of keeps or having both
purposes such institutions.
(o) 'Physiotherapy Institution'
this includes disease or
treating illnesses or improvement in health or for the purpose
of rest or any other purpose mentioned earlier in this section
directly or indirectly or any other purpose generally, massage,
hydrotherapy relief
exercises
any
Institution does
such
treatment.
(p) 'Private Medical Institution'
means any Institution run,
managed or sponsored medical institution one other than the
following
(i) State Government or Central Government or
(ii) Owned by State or Central Government or Public Sector
Industries regulated by Governoent or other legal
corporation!
(iii) Owned by State or Central Government or their regulated
autonomous Institutions.
(iv) State or Central Government or both or a co-operative
society having more than fifty percentage shares, registered
under Karnataka co-operative Societies Act 1959.
4
(v)
Owned by State or Central Government or regulated by them
and registered Co-operative Society registered under Karnataka
Co-operative Societies registration Act. 1960.
(vi) Any Local authority owned by State or Central Government
or Trust managed by.
All Private Medical Institutions should get recognition
III.
Any Private Medical Institution should not be established, run
or managed in State after a prescribed date or after given
recognition, rules and under conditions and according to under
this Act.
But, an Institution existing before the prescribed date, should
submit application for such recognition within ninety days from
the prescribed date and could run and manage till related
orders are despatched or arrived.
.
p',
I
Recognitory Authority
IV.
1. There should be one Recognitory authority for Bangalore
Metropolitan Area and another Recognitory Authority for other
than Non Bangalore Metropolitan areas..
h ' r
2.
(a) Bangalore Metropolitan Are Recognitory authority should
have the following
(i) Director, Medical Education - president
(ii) Medical Officer Bangalore Metropolitan
Corporation
Member
(iii) Regional Joint Director, Bangalore - Member, Secretary
M
J
(b)
Other
than
</.■■ •
1
Bangalore’
Metropolitan
Area
Recognitory
Authority should have following
(i) Director, Health & Family Welfare Services - President
(ii)
(iii)
Joint Director, Medical Education - Member
Medical Education Directorate Office
Joint
Director
(Medical)
Health
#<-^Member
Family Welfare Services Directorate Office.
Secretary
7‘b|||4
But
apart
from Allopathy
any
other
recognised
Medical
Institution related to Indian Medicine giving treatment for
Bangalore Metropolitan
area
recognitory Authority should
and
alos
for
states
other
area
select Director, Indian
5
System of Medicine or a representative not less than the grade
of Asst. Director.
Q' ■ " ' ‘
V.
Application for Recognition
Every individual wish to
establish run or manage continue to manage Medical Institution
in a specified form and method with such fee remit with
application to the concerned authority and could specify
(order) different fee for different grade or grades private
Medical Institution.
VI.
W
kc '''
'
* 4
j"-
(1) Grading (Ranking) (Assorting) of applications
After receiving application under Section 5, the Recognitory
Authority should keep clauses
section 7 in mind and after
necessary enquiry by the local study committee and under
specified (ordered) conditions could give recognition or reject
the application.
But Recognitory authority should not reject the application
unless the applicant is given aA appropriate oppurtunity for
(hearings) and such reasons for rejection is documented^'1'
(noted) (Made note of) /.
.
,•
,.
, ... .
m oJ
bo
(2) Applicant should be informed immediately about each order
released under No.l sub section.
(3) Every recogniton given under No.l sub section will be
vali^d for five years and could be renewed once in five years
through an application and payment of such fee should be
remitted in such specified form.
VII. Factors to be considered in disposing applications under
6th section
Recognitoa'L| authority while disposing applications under 6th
section should keep in mind the following factors that means
i.e.
(i) The place surrounding Private Medical Institution should be
in a healthy environment and it should be (fit) otherwise
appropriate for the purposes of establishment or want to
establish one in future.
(ii) Private Medical Institution should have sufficient number
of qualified Doctors, Nurses, Technical & other Para Medical
staff.
6
(iii)
Private
Medical
Institution
Uayc.
for
their
maintenance
of
various Departments should buildings with adequate space, means
machineries and other infrastructural facilities.
(iv) Private Medical
Institution
should have
(specified
facilities and) such Human Resource means, machinaries and
should be in a position to maintain such standards.
(v) Private Medical Institution
standards mentioned in section 9.
(vi)
Specified such other matters.
VIII.
Local Study Committee
be
should
according
to
the
1. There should be a Local Study Committee comprising of the
following individuals for every district.
(a) District Surgeon - chairman
(b) District Health & Family Welfare Officer - Co-Chairman
(c) President
Secretary
Indian Medical Association, Dist.
Central Office Branch -
- Member
(d)
(e)
Senior Expert (Surgery)
- Member
Senior Expert /[obstetrics & GynecologyJ - Member
(f)
(g)
Dist. Public Hospitals Nursing/Superintendent - Member
Resident Medical Officer of Dist. Public Hospital - Member,
Secretary
But for Bangalore Metropolitan Area State Government could
constitute a seperate study committee with specific individuals
through a notification (-instruction).
'
I '/■
And but, for the purposes of study of other than allopathy
Medical Institutions providing treatment through Indian system
of Medicine respective District Indian Medicine Department's
Asst. Director also should be selected as a Member of Local
Study Committee.
C” Ie
' V'A‘'A;
?’■ 1
' ' J I '' '
2. Local Study Committee could on its own or after receiving
complaint,
at any time,
conduct
study
(supervision)
to
understand whether any medical institution is observing clauses
or rules and recognition conditions made under this act.
The
Manager of Private Medical Institution is responsible to
provide all facilities for such supervision (study).
7
3.
a£. the
time of supervision (study) if Local Study Committee
se^S any defects
or deficienses
should
report
to
the
Recognition Authority and could instruct the Private Medical
Institution Manager to rectify specified within a reasonable
time.
After that the Manager should follow every instruction
and report to the Recognition Authority about the following
(observing) of instructions within a specified time.
IX.
Standards
1. Every Private Medical Institution staff and their necessary
qualification, operation theatre, buildings, necessary space, !
i I.
l
e
means, machinaries, facilities to be provided for patients and '
their attendants, maintenance or any other matter related
should be according^standards mentioned under this act or any
other law.
(
'
2. For the purpose of this act the State Government under
sub-section No.l related to specific standards could grade and
set Private Medical Institutions under different categories of
Medical Institutions according to standards.
X.
Fee charges to be informed
For patients and for Public information every Private Medical
Institution should inform fee charged for various Medical
treatment and other services, details of fee structure (tariff
card) should be displayed on the Notice Board in a prominent
place.
2. No Private Medical Institution should charge or collect more
than what is mentioned in Tariff Card from the patients or
relatives and even
amount if charged or collected give
suitable receipt.
XI.
Responsibilities of Private Medical Institutions
1. Every Private Medical Instituttion ,
(i) To provide necessary first aid and life saving
maintaining emergency Medical care for all medicolegal
or
or
possible medicolegal incidents, street accidents, Accidential
or provoked burns or poisoningefjtjon or criminal assault or of
similar pattern.
8
(li) To participate actively in all National and State Health
programmes specified from time to time by the State Government
and to submit reports (regarding) regularly to concerned
authorities.
(iii) To maintain appropriate Medical records in specified such
form and in such method.
(iv) To prevent infectious diseases spreading from rhe person
affected to others and to take all legal actions, carry out and
report immediately to public health authorities.
2. Carry out these no Private Medical Institution should take
the services of Government Doctor and Para Medical Staff.
XII.
Suspension or Cancellation of recognition
(i) Recognitory authority either by itself of by a complaint of
Violation of rules or recognition conditions made under clauses
or sub sections of this act, can give show cause notice to
anyPrivate
Medical
Institution
and
ask
why
not
their
recognition
mentioned.
be
suspended
or
cancelled
for
the
reasons
(ii) After having given suitable time (chance) and conducted
possible necessary enquiry if recognition authority understands
that, such violation has taken place, it can suspend or cancel
recognition till such date it feels right and intimate to the
Private Medical Institution immediately.
But while suspending or cancelling recognition of Private
Medical Institution for violation of section 11 sub section 2
recognition authority should immediately report to the State
Government about suspension or cancellation also action to be
taken against
staff.
XIII.
concerned
Government
Doctor
and
Para
Medical
Appeals
(i) Any Private Medical Institution submitted application for
recognition has been rejected or suspendednoted- recognition
or faced any other difficulty due to basic order under this Act
can appeal to the appellate enquiry authority in a fixed method
and after paying such fee.
10
(d) To fulfil the objectives of this act may be necessary in
future execute other officers.
But, not to necessiate any individual to answer any question or
to provide any witness which entiles himself or herself in
crime under this sub section.
But also, not to enter and search any residential area (not a
Private Medical
Institution also residence)
without the
authority through a search warrant of a magistrate having
jurisdiction of that area and all search and confiscation
according to this section as far as possible should be done
according to sub section of Criminal procedure code of 1973
(■Central Act rrf 1979) (1974 Central Act 2)
(ii) Appointed Officer should report to the recognition
authority about the result of study, search and confiscation
under (1) sub section and recognition authority should take
neicessary action regarding the current order under this act.
XIV.
-C rimes from Company
1. If a company has committed any crime against any rules of
sub section of this act or under.
Every individual (person)
who is incharge of the company and was responsible to run the
business of the company also at the time of the crime should be
thought of guilty of crime oempaBy and according to that submit
oneself for litigation and (to carry on legal proceedings)
should be bound to penalisation.
2. Any thing that is inclusive in (1) sub section, proved if a
company has committed such crime and crime committed by any one
of Director, Manager, Secretary or from the consent of other
Officer, or if accused as (charged) happend due to any
managerial reasons, such Director, Manager, Secretary or other
Officer should be thought of guilty of crime and according to
that submit
penalized.
oneself
to
carry
on
legal
procedures
and
get
Description - for the purpose of this section (a) 'Company'
means, this includes a limited corporation, and that trust,
firm a union of individuals of other institutions.
(b) 'Director' means (i) A partner of a firm related to a firm.
(ii) Union, Trust or other institution in relation to a union,
11
a trust or individuals in relation to other institution means
an individual or person who has taken the
management subject to the affairs
under their rules.
XVII.
of
responsibility of
union,
trust
or
other
Cognisance of Crimes
Any court, Local Study Committee Chairman, should not take
cognisance of Crime which could be punished under this act
unless submitted along with pre acceptance of recognition
authority with a written complaint.
XVIII. Power of the State Government to give the direction to
Recognitory Authorities.
To guard (observe) (protect) the objectives of this act the
State Government can give necessary or opines appropriate
direction to recognitory authority or local study committee.
The Government shall current directions and reasons, that
necessiate to release and to observe such directions shall be
duty of Recognitory Authority or Local
Study committee
accordingly.
IX.
Protection for action taken with good intention.
No prosecution or legal proceedings will be filed (booked)
against any individual of State Government any officer or
authority with relation to any action intended or taken with
good intention in following any rde or order made under sub
sections of this act.
XX.
Prevention of problems
If any problem arises in implementation of sub sections of this
act the State Government can publish orders in gazette to
prevent problems which
necessary or seen appropriateby it
can make sub sections which are not in consistent to the sub
sections of this act.
But any such order shall not be made the expiry of two years
duration of this act since act since its beginning.
12
c
. Power to formation of rules
(i) Formation of rules can be done by the State Government to
fulfil the objectives of this act through gazette notification
and after pre publication.
O
(ii) Specially and which does not generally obstruct the powers
mentioned previously (before)
such rules can create sub
sections on any matter, mentioned below, that means(a) Method of submitting application for recognition and fees
prescribed with application under section (5)
(b) Under which condition, what (which) form and for what
duration recognition could be given any such conditions, form
and duration under section (6)
(c) Which method and which form what duration and on what
payment of fee for renewal of recognition such method and form,
duration and fee under section (6)
(d) Factors to be considered by
section (7)
recognitory
authority under
(e) Standards to be (enacted) executed by recognitory authority
under section (9)
(f) Method to submit appeal and payment of fee to be made under
section (13)
(g) Any necessary rules or any other matter to be laid down (be
ordered) (to nominate)
XXII. Rules and orders
legislature houses.
to
be
placed
i-n
r' f
I* ”*
front
of
state
Every order made under section 18 and every rule made under
section 19 shall be placed after its formulation in front of
each house of State Legislature at the earliest during one or
two or more cdflecutive sessions contained in a duration of
total thirty days when the session is on and before closing of
above
mentioned
session.
Immediate
after
session
or
consequtive sessions, if both the houses agree to make any
13
changes in any rule or order or if decides not to make any rule
or order, after that that rule or order shall come into effect
or shall not come into effect only in such changed manner
(method) .
Even then any such change or cancellation will not
come in the way of any existing action made under this rule or
order.
XIII. Repeal and Retain
(i) Karnataka Private Nursing Home (regulation) act, of 1976
(1976 Karnataka Act 75) has been repealed through this.
(ii) Even though repealed
(a) Any act or any action under the repealed act should be
thought made or done under agreed upon .sub section of the act.
(b) according to repealed act all the pending applications
submitted before and on the date of commencement of this act
submitted for consideration registration or renewal shall Li
cancelled and all the fee paid anything related to such
application to be repaid to applicant and such applicant may
submit a fresh application for the lapses under sub sections of
this act.
OBJECTIVES AND STATEMENT OF REASONS:
To obtain effective regulation of Private Medical Institution's
policy.
(For the purpose of obtaining), it is felt necessary to bring a
comprehensive policy, instead of Karnataka Private Nursing Home
(Regulation) act, 1976.
This act, along with other matter
create sub section regarding the following.
(i) Private Medical Institutions recognition and suspension of
regulation and cancellation.
(ii) Formaiation
committee.
of
regulatory
authority
and
local
study
(iii) To classify Private Medical Institutions in relation to
various standards and to necessiate to observe standards with
relation to Private Medical Institutions, staff, operation
theatre, buildings, means and machinaries etc.,
14
(iv)
To necessiate each Private Medical Institution to publish
its fee (charge) order method for various Medical treatment and
other services.
(v)
Responsibility of Private Medical Institution
(vi) Penalty for violation of act and rules.
Few other
effective and incidental transaction of purpose has also been
made.
Hence this act.
FINANCIAL MEMORANDUM
There will not
present action.
be
extra
(additional)
Memorandum regarding power to formulate
expenditure
from
the
legislation
Section 5 this section gives power to the State Government in
relating to obtain
recognition
for Private Medical
Institution related to form of submission of application and
method and fee to be paid.
section 6 This section gives power to the State Government to
formulate rules with relation to following matters.
(i)
Recognition
approval
conditions
(for
approval
of
recognition)
(ii) Application form (specimen) & method & payment of fees.
Section 7
Facilities to be provided by Private Medical
Institution necessary skilled Human Power
(resource)
and
machineries and standards to be maintained (observed) and gives
power to the State Government with relation to formation of
rules of such other matter.
Section 9
Gives power to the State Government to formulate
rules to specify various standards for separate classes of
Private Medical Institutions.
Section 11
Gives power to the State Government to formulate
rules regarding what form and which method to maintain Medical
records of Private Medical Institutions.
14
(iv) To necessiate each Private Medical Institution to publish
its fee (charge) order method for various Medical treatment and
other services.
(v) Responsibility of Private Medical Institution
(vi) Penalty for violation of act and rules.
Few other
effective and incidental transaction of purpose has also been
made.
Hence this act.
FINANCIAL MEMORANDUM
There will not
present action.
be
extra
(additional)
Memorandum regarding power to formulate
expenditure
from
the
legislation
Section 5 this section gives power to the State Government in
relating to obtain an#- recognition
for Private Medical
Institution related to form of submission of application and
method and fee to be paid.
section 6 This section gives power to the State Government to
formulate rules with relation to following matters.
(i)
Recognition
approval
conditions
(for
approval
of
recognition)
(ii) Application form (specimen) & method & payment of fees.
Section 7
Facilities to be provided by Private Medical
Institution necessary skilled Human Power
(resource)
and
machineries and standards to be maintained (observed) and gives
power to the State Government with relation to formation of
rules of such other matter.
Section 9
Gives power to the State Government to formulate
rules to specify various standards for separate classes of
Private Medical Institutions.
Section 11
Gives power to the State Government to formulate
rules regarding what form and which method to maintain Medical
records of Private Medical Institutions.
15
Section 13
Gives power to the State Government to formulate in
relation to which method and what fee while submitting appeal
to appelate authority regarding any problem faced by Private
Medical Institution due to any basic order.
Section 14
Gives power co the State Government to formulate
rules to fulfill the objectives of this act and carry on any
other action of other matter.
Dr. H.C.MAHADEVAPPA
Minister, Health & Family Welfare-
Mr.H.C.RUDRAPPA
Secretary
Translated from Kannada to English
Dr.T.N.MANJUNATH
Mysore.
Telephone No. 443565
mail.
e.
manjanatgtn@ Hotmail.Com
Li
IT98
INCOME
TAX EXEMPTION TO EDUCATIONAL AND MEDICAL INSTITUTIONS
- AMENDMENTS MADE BY FINANCE ACT 1998
The educational and medical institutions in India have
enjoying the benefit of exemption from Income Tax for
decades.
been
some
Section 10 (22) of the Income Tax Act 1961 provided for exemption
of "any income of a University or other educational institutions
existing solely for educational purposes and not for the purposes
of profit".
Section 10 (22A) of the Act provided for exemption of "any income
of a hospital or medical institution existing
solely for
philanthropic purposes and not for the purposes of profit".
Through an amendment made by the Finance Act 1998 the above two
clauses have been omitted with effect from 1999-2000.
According
to the Union Finance Minister, the Government had to resort to
such an action since "the blanket exemption” from Income Tax in
respect
of educational and medical institutions had
been
"misused" and, therefore such institutions need "to come under a
discipline”.
There were wide protests from different quarters against the move
of the Central Government in taking away the privileges of
educational and medical institutions.
In response to
the
representations made by various organizations, associations and
our member institutions, the Union Finance Minister has agreed to
continue the exemption with certain modifications in the Act for
education and medical institutions.
Accordingly, Section 10 (230 of the Income Tax 1961 has been
ammended and certain clauses have been inserted to provide
exemption to any income of such University or other Educational
institution
or hospital or medical institution
which
is
established not for the purpose of profit and
or
which is wholly
Government; or
substantially
whose
aggregate annual
prescribed amount; or
receipts
financed
do
not
by
the
exceed
a
which may be approved by the prescribed authority under
Section 10 (23C).
1
Other
Educational and Medical Institutions which
are
of
charitable nature will henceforth have to claim income tax
exemption
under Sections 11 and 12 of the Act subject to the
fullfilment of necessary conditions. They will have to make
application for registration under Section 12A of the Act and
shall be required to obtain order for registration.
The Prescribed Amount
The Finance Minister has announced that the "prescribed amount"
will be Rs 1 crore for the time being.
It may be reduced later.
Approval Under Section 10 (23C)
Under Section 10 (23C) any income received by any
behalf of the following funds, is exempt from tax :
on
person
[sec
a.
the
Prime Minister's
10(23C)(i)]; or
b.
the Prime Minister's Fund (Promotion of Folk Art) [sec.
10 (23C)(ii)]; or
c.
the Prime Minister's Aid to Students
(23C) (iii); or
[sec.
10
d.
the National Foundation for Communal Harmonay [sec.
(230 (ilia)]; or
10
e.
any other charitable fund or institution
notified by the Central Gorvernment [sec.
(iv)]; or
f.
any trust (including any other legal obligation) or
institution wholly for public religious purposes or
wholly for religious and charitable purposes which is
notified by the Central Government [sec. 10 (230(v)].
Application for
& f above)
National
Relief
Fund
Fund
which is
10 (230
approval under sub-clause (iv) and (v) (Refer
e
Public charitable and religious trusts/associations/societies
registered under the Societies Registration Act, 1860, etc, which
seek notification by the Central Government under
section
10(230(iv)/(v) are advised to file an application directly to
the Commissioner of Income-tax under whose jurisdiction the case
of the trust / association / society falls. In the case of a
trust/association/society which enjoys recognition certificate
under section 80G it will be the Commissioner who has issued the
certificate. In cases where no 80G certificate has been obtained
it will be the Commissioner in charge of Trust Circle.
2
Along with the application, the following
submitted to the Commissioner:
details
should
be
and
articles
of
of
the
*
A copy of the deed of trust/memorandum
association.
*
A
list of trustees
Governing Council, etc
*
A photostat copy of the registration granted by the
Commissioner / Registrar of Societies.
*
A photostat copy of the communication from the Commissioner
with reference to the application of the trust / society for
registration under section 12A(a).
*
A photostat copy of the latest 80G certificate issued by the
Commissioner.
*
True copies
three years.
the
last
*
Copies of audited accounts and balance sheet for the
subsequent to the assessment.
years
*
Copies of annual reports wherever available.
including
settlor/members
of the assessment orders passed for
Charity
An extra copy of this application with the enclosures may be
endorsed to the Secretary (IT) (A-I), Central Board of Direct
Taxes, Department of Revenue, Ministry of Finance, North
Block,
New Delhi.
Exemptions under Section 10 (23C) (iv) and (v) is subject to
following conditions:
the
1.
Government has been empowered (for the prupose for the grant
of exemption) to notify any fund or institution established
for charitable purposes, having regard to its objects and
importance throughout India or throughout any one or more
States; and any trust and institutions, which is either
wholly for public religious purposes or wholly for public
religious and charitable purposes having regard to the fact
that it is administered and supervised in
a manner to
insure that its income is properly applied for its objects.
2.
For
availing the exemption the trust or
institution
(educational or medical) has to comply with the following
provisions of the section 10 (230:
a.
make an application to the prescribed authority [i.e.
the Director General (Income Tax - Exemption)] for the
purpose for the grant of exemption or continuance
thereof;
3
b.
furnish documents including audited annual accounts or
information to the Central Government inorder
to
satisfy itself about the genuineness of the activity
of the fund or trust or institution ;
c.
apply or accumulate its income wholly and exclusively
to the objects for which it is established;
d.
invest solely in investments specified under Section 11
(5) of the Act;
e.
do only the business incidental to the attainment of
its objectives and maintain separate books of account
in respect of such business.
The Educational and Medical Institutions which may be approved
under Section 10 (23C) will have to convert their investments
made before 1 June 1998 to those approved under Section 11 (5)
on or before 30 March 2001.
Forms or Modes of Investment under Section 11 (5)
A uniform pattern of investment is laid down, with effect from
April 1 1983 for all categories of funds belonging to charitable
and religious trusts or institutions. The same pattern
of
investment will apply in relation to accumulation of income in
excess of 25 per cent. The uniform forms or modes for investing
funds of charitable and religious trusts and institutions are
given below:
a.
investment in Government savings
b.
deposit
c.
deposit in any account with any scheduled bank or a co
operative society engaged in carrying on the business
of banking (including a co-operative land mortgage
bank or a co-operative land development bank);
d.
investment
in any Central
Government securities;
e.
investment in units of the Unit Trust of India;
f.
investment in debentures of any corporate body,
principal
whereof and the interest
whereon
guaranteed by the Central or a State Government;
g.
investment or deposits in any public sector company;
h.
immovable property;
i.
deposits with or investment in any bonds issued by any
financial corporation engaged in providing long-term
funds for industrial development in India, if the
corporation is approved by the Central Government
for
the purpose of Section 36(l)(viii);
in any Post Office
4
certificates;
Savings BAnk Account;
Government
or
State
the
are
b.
furnish documents including audited annual accounts or
information to the Central Government inorder
to
satisfy itself about the genuineness of the activity
of the fund or trust or institution ;
c.
apply or accumulate its income wholly and exclusively
to the objects for which it is established;
d.
invest solely in investments specified under Section 11
(5) of the Act;
e.
do only the business incidental to the attainment of
its objectives and maintain separate books of account
in respect of such business.
The Educational and Medical Institutions which may be approved
under Section 10 (23C) will have to convert their investments
made before 1 June 1998 to those approved under Section 11 (5)
on or before 30 March 2001.
Forms or Modes of Investment under Section 11 (5)
A uniform pattern of investment is laid down, with effect from
April 1 1983 for all categories of funds belonging to charitable
and religious trusts or institutions. The same pattern
of
investment will apply in relation to accumulation of income in
excess of 25 per cent. The uniform forms or modes for investing
funds of charitable and religious trusts and institutions are
given below:
a.
investment in Government savings
b.
deposit
c.
deposit in any account with any scheduled bank or a co
operative society engaged in carrying on the business
of banking (including a co-operative land mortgage
bank or a co-operative land development bank);
d.
investment
in any Central
Government securities;
e.
investment in units of the Unit Trust of India;
f.
investment in debentures of any corporate body,
principal
whereof and the interest
whereon
guaranteed by the Central or a State Government;
g.
investment or deposits in any public sector company;
h.
immovable property;
i.
deposits with or investment in any bonds issued by any
financial corporation engaged in providing long-term
funds for industrial development in India, if the
corporation is approved by the Central Government
for
the purpose of Section 36(l)(viii);
in any Post Office
4
certificates;
Savings BAnk Account;
Government
or
State
the
are
j.
deposits with or investment in any bonds issued by any
public company carrying on the business of providing
long-term finance for construction or purchase of house
in India for residential purposes, if the company is
approved by the Central Government for the purpose of
section 36(1) (iii);
k.
deposits
with Industrial Development Bank
(with effect from April 1, 1985); and
1.
Investment in Units issued under any scheme of
fund referred to in section 10 (23D).
*
of
India
mutual
SBI Mutual Fund and Canbank Mutual Fund set up by
the
State Bank of India and
Canara
Bank
respectively.
*
LIC Mutual Fund.
*
The India Magnum Fund
State Bank of India.
N.V.
Mutual Fund set up by
*
Indian Bank Mutual Fund set up by Indian Bank.
*
PNB Mutual Fund set up by Punajb National Bank.
*
BOI Mutual Fund
*
Asian
Convertibles and Income Fund
set up by State Bank of India.
*
GIC Mutual Fund set up by the
Corporation of India.
*
Canbank (offshore)
Canara Bank.
*
BOB Mutual Fund set up by the Bank of Baroda.
set up by Bank of India.
Fund
Mutual
General
Insurance
Mutual Fund set up
by
the
*
ICICI Mutual Fund * Indbank Offshore Mutual Fund.
*
Commonwealth Equity Fund Mutual Fund.
*
Kothari Pioneer Mutual Fund
*
Morgan Stanley Mutual Fund *
*
CRB Mutual Fund *
*
20th Century Mutual Fund
*
JM Mutual Fund
*
Shriram
*
*
Taurus Mutual Fund.
Apple Mutual
Birla Mutual Fund.
IDBI Mutual Fund.
*
Ind Bank Communicatins (Offshore) Fund.
*
HB Mutual Fund
5
*
Fund.
Mutual Fund.
Alliance Capital Mutual Fund.
TAX EXEMPTION FOR CHARITABLE AND OTHER TRUSTS
Income of a charitable trust is exempt from tax according to the
provisions of Sections 11 and 12. The trust should be one
established in accordance with the law and its objects should
fall within the definition of the term "Charitable Purposes".
Charitable Purposes
Definition
In India the expression 'Charitable Purposes' was defined for
the first time in the Charitable Endowments Act, 1890 (Act No.
VI of 1890). Section 2 of that Act defined Charitable Purposes
as including "Relief of the Poor, Education, Medical Relief and
the advancement of any other object of general public utility but
not including a purpose which relates exclusively to religious
teaching or worship".
Section 2 (15) of the Income Tax 1961 uses the above definition
for charitable purposes as follows: "to include relief of the
poor, education, medical relief, and the advancement of any other
general public utility".
The test to determine the 'charitable purpose'
within the
meaning of Income Tax Act for the purpose of grant of exemption
is "what is the predominant object of the activity—whether it is
to carry out a charitable purpose or to earn profit ?"
If the
predominant object is to carry out a charitable purpose and not
to earn profit, the purpose would
not lose its charitable
character merely because some profit arises from the activity.
[C.I.T. vs A.P.R.T. Corporation (1986); AIR 1986 SC 1054].
The
essential factor to determine whether it is a charity or not
would be whether there is any private gain by setting up the
institution or society.
Essential Condition for Exemption under Section 11
1.
The property from which income is derived should
under a trust or other legal obligation.
2.
The property should be held for charitable or religious
purposes. In the case of a charitable trust created on or
after 1 April 1962, the following conditions are also to be
complied with:
be
held
a.
the trust should not be created for the benefit of any
particular religious community or caste;
b.
no part of the income should enure directly
or
indirectly for the benefit of the settlor or other
specified persons, and
c.
the property
purposes;
should
6
be held
wholly
for
charitable
3.
The exemption is confined to only such portion
of the
trust's income
which is applied to charitable or religious
purposes or is accumulated for applying to such purposes
within the limit if accumulation permitted under Section 11
(1) and (2).
4.
The
trust
should get itself
registered
with
the
Commissioner of Income Tax within one year from the date on
which the trust is created. The accounts of the trust
should be audited for such accounting year in which its
income exceeds Rs 50,000/-. The funds of the trust should
be invested in any one or more of modes or forms mentioned
in Section 11 (5).
5.
According to Section 11 (1), in order to claim
exemption, a charitable trust or institution has
atleast 75% of the income to charitable or
purposes.
full tax
to apply
religious
CHARITABLE / RELIGIOUS TRUST — APPLICATION FOR REGISTRATION
Application for registration of charitable / religious trust etc
shall be made in duplicate in Form No. 10A and shall be
accompanied by the following documents:
1.
Original
copy
of instrument creating
the
trust
/
institution, i.e. trust deed, with one copy thereof, where
trust
/institution
is created under
an
instrument.
Certified copy in lieu of original copy of trust deed can
also be accepted by the Commissioner.
2.
Documents evidencing the creation of trust / institution,
with one copy thereof, where trust / institution is created
otherwise than under an instrument.
3.
Where the trust / institution has been in existence
during
any year(s) prior to financial year in which application for
registration is made, the applciation should be accompanied
by two copies of accounts of trust / institution relating to
prior year or years, not being more than 3 years immediately
preceding the year in which application is made.
Conclusion
For the persent those institutions with annual receipts below Rs
1 crore will continue to enjoy income tax exemption as in the
past.
But the Law has become more complex for educational and
medical
institutions
which are not
financed
wholly
or
substantially by the Government and those whose receipts
exceed
Rs 1 crore they will have adhere to all the regulations under
Section 10 (23C) besides obtaining specific approval of the
Government and conversion of all the existing investments under
Section 11(5) on or before 30 March 2001.
7
Educational and medical institutions in the voluntary sector
especially those which are run by the Christian Minority in our
Country contribute substantially to education and health care,
thereby supplementing the Governments' efforts in eradicating
illiteracy and improving the health of the people. Withdrawal of
the exemption will adversely affect the health care institutions.
The end-result, overburdening of people, especially the poor and
the marginalized, with escalating cost in health care.
Besides,
the quality of health care services now being provided by the
institutions will suffer. Exemption from income tax has been of
great help.
The savings, along with the contributions from
philanthropists and general public, are being utilised for
upgrading the skills of the personnel involved in the delivery of
health care and in equipping the institutions with latest
technology. Such being the case, one expects the government to
render additional support, rather than taking away the already
extended benefit.
Compiled by Mr Thomas Kunnil, CHAI, Secunderabad
F:\USER\MEM\PHLDOC.11 September, 1998
PRIVATE HOSPITAL LEGISLATION
Thomas Kunnil
1.
INTRODUCTION
Recent years have witnessed a mushrooming of private hospitals, nursing
homes, clinics, dispensaries, etc all over the country. These are run to provide
medical care facilities to people but many of them function in an unorganized
and haphazard manner. Some of the institutions charge exorbitantly for their
services. In the process, the poor and the needy are denied the services. They
either flout or do not follow health norms or ethical principles. Many of them
are located in unhygenicand environmentally polluted areas.
It is the duty and responsibility of every government to set standards for health
care and to see that quality care is offered. Health being a State subject (Entry 6
of List II of 7th schedule to the Constitution of India), it is the State
legislature that makes Laws on the subject. So, legislations on health may not
be uniform throughout India.
Usually, the State legislature passes the broad outlines or skeleton of the Act. It
is the bureaucrats who give ’flesh and blood to the Act so that it may live’.
Legislation on private nursing homes is not a new phenomenon. It was
there even before Independence.
In the early 50’s, a few States had made
attempts to bring out legislations for controlling private nursing homes and
clinics.
2.
BILLS ON PRIVATE HOSPITALS/NURSING HOMES
a)
Maharashtra
There was an Act known as “Bombay Nursing Homes Registration Act 1949”
(Bombay Act No. XV of 1949). In 1973 rules were made known as
"Maharashtra Nursing Homes Registration Rules 1973".
b) Delhi
The Union Territory of Delhi enacted "The Delhi Nursing Homes
Registration Act, 1953" (Act 6 of 1953). The rules made under this Act in
September 1953 were amended by the Delhi Nursing Homes Registration
(Amendment) Rules 1965. Further amendments were made by the Delhi
Nursing Homes Registration (Amendment) Rules 1992
Madhya Pradesh
c)
The Madhya Pradesh State government brought an Act in 1954 known as "The
Madhya Pradesh Nursing Home Registration Act 1954" (28 of 1954). It was
repealed in 1973 by the Act of The Madhya Pradesh Upcharyagriha Tatha
Rujopchar Sambandhi Sthapanaye Registrikaran Tatha Anugyapan Adhiniyam
1973 (No. 47 of 1973). Under this Act Rules have been made known as Madhya
Pradesh Upcharyagriha Tatha Rujopchar Sambandhi Sthapanaye (Registrikaran
Tatha Anugyapan) Rules 1997.
d) Bihar
An attempt was made by the Government in 1975 by issuing an ordinance to
control the Nursing Homes and clinical establishments but it could not become a
law due to various reasons. Finally in 1996 the Bihar government brought
another proposal to control the private nursing homes under an Act known as
"Bihar Nursing Homes and Clinical
Establishment" (Registration and
License) Act 1996.
e)
Kerala
In 1997 Mr P P Sulaiman Rawther, MLA presented a Bill in the State
Assembly known as Kerala Private Hospitals (Control Board) Bill (Bill No.
58 of 1997). But no discussion or follow-up was made by the Government.
f)
Tamil Nadu
The Tamil Nadu Government has enacted the Tamil Nadu Private Clinical
Establishments (Regulations) Act 1997. Subsequently, Tamil Nadu Private
Clinical Establishments (Regulations) Rules 1998 have been made and published.
g)
Andhra Pradesh
On 16 May 1995 the Speaker of the Andhra Pradesh State Legislative
Assembly constituted a House Committee to go into the question of
concessions, tax/import duty exemptions and other benefits given to the
corporate hospitals like Deccan Medical Centre (Appolo Hospital), CDR,
Medwin, Medinova, Medicity and other private nursing homes by the State
and Central Governments and the conditions upon which such concessions etc
were given and to find out:
a)
Whether or not the said Corporate Hospitals/Nursing Homes honoured the
conditions imposed for granting such conditions, exemptions, benefits etc.,
b)
to examine the efforts made by the authorities concerned in seeking
compliance of the terms and conditions
imposed upon them by
2
Government for granting such concessions, etc., and the action if any taken
against them for failure to honour the conditions;
c)
to make suitable recommendations for strict compliance of the conditions
imposed on the Hospitals by the Government in future.
The Committee had made a thorough study of the matter and given a number
of recommendations including the need to bring "a comprehensive legislation
to regulate Private Hospitals, Nursing Homes, Diagnostic Centres etc by the
Government and to issue licences to the Private Hosptials / Nursing Homes. The
Committee also recommended that a provision be made in the Legislation to
the effect that unnecessary investigations and prescriptions of drugs are avoided.
The Committee also drafted a model Bill to be enacted by the State Legislature and
the Act is to be called "The Andhra Pradesh Private Hosptials, Nursing
Homes, Clinical Establishments (Licensing & Registration) Act 1996.
h.
Gujarat, Karnataka, Rajasthan & West Bengal
Similar legislations are being contemplated by the States
Karnataka, Rajasthan & West Bengal. Details are not available.
3.
POSSIBLE REASONS FOR THE SUDDEN
LEGISLATION ON PRIVATE HOSPITALS.
of Gujarat,
EMERGENCE
OF
• There is a drastic cut in the governmental expenditure on health.
• International funding agencies insist on a cut on the subsidy given to health
care.
• Taking advantage of the situation and the encouragement on the part of the
Government, a large number of Private Hospitals have come up. Most of
these hospitals, nursing homes, clinics are without proper and adequate
personnel and facilities leading to sub-standard health care.
• Enlightened consumers through various forums started pressurising the
government to bring, adequate control over the functioning of private
health care institutions.
4.
Objectives
Through the proposed legislation various State Governments aim to:
• regulate and streamline the private and other health care institution
• ensure maintenance of proper medical ethics and guidelines
• set standard for health care al different levels
• introduce uniform fee structure
• control private practice of government doctors, and
• to help to earn some revenue which would be used for rural health services
3
5) VARIOUS PROVISIONS OF THE BILL/ACT :
a) Applicability
It applies to all health care institutions under private sector i.e. hospitals,
dispensaries, maternity
homes, clinical establishments, pathological
laboratories, x-ray, ultra-sound, body scan, endoscopy and all other types of
diagnostic centres. It also applies to all systems of medicine-allopathy,
ayurveda, homoeopathy, unani and various other alternative systems.
It does not apply to hospitals, clinics, dispensaries and other clinical
establishments of central or state government or local authority.
It also does not apply to any asylum for lunatics, or hospital for patients
suffering from mental diseases within the meaning of the Indian Lunacy
Act any asylum for leprosy patients within the meaning of Leprosy Act (Act 3
of 1898).
In Madhya Pradesh, the Act applies only to areas with population of 50,000
and above.
b)
Registration
Registration and licence is a legal requirement for running a health care
establishment. No preson shall be permitted to carry on any nursing home
or clinical establishment unless the same is duly registered in accordance
with the provisions of the Act.
The existing health care institutions are expected to register under the
Act within three months from the date of the enactment of the Act.
c)
Application for registration and licence
Any person intending to start or carry on nursing home or a
clinical
establishment shall make an application to the authority in such form and
manner as may be prescribed by the Government.
4
Registration fee / Renewal fee
d)
The registration fee varies from State to State. Usually the prescribed fee is shown
in the rules made under the Act. The governments of Delhi, Madhya Pradesh,
Maharashtra and Tamil Nadu have already brought out the Rules. Registration/
Renewal fee in these States are shown as follows:
Delhi
Up to 10 beds Rs 500/-; 11-30 beds Rs 1000/-; above 30 beds Rs 2000/Madhya Pradesh
Up to 10 beds Rs 200/-; 11-20 beds Rs 350/-; 21 - 30 beds Rs 450/-; For each
additional bed above 30 beds Rs 15/-; Physiotherapy centre Rs 200/-; Clinical
laboratory Rs 200/- For outdoor clinics Rs 200/Maharashtra : Up to 10 beds Rs 50/-; above 10 beds Rs 100/Tamil Nadu
Clinics
Rural Area
Rs
250.00
Urban Area
Rs
250.00
Health Centres, Hosptials
Upto 10 beds
11 to 40 beds
more than 40 beds
500.00
1000.00
1500.00
1000.00
2000.00
3000.00
Hospitals, Health Centres
with lab or Xray or scan
2000.00
4000.00
Clinical Laboratories and
or Xray centres or ultra
sonogram centre
CT Scan and or MRI Scan
Centre
Physiotherapy Centre
1000.00
2000.00
1500.00
3000.00
1000.00
2000.00
[Note : 1. The maximum for any combination of two or more
establishments shall not exceed Rs. 5000/2. Renewal fee shall be one half of the fees shown above.]
e)
Certificate of Registration:
It will be granted to the applicant within 30 days if he/she has complied with
all requirements of the Act and the rules made thereunder. Such certificate
should be displayed in a conspicuous place in the nursing home.
5
If, after the inquiry and after giving an opportunity to the applicant of being
heard, the competent authority is satisfied that the applicant has not complied
with the requirements of this act and the rules made thereunder, it shall, for
reasons to be recorded in writing, reject the application for registration.
Validity of the Certificate of Registration:
f)
Andhra Pradesh : 1 year;
Kerala
: 3 years;
Madhya Pradesh : 1 year;
g)
Bihar
Tamil Nadu
Delhi
: 1 year
: 5 years
: 1 year
Suspension or cancellation of registration
At anytime after the grant of registration and licence, if the competent
authority receives any complaints or comes to know that the clinical
establishment is not adhering to the terms and conditions of the licence, an
enquiry will be ordered. If the competent authority is satisfied that there
has been a breach of any provision of the Act or the rules made thereunder
or the conditions of the registration, action will be taken against such
clinical establishment and suspend its registration for such period as it may
think fit or cancel its registration.
h)
Inspection or enquiry
The competent authority shall have the right to order an inspection of, or
inquiry in respect of any clinical establishment, its buildings, laboratories
and equipment and also the work conducted or done by the clinical
establishment. This can be done at any time of the day and with or without
serving any notice to the institution concerned.
i)
Appeal
Any private clinical establishment aggrieved by an order of the competent
authority rejecting an application for registration or an order of suspension or
cancellation of the registration or the inquiry ordered, may within thirty
days of the receipt of the order, prefer an appeal to such authority and in such
manner as may be prescribed. The appeal to be submitted to :
i. Bihar
To the state level committee whose
decision shall be final which would not
be challenged in a court lower than High
Court.
ii. Delhi
To the Chief Commissioner
iii. Andhra Pradesh
iv.Tamil Nadu
j)
:
To the Appellate Board consisting of the
Director of the Medical Education and
Secretary, Health and Medical and Family
Welfare and two other experts in the field
of medical science to be nominated by the
State Government.
To the Appellate Authority (the Director of
Medical and the Rural Health Services).
Penalty
Whoever contravenes any of the provisions of the Act or any condition of the
registration will be punished. The penality clause varies from State to State.
a.
Bihar
Imprisonment for 6 months or a fine of Rs 50,000/-. A second or
subsequent proved offence will be punished by an imprisonment of one
year and or a fine of Rs 50,000/-. For every day of continuing offence
from the date on which the offence has been proved, an additional fine
of Rs 5,000/- in respect on each day on which the offence continuing after
such conviction. Such offenders and illegally operating institutions can
be closed by use of force by the licensing authority.
b.
Kerala : A fine of Rs 50,000/- or 5 years imprisonment or both.
c.
Tamil Nadu: A fine of not less than Rs 5000/- which may extend upto
Rs. 15,000/-
d. Madhya Pradesh : A fine of Rs 500/-
e. Andhra Pradesh :
Major offence with a fine of not less than Rs 20,000/- which may extend
upto Rs 1 lakh. In case of continuing contravention, a fine of Rs 1000/per day. Minor offence with a fine of not less than Rs 500/- which may
extend upto Rs. 2000/- in case of continuing contraventions a fine of Rs
50/- per day.
k)
Furnishing returns:
Every Private Hospital / Clinical Establishment shall within the time fixed
furnish such returns from time to time to the competent authority.
7
I)
Display of service charges
i) Kerala
The Private Hospital Control Board has been authorised to fix the charges
for various services rendered by the clinical establishment. If anyone
collects more than what is fixed by the government, he/she will be punished
as per the rules made under the Act. The clinical establishment is expected
to issue separate receipts for consultation fee, treatment charges, room rent
etc.
ii)
Delhi
The owner or keeper of the nursing home shall display the charges levied for
various services available in the nursing home.
6. VARIOUS VIEW POINTS
Any legislation introduced with a view to regulating the health care system is
welcome. But the proposed Bill in its present form cannot be accepted due to the
following reasons:
1.
Equality before Law
A law made to regulate or streamline must apply equally to all health care
institutions-whether governmental or non-governmental. Making it applicable
only to non-governmental institutions is discriminatory.
2.
Private and Voluntary
Clubbing together all non-governmental institutions as "private" is not
correct. The "voluntary, not-for-profit" institutions must be separated from the
"private-for-profit-institutions”.
It is unconstitutional to treat "dissimilar
institutions as similar".
The Voluntary, not-for-profit health care institutions are helping the government
in the discharge of the duties and responsibilities of the government to provide
health care to the people. As such, governments should support such
institutions as are providing free or concessional care to the poor.
3.
Rural vs Urban
It is not proper to bring all kinds of institutions - large and small, urban and
rural - under the same umbrella.
8
4.
Registration, Renewal and Fee
It is an impossible task to get a clinical establishment registered within the
prescribed time limit of 3 months. The rigid requirements of registration will
definitely entail a long delay due to administrative constraints.
At least 6 months' time should be given for registration etc. The period of
renewal must be 5 years. There should be different rates of fees for issuing
licence and its renewal, depending upon the type of institutions and its location.
5.
Licencing Authority
The appropriate authority / competent authority to issue the license should be
autonomous and not consisting of government servants alone.
There has to be an appellate body, independent of the government.
6.
Uniform Fees
The government should not decide on a uniform maximum fees to be charged by
the institutions. Fees would vary, based on the type of institution, facilities
available, quality of services, types of investigations etc. Primary health care
has to be made affordable and accessible, ensuring equity.
7.
Inspection & Enquiry
The inspection by the competent authority should be carried out only at reasonable
time and only after giving notice to the institution concerned.
No licence may be withdrawn without proper inspection, inquiry and
without issuing a notice. A representative of the institution should be included
in the committee for inspection and inquiry.
7. HOW SHOULD WE RESPOND?
a) Create Awareness
CHAI members and other NGOs involved in the health care activites should be
made aware of the implications of the proposed Bills / Acts. Besides, the people
whom we serve should be taken into confidence and they be made part of
our campaign against any Laws that affect the poor and the needy.
Seminars/workshops at different levels may be conducted for the benefit of
the members and others.
9
b) Committees I Forums
In order to address various issues including Hospital Legislation that affect
the health care institutions under voluntary sector, State committees / forums
could be created . Through them we could voice our concern and take appropriate
action to prevent such laws which hamper the smooth functioning of health care
institutions in the voluntary sector.
d)
Presentation of Memorandum
The voluntary sector can voice their views and recommendations to the
State Government concerned
by presenting
a memorandum.
The
memorandum should be highlighting the contribution of the sector to the
well-being of the people. These may be supported with facts and figures
showing the number of persons treated under different categories and also
the free services rendered.
e)
Alternative Legislation
Drafting and presenting alternative legislation to the government may be
another method of making the governments pass laws that are pro-people. It is
easier for the politicians to say yes when they are given options.
f)
Lobbying
Through lobbying the various policies of the government can be influenced.
Establishing close contacts with local politicians, especially the MLAs and
MPs will go a long way in voicing our concern in the State legislatures and
Parliament. The government should be requested to include representatives of
the voluntary sector in the consultative / expert committees working on various
health legislations.
g)
Legal Action
Needless to mention, we have every right to get justice from a court of law-either
High Court or Supreme Court-against unconstitutional laws as Justice(Retd) V R
Krishna Iyer puts it "equals cannot be equated with unequals".
8.
PRO-ACTIVE ROLE OF CHAI MEMBERS
We have to respect and accept any law that is made to streamline and regulate
the private health care delivery systems which is not efficient or adequate to meet
the needs of the people, especially the poor. How do we contribute to such a
process ?
10
a) Setting Standards
We need to develop
standards for our hospitals and other health care
institutions consistent with the needs of the community and in tune with the
developments in the health care and social fields. Our health care services are to
be streamlined in such a way as to maintain and develop, according to the
needs of the Community, essential services for health promotion and prevention
of ill-health.
Standards
have to be maintained for quality
performance. Implicit in
performance is the need to achieve the desired outcome. It would include
professional competence and all aspects of care.
Such standards must be worked out to ensure
them are :
quality
in health care. Among
*
effectiveness
:
doing the right things, the services provided should
meet
the needs of the people;
*
efficiency
:
doing things right; using the resources carefully, with
clear standards;
*
acceptability
:
choice of service, confidentiality, culturally suited;
*
accessibility
:
people must be able to use the services;
*
appropriateness
:
relevance to the siutation
*
equity
:
all persons needing care get the services.
(Courtesy : Dr C M Francis’ article in Health Action (September 1997))
Standards have to be evolved for
i) Personnel
The institution should have adequate personnel with sufficient training. A
qualified, efficient and committed band of personnel is an asset to the
institution. Their continued medical education should be ensured.
ii) Space and facilities
Adequate space and facility for in-patient and out-patient care should be made
available. For example : The floor space for nursing home shall be 100 square
feet for one bed. A labour room I operation theatre shall have minimum 180 sq
feet floor space etc.
11
iii)
Equipment and instruments
The hospital or health care institutions should have all
and instruments for the patients’ care.
iv)
necessary equipment
Functional programmes
The doctor-patient and nurse-patient ratio should be maintained. The
diagnosis and other support services should be according to the bed strength of
the institution.
In short ,each institution, based on its size, location and needs of the people in
the area will have to decide on the standards to be maintained so that quality
of care is ensured.
The Bureau of Indian Standards (BIS) has laid down some
standards for
hospitals which are 30 bedded and above. The National Institute for Health
and Family Welfare has also formulated standards of Hospitals with 50 beds
and above.
Nearly 70% of CHAI members fall within the category of 1-20 beds. No
standards have been worked out so far for institutions below 30 beds by the
government or any other agencies. Therefore, CHAI has initiated the process
of evolving its own standard for institutions upto 20 beds by conducting a
study with special emphasis to Bihar. We hope by the beginning of 2000 we
will have our own standard for institutions below 20 beds.
b) Self Regulation
Self-Regulation is another method to ensure quality from within. Here the
members define and set the minimum standard, internal administration which
includes personnel management and patient care. The members create their
own inspection team for quality control.
While making assessment of various services rendered by the hospital or other
health care institutions, according to Dr C M Francis, the following questions can
be asked.
* Does the hospital show genuine interest in solving the problems of the patient
*
When the hospital promises to do something by a certain time, does it
do so ?
* Are the records maintained error-free ?
*
Do the personnel give personal attention, are they willing
consistently courteous ?
to
help and
12
* Are the staff accessible / approachable ?
* Do the staff have adequate knowledge and are they willing to answer the
questions of the patients and their families to their satisfaction ?
* Are the hospital facilities good ? Do they have the appropriate equipment ?
Are they maintained in good working order ?
* Is the hospital clean ?
*
Are the staff neat and clean ?
*
Are the staff honest in their dealings ? Do they maintain confidentiality ?
Do they respect the dignity and rights of the patients ?
*
Is the waiting time reasonable ?
* Does the hospital attend to all the needs of the patient - physical, mental,
social and spiritual ?
*
Is the hospital involved in community health in the neighbourhood ?
*
Is the cost of care reasonable and affordable ?
(Courtesy : Dr C M Francis’ article in Health Action (September 1997))
It is also necessary to ensure that our health care institutions take into
consideration the various laws applicable to hospitals while evolving personnel
policies. For example; such as The Industrial Employment (standing orders) Act
1946, Payment of Wages Act 1936, Minimum Wages Act 1948. The Employees
Provident Fund Act 1952, Payment of Gratuity Act 1972, The Trade Union Act 1926.
The workers compensation Act 1923, Industrial Dispute Act 1947, etc.
CONCLUSION
We need to appreciate the Government’s efforts to streamline and regulate the health
care delivery system through legislation and thereby bringing accountability and
quality of care in health care institutions under the Private Sector. But before
embarking on making legislation, the Government should be taken into confidence
all the stakeholders in the process and more importantly, the person at the receiving
end, the common people. At the same time, we need to get our house in order by
introducing our own standards of care which are adequate and appropriate to the needs
of the community.
______ 00*0_______
13
OUR COMMON HUMANITY
The Final Draft of The Asian Charter on Human Rights
Preamble
For long the peoples of Asia suffered from gross
violations of their rights and freedoms during colonial
rule. Today large sections of our people continue to
be exploited and oppressed and many of our societies
are torn apart by hatred and intolerance. Increasingly
the people realise that peace and dignity are possible
only when the equal and inalienable rights of all
persons and groups are recognised and protected.
They are determined to secure peace and justice for
them and the coming generations through the struggle
for human rights and freedoms. Towards that end
they adopt this Charter as an affirmation of the desire
and aspirations of the peoples of Asia to live in peace
and dignity.
Background to the Charter
1.1.
The Asian struggle for rights and freedoms
has deep historical roots, in the fight against
oppression in civil society and the political oppression
of colonialism, and subsequently for the establishment
or restoration of democracy. The reaffirmation of
rights is necessary now more than ever before. Asia
is passing through a period of rapid change, which
affects social structures, political institutions and the
economy. Traditional values are under threat from
new forms of development and technologies as well
as political authorities and economic organisations
that manage these changes.
1.2.
In particular the marketization and
globalization of economies are changing the balance
between the private and the public, the state and
the international community, and worsening the
situation of the poor and the disadvantaged. These
changes threaten many valued aspects of life, the
result of the dehumanising effect of technology, the
material orientation of the market, and the destruction
of the community. People have decreasing control
over their lives and environment, and some
communities do not have protection even against
eviction from their traditional homes and grounds.
There is a massive exploitation of workers, with
wages that are frequently inadequate for even bare
subsistence and low safety standards that put the
lives of workers in constant danger.
1.3.
Asian development is full of contradictions.
There is massive and deepening poverty in the midst
of growing affluence of some sections of the people.
Levels of health, nutrition and education of large
numbers of our people are appalling, denying the
dignity of human life. At the same time valuable
resources are wasted on armaments, Asia being the
largest purchaser of arms. Our governments claim
to be pursuing development directed at increasing
levels of production and welfare but our natural
resources are being depleted most irresponsibly and
the environment is so degraded that the quality of
life has worsened immeasurably, even for the better
off among us. Building of golf courses has a higher
priority than the care of the poor and the
disadvantaged.
1.4.
Asians have in recent decades suffered from
various forms of conflict and violence arising from
ultra-nationalism, perverted ideologies, ethnic
differences, and fundamentalism of all religions.
Violence emanates from both the state and sections
of civil society. For large masses, there is little
security of person, property or community. There is
massive displacement of communities and there are
an increasing number of refugees.
1.5.
Governments have arrogated enormous
powers to themselves. They have enacted legislation
to suppress people's rights and freedoms and colluded
with foreign firms and groups in the plunder of
national resources. Corruption and nepotism are
rampant and there is little accountability of those
holding public or private power. Authoritarianism
has in many states been raised to the level of national
ideology, with the deprivation of the rights and
freedoms of their citizens, which are denounced as
foreign ideas inappropriate to the religious and cultural
traditions of Asia. Instead there is the exhortation of
spurious theories of 'Asian Values' which are a thin
disguise for their authoritarianism. Not surprisingly,
Asia, of all the major regions of the world, is without
a regional official charter or other regional
arrangements for the protection of rights and
freedoms.
1.6.
In contrast to the official disregard or
contempt of human rights in many Asian states, there
is increasing awareness among their peoples of the
importance of rights and freedoms. They realise the
connections between their poverty and political
powerlessness and the denial to them of these rights
and freedoms. They believe that political and
economic systems have to operate within a
framework of human rights and freedoms to ensure
economic justice, political participation and
accountability, and social peace. There are many
social movements that have taken up the fight to
secure to the people their rights and freedoms.
1.7.
Our commitments to rights are not due to
because of any abstract ideological reasons. We
believe that respect for human rights provides the
basis for a just, humane and caring society. A regime
of rights is based on the belief that we are all
inherently equal and have an equal right to live in
dignity. It is based on our right to determine our
destiny through participation in policy making and
administration. It enables us to develop and enjoy
our culture and to give expression to our artistic
impulses. It is respectful of diversity. It recognises
our obligations to future generations and the
environment they would inherit. It establishes
standards for assessing the worth and legitimacy of
our institutions and policies.
General Principles
2.1.
It is possible from specific rights and the
institutions and procedures for their protection to
draw some general principles which underline these
rights and whose acceptance and implementation
facilitates their full enjoyment. The principles .provide
the broad framework for public policies within which
we believe rights should be promoted.
Universality and Indivisibility of Rights
2.2.
We endorse the Universal Declaration of
Human Rights, the International Covenant on
Economic, Social and Cultural Rights, the International
Covenant on Civil and Political Rights, and other
international instruments for the protection of rights
and freedoms. We believe that rights are universal,
every person being entitled to them by virtue of being
a human being. Cultural traditions affect the way in
which a society organises relationships within itself,
but they do not detract from the universalism of rights
which are primarily concerned with the relationship
of citizens with the state and the inherent dignity of
persons and groups. We also believe that rights and
freedoms are indivisible and it is a fallacy to suppose
that some kinds of rights can be suppressed in the
name of other rights. Human beings have social,
cultural and economic needs and aspirations that
cannot be fragmented or compartmentalised, but are
mutually dependent. Civil, political and cultural rights
have little meaning unless there are the economic
resources to exercise and enjoy them. Equally, the
pursuit and acquisition of material wealth is sterile
and self-centred without political freedoms, the
opportunity to develop and express one's personality
and to engage in cultural and other discourses.
2.3.
Notwithstanding their universality and
indivisibility, the enjoyment and the salience of rights
depend on social, economic and cultural contexts.
Rights are not abstractions, but foundations for action
and policy. Consequently we must move from
abstract formulations of rights to their concretisation
in the Asian context by examining the circumstances
of specific groups whose situation is defined by
massive violations of their rights. It is only by relating
rights and their implementation to the specificity of
the Asian situation that the enjoyment of rights will
be facilitated. Only in this way will Asia be able to
contribute to the worldwide movement for the
protection of rights.
2.4.
Widespread poverty, even in states which
have achieved a high rate of economic development,
is a principal cause of the violation of rights. Poverty
forces individuals, families, and communities into the
alienation of their rights: prostitution, child labour,
slavery, sale of human organs, and the mutilation of
the body to enhance the capacity to,beg. A life of
dignity is impossible in the midst of poverty. The
Asian states must direct their development policies
towards the elimination of poverty through more
equitable forms of development.
The Responsibility for the Protection of
Human Rights
2.5.
The responsibility for the protection of rights
is both international and domestic. The international
community has agreed upon norms and institutions
that should govern the practice of human rights. The
peoples of Asia support international measures for
the protection of rights. State sovereignty cannot
be used as an excuse to evade international norms
or institutions. The claim of state sovereignty is
justified only when a state fully protects the rights
of its citizens.
2.6.
On the other hand, international responsibility
cannot be used for the selective chastisement or
punishment of particular states; or for the privileging
of one set of rights over others. Some fundamental
causes of the violation of human rights lie in the
inequities of the international world economic and
political order. The radical transformation and
democratization of the world order is a necessary
condition for the global enjoyment of human rights.
The logic of the universalism and equality of rights is
the responsibility of the international community for
the social and economic welfare of all people
throughout the world, and consequently the obligation
to ensure a more equitable distribution of resources
and opportunities across the world.
2.7.
The primary responsibility for the promotion
of human rights is that of states. The rights of states
and peoples to just economic, social, political and
cultural development must not be negated by global
processes. States must establish open political
processes in which rights and obligations of different
groups are acknowledged and the balance between
the interests of individuals and the community is
struck. Democratic and accountable governments
are the key to the promotion and protection of rights.
2.8.
The capacity of the international community
and states to promote and protect rights has been
weakened by processes of globalization as more and
more power over economic and social policy and
activities has moved from states to business
corporations. Business corporations are responsible
for numerous violations of rights, particularly those
of workers, women and indigenous peoples. It is
necessary to strengthen the regime of rights to make
corporations liable for the violation of rights.
Sustainable Development and the
Protection of the Environment
2.9.
Economic development must be sustainable.
We must protect the environment against the
depredations of commercial enterprises to ensure that
the quality of life does not decline just as the gross
national product increases. Technology must liberate,
not enslave human beings. Natural resources must
be used in a manner consistent with our obligation
to future generations. We must never forget that
we are merely temporary custodians of resources of
nature. Nor should we forget that these resources
are given to all humankind, and consequently we have
a joint responsibility for their responsible, fair and
equitable use.
Rights
3.1.
We endorse all the rights that are contained
in international instruments. It is unnecessary to
restate them here. We believe that these rights need
to be seen in a holistic manner and that individual
rights are best pursued through a broader
conceptualisation which forms the basis of the
following section.
The Right to Life
3.2.
Foremost among rights is the right to life,
from which flow other rights and freedoms. The
right to life is not confined to mere physical or animal
existence but includes the right to every limb or
faculty through which life is enjoyed. It signifies the
right to live with basic human dignity, the right to
livelihood, the right to a habitat or home, the right to
education and the right to a clean and healthy
environment without which there can be no real and
effective exercise or enjoyment of the right to life. A
state must also take all possible measures to prevent
infant mortality, to eliminate malnutrition and
epidemics, to increase life expectancy through a clean
and healthy environment and adequate preventive
as well as curative medical facilities and to make
primary education free and compulsory.
3.3.
Yet in many parts of Asia, wars, ethnic
conflicts, cultural and religious oppression, corruption
of politics, environmental pollution, disappearances,
torture, state or private terrorism and other acts of
mass violence continue to be a scourge of humanity
and take the lives of thousands of innocent human
beings.
3.4.
To ensure the right to life, propaganda for
war or ethnic conflict or incitement to hatred and
violence in all spheres of individual or societal or
national or international life should be prohibited.
3.5.
A state has the responsibility to thoroughly
investigate cases of torture, disappearances and
custodial deaths, rapes and sexual abuses and to
bring the culprits to justice.
3.6.
There must be no arbitrary deprivation of life.
States should take measures not only to prevent and
punish deprivation of life by criminal acts and acts of
terrorism by individuals and groups but also prevent
arbitrary killings and mayhem by their own security
forces. The law must strictly control and limit the
circumstances in which a person may be deprived of
his or her life by state authorities or officials.
3.7.
Every state must abolish the death penalty.
Where it exists, it may be imposed rarely and only
for the most serious crimes. Before a person can be
deprived of life by the imposition of the death penalty,
he or she must be ensured a far trial before an
independent and impartial tribunal with full and
adequate opportunity of legal representation of his
or her choice, adequate time for preparation of
defence, presumption of innocence and the right to
review by a higher tribunal. Execution should never
be carried out in public or otherwise exhibited in
public.
only if the states are accountable to the international
community.
4.5 The international community of states has
been deeply implicated in wars and civil conflicts in
Asia. They have used Asian groups as surrogates to
wage wars and have armed groups and governments
engaged in internal conflicts. They have made huge
profits out of the sale of armaments. The enormous
expenditures on arms have diverted public revenues
from programmes for the development of the country
or the welfare of the people. Military bases and other
establishments (often of foreign powers) have
threatened the social and physical security of the
people who live in their vicinity.
The Right to Peace
4.1.
All persons have the right to live in peace so
that they can fully develop all their capacities,
physical, intellectual, moral and spiritual, without
being the target of any kind of violence. The peoples
of Asia have suffered great hardships and tragedies
due to wars and civil conflicts which have caused
many deaths, mutilation of bodies, external or internal
displacement of persons, breakup of families, and in
general the denial of any prospects of a civilised or
peaceful existence. Both the state and civil society
have in m.aoy countries become heavily militarized in
which all scores are settled by force and citizens
have no protection against the intimidation and terror
of state or private armies.
4.2.
The duty of the state to maintain law and
order should be conducted under strict restraints in
accordance with standards established by the
international community, including humanitarian law.
Every individual and group is entitled to protection
against all forms of state violence, including violence
perpetrated by its police and military forces.
4.3.
The right to live in peace requires that political,
economic or social activities of the state, of the
corporate sector or of the civil society, should respect
the security of all peoples, especially of vulnerable
groups, in relation to the natural environment they
live in, the political economic and social condition
which permit them to satisfy their needs and
aspirations without recourse to oppression,
exploitation, violence, and without detracting from
all that is of value in their society.
4.4.
In fighting fascist invasion, colonialism, and
neo-colonialism, Asian states played a crucial role in
creating condition for their peoples to live in peace.
In this fight, they had justifiably to stress the
importance of national integrity and non-intervention
by hegemonic powers. However, the demands of
national integrity or protection against foreign
domination cannot now be used as a pretext for
refusing to the people their right to personal security
and to peaceful existence any more than the
suppression of people's rights can be justified as an
excuse to entice foreign investments. Neither can
they justify a refusal to inform the international
community about the individual security of its people.
The right of persons to live in peace can be guaranteed
The Right to Democracy
5.1.
Colonialism and other modern developments
completely changed the nature of Asian political
societies. The traditional systems of accountability
and public participation in affairs of state as well as
the relationship of citizens to the government were
altered fundamentally. Citizens became subjects,
while the government became more pervasive and
powerful. Colonial laws and authoritarian habits and
style of administration persisted after independence.
The state has become the source of corruption and
the oppression of the people. The democratisation
and humanisation of the state is a pre-condition for
the respect for and the protection of rights.
5.2.
The state, which claims to have the primary
responsibility for the development and wellbeing of
the people, should be humane, open and accountable.
The corollary of the respect for human rights is a
tolerant and pluralistic system, in which people are
free to express their views and to seek to persuade
others and in which the rights of minorities are
respected. People must participate in public affairs,
through the electoral and other decision-making and
implementing processes.
The Right to Cultural Identity
6.1.
The right to life involves not only material
but also the moral conditions which permit a person
to lead a meaningful existence. This meaning is not
only individually determined but is also based on
shared living with other human beings. The Asian
traditions stress the importance of common cultural
identities. Cultural identities help individuals and
communities to cope with the pressures of economic
and social change; they give meaning to life in a
period of rapid transformation. They are the source
of pride and security. There are many vulnerable
6
communities in Asia as elsewhere whose culture is
threatened or derided. Asian peoples and
9overnments must respect cultures and traditions of
its diverse communities.
6.2.
The plurality of cultural identities in Asia is
not contrary to the universality of human rights but
rather as so many cultural manifestations of human
dignity, enriching universal norms. At the same time
we Asian peoples must eliminate those cultural
features in our own cultures which are contrary to
the universal principles of human rights. We must
transcend the traditional concept of the family based
on patriarchal traditions so as to retrieve in each of
our cultural traditions, the diversity of family norms
which guarantee women's human rights. We must
be bold in reinterpreting our religious beliefs which
support gender equality. We must also eliminate
discriminations based on caste, ethnic origins,
occupation, place of origin and others, while
enhancing in our respective cultures all values related
to mutual tolerance and mutual support. We must
stop practices which sacrifice the individual to the
collectivity or to the powerful, and thus renew our
communal and national solidarity.
The Right to Development and Social
Justice
7.1.
Every individual has the right to the basic
necessities of life and to protection against abuse
and exploitation. We all have the right to literacy
and knowledge, to food and clean water, shelter and
to medical facilities for a healthy existence. All
individuals and human groups are entitled to share
the benefits of the progress of technology and of the
growth of world economy.
7.2.
Development, for individuals and states, does
not mean merely economic development. It means
the realisation of the full potential of the human
person. Consequently they have the right to artistic
freedom, the freedom of expression and the
cultivation of their cultural and spiritual capacities.
It means the right to participate in affairs of the state
and the community. It implies for states the right to
determine their own economic, social and cultural
policies free from hegemonies pressures and
influences.
Rights of Vulnerable Groups
8.1.
Asian states should formulate and implement
public policies within the above general framework
of rights. We believe that in this way we would
establish fair and humane conditions for our individual
and corporate lives and ensure social justice.
However, there are particular groups who for historical
or other reasons are weak and vulnerable and
consequently require special protection for the equal
and effective enjoyment of their human rights. We
discuss the situation of several such groups, but we
recognise that there are also other groups who suffer
from discrimination and various forms of oppression.
They include people who through civil conflict,
government policies or economic hardships are
displaced from their homes and seek refuge in other
places internally or in foreign lands. Our states and
societies have become less tolerant of minorities and
indigenous people, whose most basic rights are
frequently violated. Various economic groups, like
peasants and fishing communities, suffer from great
deprivation and live in constant fear of threats to
their livelihood fron. landlords and capitalist
enterprises. They are also deserving of special
attention. We urge states and communities to give
the highest priority to the amelioration of their social
and economic conditions.
Women
9.1.
In most Asian societies women suffer from
discrimination and oppression. The causes of their
oppression lie both in history and contemporary social
and economic systems.
9.2.
The roots of patriarchy are systemic and its
structures dominate all institutions, attitudes, social
norms and customary laws, religions and values in
Asian societies, crossing the boundaries of class,
culture, caste and ethnicity. Oppression takes many
forms, but is most evident in sexual slavery, domestic
violence, trafficking in women and rapes. They suffer
discrimination in both public and private spheres. The
increasing militarization of many societies in Asia has
led to the increase of violence against women in
situations of armed conflict, including mass rape,
forced labour, racism, kidnapping and displacement
from their homes. As women victims of armed
conflict are often denied justice, rehabilitation,
compensation and reparation of the war crimes
committed against them, it is important to emphasise
that systematic rape is a war crime and crime against
humanity.
9.3.
There are few legal provisions to protect
women against violations of their rights within the
domestic and patriarchal realm. Social measures
should be taken to ensure full and equal participation
of women in the political and public life of the society.
In doing so discrimination should be eliminated to
ensure women the right of participation in the
formulation of government policy and to hold public
office, in order to perform government functions at
all levels.
9.4.
To end discrimination against women in the
field of employment and the right to work, women
should be given the right to employment
opportunities, the free choice of profession, job
security, and equal remuneration; th'e right to
protection of health and safe working conditions,
especially in safeguarding of the function of
reproduction and special protection in times of
pregnancy from work that proved harmful.
9.5.
Women should be given the full right to
control their sexual and reproductive health, free from
discrimination or coercion, and be given access to
information about sexual and reproductive health care
and safe productive technology. That the recognition
of sexual preference or orientation must be genuine
and real, and that all overt and covert ways of denying
such preference based on social habits or cultural
inhibitions and other forms of social oppression is a
basic violation of human rights.
Children
means of subsistence or shelter. We call on Asian
states to ratify and implement the Convention on the
Rights of the Child. We also call on communities to
take the responsibility for monitoring violations of
children's rights and to press for the implementation
of the UN Convention in appropriate ways in their
own social contexts.
Disabled Persons
11.1.
Traditionally Asian societies cared for those
who were physically or mentally handicapped.
Increasingly our communal values and structures,
under the pressure of new forms of economic
organisations, are less tolerant of such persons. They
suffer enormous discrimination in access to education,
employment and housing. They are unable to enjoy
many of their human rights due to prejudice against
them and the absence of provisions to meet their
special demands. Their considerable abilities are not
properly recognized and they are forced into jobs
which offer low pay and little prospects of promotion.
They have the right to provisions which enable them
to live in dignity, with security and respect, and to
have opportunities to realise their full potential.
11.2.
10.1.
Children are the second major category of
vulnerable groups. As with women, their oppression
takes many forms, the most pervasive of which are
child labour, sexual slavery, child pornography, the
sale and trafficking of children, prostitution, sale of
organs; conscription into drug trafficking; the
physical, sexual and psychological abuse of children
within families; discrimination against children with
HIV/AIDS; forced religious conversion of children; the
displacement of children with and without their
families by armed conflicts, discrimination, and
environmental degradation. An increasing number
of children are forced to live on the streets of Asia's
cities and are deprived of the social and economic
support of families and communities;
10.2.
Widespread poverty, lack of access to
education and social dislocation in rural areas, are
among the causes of the trends which increase the
vulnerability of children. Long-established forms of
exploitation and abuse, such as bonded labour or the
use of children for begging or sexual gratification,
have been extended in degree and kind. Female
infanticide due to patriarchal gender preference, and
female genital mutilation are widely being practised
in some Asian countries.
10.3.
Asian states have failed dismally to look
after children and provide them with even the bare
8
The need to treat such persons with respect
for their human rights is evident in the way Asian
states treat those with HIV or AIDS. There is
considerable discrimination against them. A civilised
society which respects human rights would recognise
their right to live and die with dignity. It would secure
to them the right to adequate medical care and to be
protected from prejudice, discrimination or
persecution.
Workers
12.1.
The rapid industrialization of Asian societies
has undermined traditional forms of the subsistence
economy and destroyed possibilities of their
livelihood. Increasingly people are forced into wage
employment, often in industry, working under
appalling conditions. For the majority of the workers
there is little or no protection from unfair labour laws.
The fundamental rights to form trade unions and
bargain collectively are denied to many. Their wages
are grossly inadequate and working conditions are
frequently dangerous. Globalization adds to the
pressures on workers as many Asian states seek to
reduce the costs of production, often in collusion
with foreign corporations and international financial
institutions.
12.2.
A particularly vulnerable category of workers
are migrant workers. Frequently separated from their
families, they are exploited in foreign states whose
laws they do not understand and are afraid to invoke.They are often denied equality of rights and conditions
with local workers, without access to adequate
accommodation, health care, or legal protection. In
many cases they suffer racism and xenophobia, and
domestic helpers are subjected to humiliation and
frequently sexual abuse.
must take urgent action to implement the human
rights of their citizens and residents.
Principles for Enforcement
1 5.2. We believe that systems for the protection
of rights should be based on the following principles.
15.2.1.
The promotion and enforcement of rights
is the responsibility of all groups in society, although
the primary responsibility is that of the state. There
is a clear and legitimate role-for NGOs in raising
consciousness of rights, formulating standards, and
ensuring their protection by the governments and
other groups. Professional groups like lawyers and
doctors have special responsibilities connected with
the nature of their work to promote the enforcement
of rights and prevent abuses of power.
Students’
13.1.
Students in Asia struggled against
colonialism and fought for democratization and social
justice. As a result of their fearless commitment to
social transformation they have often suffered from
state violence and repression and remain as one of
the key targets for counter-insurgency operations and
internal security laws and operations. Students are
frequently denied the right to academic freedom, to
the freedom of expression and association.
Prisoners and Political Detainees
14.1.
In few areas is there such a massive violation
of internationally recognised norms as in relation to
prisoners and political detainees.
15.2.2.
Since rights are seriously violated in
situations of civil strife and are strengthened if there
is peace, it is the duty of the state and other
organisations to find peaceful ways to resolve social
and ethnic conflicts and to promote tolerance and
harmony. For the same reasons no state should seek
to dominate other states and states should settle
differences among themselves peacefully.
14.2.
Arbitrary arrests, detention, imprisonment,
ill-treatment, torture, cruel and inhuman punishment
are common occurrences m many parts of Asia.
Detainees and prisoners are often forced to live in
unhygienic conditions, are denied adequate food and
health care and are prevented from having
communication with, and support from, their families.
Different kinds of prisoners are frequently mixed in
one cell, with men, women and children kept in
proximity. Prison cells are normally overcrowded.
Deaths in custody are common. Prisoners are
frequently denied access to lawyers and the right to
fair and speedy trials.
15.2.4.
Many individuals and groups in Asia are
unable to exercise their rights due to restrictive or
oppressive social customs and practices, particularly
those related to caste, gender, or religion. Therefore
the immediate reform of these customs and practices
is necessary for the protection of rights. The reforms
must be enforced with vigour and determination.
14.3.
Asian governments often use executive
powers of detention without trial. They use national
security legislation to arrest and detain political
opponents. It is notable that, in many countries in
Asia, freedom of thought, belief and conscience, have
been restricted by administrative limits on freedom
of speech and association.
15.2.5.
A humane and vigorous civil society is
necessary for the promotion and protection of human
rights and freedoms, for securing rights within civil
society and to act as a check on state institutions.
Freedoms of expression and association are necessary
for the establishment and functioning of institutions
of civil society.
The Enforcement of Rights
15.2.6.
The enjoyment of many rights, especially
social and economic, require a proactive role of the
governments.
15.1.
Many Asian states have guarantees of
human rights in their constitutions, and many of them
have ratified international instruments on human
rights. However, there continues to be a wide gap
between rights in these documents and the reality of
the exercise or enjoyment of rights. Asian states
15.2.3.
Rights are enhanced if democratic and
consensual practices are followed and it is therefore
the responsibility of all state and other organisations
to promote these practices in their work and in their
dealings with others.
Strengthening the Framework for Rights
15.3.1.
It is essential to secure the legal framework
for rights. All states should include guarantees of
rights in their constitutions. They should also ratify
9
international human rights instruments. They should
review their legislation and administrative practices
against national and international standards with the
aim of repealing provisions which contravene these
standards, particularly legislation carried over from
the colonial period.
15.3.2.
Knowledge and consciousness of rights
should be raised among the general public, and state
and civil society institutions. Awareness of the
national and international regime of rights should be
promoted. Individuals and groups should be
acquainted with legal and administrative procedures
whereby they can secure their rights and prevent
abuse of authority. NGOs should be encouraged to
make familiar with and deploy mechanisms, both
national and international, for monitoring and review
of rights, judicial and administrative decisions on the
protection of rights should be widely disseminated,
nationally and in the Asian region.
15.3.3.
Numerous violations of rights occur while
people are in custody and through other activities of
security forces. Sometimes these violations take
place because the security forces do not realise the
permissible scope of their powers or that the orders
under which they are acting are unlawful. Members
of the police, prison services and the armed forces
should be provided training in human rights norms.
The Machinery for the Enforcement of
Rights
15.4.1.
The judiciary'is a major means for the
protection of rights. It has the power to receive
complaints of the violation of rights, to hear evidence,
and to provide redress for violations, including
punishment for violators. The judiciary .can only
perform this function if the legal system is strong
and well organised. The members of the judiciary
should be competent, experienced and have a
commitment to human rights, dignity and justice, and
appointed by an independent judicial service
commission. They should be independent of the
legislature and the executive, and their tenure should
be safeguarded in the constitution. The legal
profession should be independent. Legal aid should
be provided for those who are unable to afford the
services of lawyers or access to courts, for the
protection of their rights. Rules which unduly restrict
access to courts should be reformed to provide a
broad access. Social and welfare organisations should
be authorised to bring legal action on behalf of
individuals and groups who are unable to mobilize
the courts.
15.4.2.
All states should establish Human Rights
Commissions and specialised institutions for the
protection of rights, particularly of vulnerable
members of society. These bodies supplement the
10
role of the judiciary. They enjoy special advantages:
they can help establish standards for the
implementation of human rights norms; they can
disseminate information about human rights; they can
investigate allegations of violation of rights; they can
promote conciliation and mediation; and they can seek
to enforce human rights through administrative or
judicial means. They can act proactively.
15.4.3.
They can provide easy, friendly and
inexpensive access to victims of human rights
violations.
15.4.4.
Civil society institutions can help to
enforce rights through the organisation of People's
Tribunals, which can touch the conscience of the
government and the public. The establishment of
People's Tribunals emphasises
that the
responsibility for the protection of rights is wide, and
not a preserve of the state. They are not confined to
legal rules in their adjudication and can consequently
help to uncover the moral and spiritual foundations
of human rights.
Regional Institutions for the Protection
of Rights
16.1.
The protection of human rights should be
pursued at all levels, local, national, regional and
international. Institutions at each level have their
special advantages and skills. The primary
responsibility for the protection of rights is that of
states. Therefore priority should be given to increase
state capacity.
16.2.
Asian states should adopt regional or sub
regional institutions for the promotion and protection
of rights. There should be an inter-state Convention
on Human Rights, formulated in regional forums with
the collaboration of national and regional NGOs. The
Convention must address the realities of Asia,
particularly obstacles to the enjoyment of rights. At
the same time it must be fully consistent with
international norms and standards. It should cover
violations of rights by groups and corporations in
addition to state institutions. An independent
commission or a court must be established to enforce
the Convention. Access to the commission or the
court must be open to NGO's and other social
organisations.
The Asian Human Rights Commission has
circulated the above draft of the proposed Asian
Human Rights Charter, titled "Our Common
Humanity". Endorsements may be sent to Mr.
Basil Fernando, Executive Director, Asian Human
Rights Commission, Flat E, 3/F, Kadak Building,
171 Sai Yee Street, Kowloon, Hongkong. Fax
(852) 2698 6367. email: ahrc@HK.Super.Net.
Harvard Survey
Subject: Harvard Survey
Date: Mon, 25 Sep 2000 16:07:21 -0400
From: FXB Center <£xbcenter_survey@hsph.harvard.edu>
To: fxb@hsph.harvard.edu
Dear Colleague:
The Frangois-Xavier Bagnoud Center for Health and Human Rights (FXB
Center), with support from the World Health Organization (WHO), is
currently assembling a database of organizations working in the area of
health and human rights. The aim of this project is gather information on
current sources of institutional experience and information in support of
efforts to "mainstream” the consideration of health and human rights in
national and international programs and policies. To that end we are
inviting your organization, as one working in the areas of health, human
rights or human development, to complete a brief survey about your overall
focus and your programs in the areas of health and human rights.
Programs or policies in the area of health and human rights include those
that recognize, and incorporate into their designs, implementation and
evaluation one or more of the following considerations: the effects of
health policies and programs on human rights; the health consequences of
human rights violations; and the linkage between promoting, and protecting
health and promoting and protecting human rights.
A text file containing the survey (Harvard.txt) is attached to this
message. The text file or a version of the survey in Microsoft Word may
also be downloaded from our website at
www.hsph.harvard.edu/fxbcenter/survey.htm . We appreciate your participation
in this process and look forward to receiving additional information on
your organization. We would also be grateful if you would forward copies of
the survey to your branch offices, representative or affiliated
organizations. The survey should be returned to the FXB Center by October
10, 2000.
The FXB Center for Health and Human Rights would like to make a portion of
the information gathered through the survey available to the public in a
directory of health and human rights organizations, produced in print or
through the Center's website. Additionally, the information will be
coordinated and provided to WHO to facilitate its efforts to integrate
human rights into its programs and governance.
If you have any question about the survey, please feel free to contact me
at the electronic mail address listed below.
Sincerely,
Scott Gordon
Research specialist
International Health and Human Rights Program
Frangois-Xavier Bagnoud Center for Health and Human Rights
Harvard School of Public Health
E-mail:
fxbcenter_survey@hsph.harvard.edu
For more information on the Frangois-Xavier Bagnoud Center for Health and
Human Rights please visit our website at www.hsph.harvard.edu/fxbcenter.htm.
■
■^Harvard.txt.:
Name: Harvard.txt
Type: Plain Text (text/plain)
Encoding: quoted-printable
Aninter-gpverranental organization
An inteniational network, consortium, federation, etc.
A national network, consortium, federation, etc.
An international non-governmental organization
Anational non-governmental organization
-An independent national human rights institution (e.g human rights commission a- ombudsperson)
An independent national health or development institution
A uni rersity/universty facilify/university-affiliatedresearch institute
A training'ieseaich institute
Cther (specify):
15)
What is the mission or aim of your organization?
16)
What are your organization's anient programs or what services does your organization provide?
(please list program tides and'or provide brief descriptions - attach extra sheet if necessary)?
17)
What year wasyour organization founded?
18)
Please indcate tie number of staff andregular volunteers for your organization:
Paidstaff(in country of headquarters)
Paid staff (in other countries)
Rsgular/substantive volunteers (in country of headquarters)
Regular/substantive volunteers (m other countries)
19)
Please list the names of the current officers of your organization, inducing senior members ofyour
executive staff
20)
Yes
Is your organi zati on a member of any federations a' timbrel! a organi zati ons?
No
a) Ifyes, please list the name of the federations or umbrella organization and describe tire relationship
between your organi zati on and the feeferati ons or timbrel 1 a organi zati ons:
21)
Yes
Does your organization have any regional, national cr local branch offices or chapters?
No
a) Ifyes, please describe the scope and nature of the relationship between offices or chapters (please
include a description of fie levels of cocr dilation and'or autonomy and ind cate the numbers and locations
of offices and chapters)
22)
Ifyour organization is a member of any networks or consortiums, please list their foil names and
acronyms
23)
Yes
Does your crganizati on have members?
No
a) Ifyes, please specify type of membership
Indvi duals
Qrganizati ons
Other (specify):
Please indcate the percentage offimdng receivedin 1999 from the following sources (optional):
% Private (fondng received through fundaising, indvi dual donations, giants and membership fees)
% Governmental (fiuidng received from national, federal, or local govemments/authorities)
% International (fondng received fr om intergovernmental organizations or international non
governmental organizations)
% Self-financed (fondng from organizations activities such as sales of products or fees for
const!ting services)
24)
25)
Yes
Does your organization prepiare and dstribute an annual report?
No
a) Ifyes, is the annual report is available the World AM de Web
Yes
No
i) Ifyes, please indcate website addess for annual report, if dfferent from organizations website:
26)
Please describe the relationship ofyour organization, other than financial, with any government with
respect to your organization's activities or management.
27)
Does your organization have status with any' socializedUnitedNations agency?
a) Ifyes please, describe the nature ofthis relationship.
28)
Does your organization have status with any other inter-govennnenlal organizations'?
Yes
No
a) Ifyes please, describe the nature ofthis relationship. -
Part HL Orgarization'sPrimaryFociB
hi this section, pl ease respond about the general nature of the work ofyour organizati on.
29)
Which of tie following issues areas are most central to the mission ofyour organization?
(check no more than 2):
Human rights promotion and protection for general population (or range of sub-populations)
The heal tli consequences of human rights violations
Development (non-medcally-oriented) condtions or needs of general population (e.g housing)
___ The needs or condtion of a specific population® - multiple issues (includng health and'or human
ri^its)
The linkage between promoting and protecting health and promoting and protecting human rights
The health and'or human rights condtions or needs concerning specific health or medcal issue (e.g
HTV/AIDS)
The health or medcal condtions or needs of general population (or range ofhealth or medcal
condtions)
Other (specify):
30)
Which of the following strategies are employedin pursuingyour organization’s mission?
(check all that apply):
Monitoring, documentation or data coll ection regardng human rights, dsease or health condtions
Policy,legidalion monitoring, review or advocacy
Development of advisory guidelines or standards (external to organization)
Provision of material assistance (e.g provision of vehicles, computers, pharmaceuticals)
Provision of technical assistance (e.g provision of trainers, staff, volunteers, consultants or drect
services)
Provision of financial assistance
Facilitation of networking or collaboration
Other (specify):
31)
What populations are of primary concern to your organizati on in fulfilling its mission?
(check no mere than 5 boxes):
General population (or more than 5 groups)
Women
Men
Children
Male children
Female children
Adolescents
Utterly
Racial minority
National ethnic minority
Linguistic minority
Ihdgenous populations
Religious
Sexual orientation
Political or other opinion
Property/homeless
Workers
. Economically impoverished
Disability
Mental dsahlity
Physical dsabilty
Migrants
Refugees
. Internally dspiaced populations
Prisoners/detainees
Other (specify):
32)
Yes
Do tte poptil ations of focus vai y by program?
No
33)
What is tte geographic focus ofyotr organization’s programs?
(check no more than 2):
National
Regional
Sub-Regional
Diaspora
International
34)
Does tire geograjiiic focus vary by program?
Yes
No
35)
What are tte countries where your organization works (attach additional page if necessary)?
36)
Rease list ofyour organization's relevant publications (magazines, newsletters, working papers) in the
area of health and human rights releasedance 1997 andindcate all language versions and whether
publications are annual (attach addtional page if necessary):
Part IV. Heal th Program .Areas
Please indcate whether your organizati on works within each of tte following health program areas
acccrdngto tte following activity classifications and estimate tte percentage ofyotr organization's overall
work in each of the teal th areas. Parts V-IX of the survey will askyou to provide more information on
each of tire activity classifications listed below.
NOTE Addti onal information about each of die health program areas can be found on the website of the
Franyois-Xavier Bagioud Center for Health and Human Rights
(vvww.hsphharvardedu/fitbcenta/survey.htni). There are significant levels of overlap between tie issue
areas and it is not necessary to select, only one area for die total percentages to equal 100%(atlier within
program areas or cumulatively).
(check all that apply):
Access, quality andradonal use of medcines:
Research
DocinnentatiorVMonitoring
Advocacy & Awareness Raising
Training & Educati on
Client Services
Percent of Organization's Work
%
Blood safety and clinical technology:
Research
Documented oiVMonitoring
Advocacy & Awareness Raising
Training & Education
Client Services
Percent of Organization's Work
%
Child and adolescent health:
Research
Documentation'Monitaing
Advocacy & Awareness Raising
Tr aining & Educati on j.
di ent Seivi ces
Percent of Organizati on's Work
%
Communicable dseases
Research
Documentation'Monitcring
Advocacy & Awareness Raising
Training & Education
Client Services
Percent cf Organization's Work
%
Disability/injury prevention and rehabilitation:
Research
DocumentationMonitoring
Advocacy' & Awareness Raising
Training & Education
Client Services
Percent of Organization's Work
%
Emergency preparedness and response:
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Training & Education
Cli ent Servi ces
Percent of Organizati on's Work
%
Food safety.
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Tiaining&Education
Client Services
Per cent of Organization's Work
%
Health and development
Research
Documentation'Monitoring
Advocacy & Awar eness Raising
"Raining & Education
Client Services
Percent of Organization's Work
%
Health and the environment:
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Tr aining & Education
Client Services
Percent of Organization's Work
_
%
HIV/AIDS:
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Hairing & Education
Client Services
Percent of Organization's Work
%
Immunization and vaccine development:
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Training & Education
Client Services
Percent of Organization's Work
%
Information for health pdi cy
Research
DociunentationMonitoring
Advocacy’ & Awareness Raising
Training & Education
Client Services
Percent of Organization's Work
%
Malaria'
Research
Documentation'Monitoring
Advocacy' & Awareness Raising
Hairing & Education
Client Services
Percent of Organization's Work
%
Maternal and infant health:
Research
Documentation'Monitoring
Advocacy’ & Awareness Raising
Training & Education
Client Services
Percent of Organization's Work
%
Mental health and substance abuse:
Research
Documentati oriMoritori ng
Advocacy & Awareness Raising.
Hairing & Education
Client Services
Percent of Organization’s Work
%
Non-communicable dseases:
Research
Documentati oriMoritoring _
Advocacy & Awareness Raising
Tr aining & Education
Client Services
Percent of CX'ganization's Work
%
Nutrition:
Research
Documentation'Monitoring
Advocacy & Awareness Rai sing _
Hailing & Educati on
Client Services
Percent of Organization's Work__%
Organization of health services
Research
Documentati oriMonitoring
Advocacy & Awareness Raising
Hairing & Education
Cli ent Servi ces _
Percent of Orgarizati oris Work
%
Reproductive and sexual health
Research
Documentation'Monitoring
Advocacy' & Awareness Raising
Hairing & Education
Client Services
Percent of Orgarizatioris Work
%
Research poli cy and promotion
Research
Documentati or/Moritoring
Advocacy' & Awareness Rai sing _
Hairing & Educati on __
Client Services
Percent of Orgarizatioris Work
%
Tobacco control:
Research
Documentati orYMoritoring
Advocacy’ & Awareness Raising
Hairing & Education
Percent of Q'garri zati on's Work
°/o
Tuberculosis:
Research __
Dociunentatioi/Monitoring
Advocacy & Awareness Raising
Training & Education
di ent Seni ces
Percent of Organizati on's Work
%
Women's health
Research
Documentation'Monitoring
Advocacy & Awareness Raising
Haining & Educati on
Client Services
Percent of Organization's Work
%
□i ent Seni ces.
Party. Research
Considering the overall work ofyour organization, please answer the following questions concerning your
organizati on's research activities in tie area of health and human rights.
Areas of research concerning health and human rights are defined for this strvey as inducing, but are not
limited to, the following access to medical care or other health and social services; dfferential impacts of
diseases, health policies or programs on popul ah ons at risk; factors interfering with or promoting
populations' ability' to fully realize health andfor human rights; health or medcalty-related human rights
abuses; the impacts'tenefits of utilizing a health and human rights approach to policy development or
implementation.
37)
Does your organization undertake research concerning health and human rights?
Yes
No
a) Ifyes, please answer tie following questions
b) If no, please go to section VI
38)
What types of research does your organization undertake?
(check all that apply):
Surveys
Interviews
Data analysis (existing national or local data)
Conduct ofinterventions'trials
■
Evaluation of interventionsitrials
Policy evaluation (though data collection and analysis)
Program evaluation (though data collection and analysis)
Epidemiologic surveillance
Other (specify):
-
• -
-
-
39)
Who conducts your organization's research?
(check all that apepiy):
Organization stafflvolunteers
Affi li ated institutions/inn vers ties
Consultants/contractors
Other (specify):
40)
What percentage ofyour organization's pograms'work is comprised of the conduct ofresearch?
Part VI Documentation and Moni toting
Considering tire overall work of your organizati on, please answer the following questions concerning your
organization's documentation and monitoring activities in the area cf health and human rights.
Sukject areas for documentation andmonitaing activities fa- health andhuman rights are definedin this
survey as includng, but are not limited to, tte following: access to med cal care or other health and social
services; dffiaential impacts of dseases, health policies or programs on populations at risk; factors
interfering with or promoting populations' ability to hilly realize health and'or human rights; health or
med cally-relatedhuman rights abuses; the impacts/benefits of utilizing a health andhuman rigtits approach
to policy development or implementation.
41)
Does your organization undertake documentation or monitoring activities concerning heal th andhuman
rights?
Yes
No
a) If yes, please answer the following questions
b) If no, please go to Part V1L
42)
What are tte principle sources of data or information for your organization’s documentation or
monitoring activities?
(check all that apply):
Secondary data from government data collection mechani sms (e.g. census, demographi c and heal th
sinveys, government records)
Secondary’ data h orn member or partnering aganizati ons (non-governmental)
Primary data from key informant interviews
Primary data from focus groups
Primary data fr om surveys
Otho- (specify):
43)
Does your organization maintain a documentation center or database?
Yes
No
a) Ifyes, please ind cate type and nature ofcenter or database.
44)
Does your organization belong to an international documentation network®?
Yes
No
a) If yes, pl ease specify name and type of network
45)
What percentage ofyour organization's programs'work is comprised of documentation a' morritaing
activities?
Part VH. Advocacy and/or Awareness Rai sing
Considering the overall work ofyour organization, please answer the following questions concemingyour
organization’s advocacy and'or awareness raising activities in the area of teal th andlmman rights.
Advocacy and awareness raising activities for health andhuman rigjits are definedin this survey as the use
of infatuation to effect policy or legislative changes a' to foster public awareness or uncterstandng of
issues, cond dons or reeds concerning heal th andhuman rigtits.
NOTE: the use of information to train or educate indvi dials is coveredin Part VUI ("fraining and
Education).
46) Does your organization undertake advocacy and'or awareness raising activities concerning health and
human limits?
Yes _
No
a) Ifyes, pi ease answer tire following questions
b) If no, please go to section Vm
47)
"Which of the following best describe tire thematic nature ofyour organization's advocacy ancVor
awareness raising activities concerning health andliuman rights?
(check no more than 2):
The promotion and protection of human rights
Ute health consequences of human rights violations
Hie effects of human rights on the health of populations
The linkage between pomctiqg and protecting health and promoting and potecting human rights
'Ihe effects of health policies andpograms on human rights
The human rights implications of specific direases or heal th corid ti ore;
The pomotion of health and or social services
Other (specify):
48)
"What are your organization's activities concerning government policies or legislation?
(check all that apply):
Conducting public hearings/workstopsfconferences
Direct lobbying (meetingg/dscussons with legislators a influential parties)
Public referendums
Direct action
Letter campaigns
Med a campaigns
Oths" (specify):
49)
Who are the target audencesfor government policy/legslalive related activities?
(check all that apply):
__ Legislators or executive
Judciaiy (i.e. courts cr lawyers)
Civil service
International (intergovernmental organizations or international NGQs)
Other governments (governments other than those responsible for policy/legislation)
General piblic (domesticelectoral pressure)
__ Other (specify):
50)
"What are your organization's activities concerning non-governmental polices cr- standai ds (e.g
developing or reviewing standards of pactice)?
(check all that apply):
Condicting public hearings/worlcsliops/conferences
Direct lobbying (meetings/dscusaons with committees or associations)
Publ i c referendans
Letter campai gns
Med a campaigns
Other (specify):
51)
Who are the target audencesfor non-governmental policy/standardrelated activities?
(check al 1 that apply):
Civil senica'regulatoiy agencies
Profesional associations (e.g inert cal association)
Health or legal professionals
Busi nsss/in&istry
Spedfi c popul ation(s) (specify if dfferent from those indcated in question 29):
General public
Ind vi duals (e.g. patients or clients)
Other (specify):
52)
What are your organization's awareness raising (public campaigns) activities?
(check all tliat apply):
Meda campaigns
Public education campaigns
Indvidual education/counseling
Erent coordnation
Other (specify:
53)
Who are the target audences for your organization’s awareness raiang activities?
(check all that apply):
Government (legj stators'civil service)
International (other governments, intergovernmental organizations or international NGOs)
Businessesfindusliy
Professional associations (e.g med cal association)
Meda
Specific population^) (specifyif dfferent from those indcated in question 29):
Domestic general public
International general public
Indviduals (e.g patients or clients)
Odier (specify):
54)
What percentage ofyour organization's programs'work is comprised of advocacy or awareness raising?
PartVIH Uaining and Education
Consi dering the overall work ofyour organizati on, please answer tire following questions concerning your
organization's training and'or education activitiesin the area cf health andhuman rights.
Training and education activities fa' health and human rights are defined in thi s surrey as the coordnation
and'or conduct of training or educational programs and'or the development of educational cirriculaor
andpedagogical materials regardijghealth and human rights.
55)
Does your organization undertake training and'or education activities concerning health andhuman
rights?
Yes
No
a) Ifyes, please answer the following questions
b) If no, pl ease go to Part IX
56)
Which of ths following tope areas best reflect the training and edicati on activities ofyour organization
concerning heal tli and human limits?
(check all that apply):
Human limits - general (general population or range of human rigilts areas)
___ Human rights monitoring research or evaluative skills
___ Hie health consequences of human rights violations
__ The effects of human rights on the health of populations
___ Professional standards and human rights (e.g riglits of patient or client)
___ The linkage between promoting and protecting health and promoting and protecting human rights
___ Tie effects of specific health policies (or dseases) on human rights
___ The effects of general health policies and programs on human riglits
___ Health research or evaluative skills
___ Health - general (general public health or a range of health issues)
___ Other (specify):
57)
Who are the principal target audences foryotr organization's training and education activities?
(check all that apply):
___ Policy makers (e.g. legislators or executive)
___ Judciary (e.g. courts)
___ Civil service
___ Health profess! onal s
___ Legal professionals
___ Human rights professionals
___ Specialized groups (e.g tract unions, religious groups)
___ Educators
___ Primary and secondary level students
___ University level students(general)
___ Med cal-rel ated students
___ Public health students
___ Law students
___ Med a
.Specific populations) (specify if different from those indented in question 29):
___ General public
___ Other (specify:
58)
What types of professional training and educational activities doesyour organization undertake?
(check all that apply):
___ Coitference/wcrkshop coordnation (indudng collaborative coocdnation)
___ Spedal trairiing/cotrses
___ Reviewf design of professional standards
___ Provision of specialized intemslBpsffellowships'resi derides
___ Development of bibliographies or collection of reference materials
59)
What types of training or educational courses does your organization incorporate into existing
edrcational progr ams (e.g med cal or secondary schools)?
(check all that apply):
___ Independent academic unit (e.g university course on health andhuman rights)
___ Academi c modil e (e.g porti on of course)
___ Review'design of general curricula (e.g degree requirements or school policies)
___ Conferenoe/workshop coordnation (indudng collaborative coordnation) .for targeted students
___ Special training'coirws
___ Provi si on of sped al ized i ntemslii ps'fell ovvslii ps/resi dencies
___ Development of bibliographies or collection of reference materials
60)
Does your organization develop curricula or pedagogical materials for training or educational
programs?
61)
What percentage ofyour organization's programs/work is compised of training or educational
activities?
Part IX. Client Services
Considering the overall work ofyour organization, please answer the following questions concerningyour
organization's provision of duect dient services to incivictuals (regarcless of setting) in the areas of health,
human rights or health and human rights.
62)
Does vour organization provide direct client services to indvi duals?
Yes
’
No
a) Ifyes, please answer the following questi ons
b) If no, please go to Part X.
63)
What types of client services are provided by your organization?
(check all that apply):
Client representation
Pursuit of claims
Referral services
Indvidual edication
Linkingmedcal andlegal services
Counseling (clinical or outreach programs)
Commodties assistance (e.g provision of meddnes)
Medcal treatment/dinical services provision
Other (specify):
64)
What percentage of your organization's programs/work is comprised of the provision of client seivices?
Part X Addtional organizations
65)
Please provide the names and addresses (if possible) of other organizations you fed should receive
copies of this survey
We would also be grateful ifyou would foiward copies of tlis survey to yorr branch offices, representative
or affiliated or^nizations.
Thankyoufor taking the tine to complete tlis survey'. Completed
surveys may be returned via email to:
&bcenler_survey@ispliharvnrd edu
or may be returned by post to the following add-ess
Fran^oi s-Xavi er Bagnoud Center fa- Health and Human Rights
.Attn: Health and Human Rights Survey
Harvard School of Public Health
651 Huntington Avenue, 7th Floor
Boston. MA 02115 USA.
Tel: (1)617.432.0656
Fax: (1)617.432.4310
Page 1 of 3
Community Health Cell
"Caroline Bernier” <cbernier@idrc.ca>
"IDRC Reports Distribution List" <reports-dl@lyris.idrc.ca>
Friday, November 10, 2000 11:30 AM
November 10 REPORTS-DL
From:
To:
Sent:
Subject:
The following news and feature articles are currently published on the
IDRC Reports web site at http://www.idrc.ca/reports/. To view an article, simply click on the matching
hypertext link shown at the bottom of this message.
If you do not have web access but are limited to e-mail, you can
request any of the articles present on this page by referring to the hypertext
link.
Simply send an e-mail to www4mail@unganisha.idrc.ca- leave the subject field blank, and type
the command GET http:// [followed by tile requested URL (filename)] in the body of the message.
REPORTS
SCIENCE FROM THE DEVELOPING WORLD
November 10, 2000
Restoring
[5]
Degraded Soils in India using Urban Wastes
November 10,2000 Canadian and Indian researchers are combining fly
ash from electricity generating plants, municipal sewage sludge, and
in some cases the water hyacinth plant to produce a potent soil
replacement for Indian communities. Each of these, on its own, is an
environmental menace. Together, they could hold huge benefits for
wom-out soil.
Butterfly
[6]
Lanka
Garden: A Healing Program for War-Affected Children in Sri
November 8,2000 You are invited to attend a
presentation by Dr Robert Chase of McMaster University on the
"Butterfly Garden' program in Sri Lanka. The presentation will take
place from 1:30-3:00 p.m. on Wednesday, November 15,2000, 14th floor
Auditorium, IDRC headquarters, 250 Albert Street, Ottawa.
Nepal
[7]
Conducts Consultation on National ICT Policy
November 7,2000 The Government of Nepal recently
opened the floor to the public to debate the country's proposed
national Information and Communication Technology (ICT) Policy and
Strategy. Led by the National Planning Commission, a public
consultative process addressed the use of ICTs specific to the
Nepalese context.
[8]EEPSEA Case Study: Forests for the Future: Creating Awareness in
.Malaysia
November 6,2000 For environmental economists, putting a value on the
services provided by forests is by now standard practice. To
government officials and the general public, though, it is still a
rather new idea. In Malaysia, Mohd. Shahwahid Haji Othman a member of
the Economy and Environment Program for Southeast Asia is working to
spread the message.
[9]Assessing Tobacco Control Strategies in Turkey
November 3,2000 Smoking is a serious public health problem in Turkey.
Among males over 15 years old, the incidence can rise as high as 65 %
in some regions. And conservative estimates place the annual number of
smoking related deaths at over 70,000. With funding from Research for
International Tobacco Control, a team of Turkish investigators has
conducted two surveys on behaviours and attitudes toward smoking. The
11/22/00
Page 2 of 3
team is also examining people's reactions to anti-smoking legislation.
[13JIDRC Web Site
The
[14]
Bellaaet Initiative
from The Micronutrient Initiative
News
[15]
[16]Ncws from The Model Forestry Secretariat
Pan
[17]
Asia
[I8]IISDnet
REPORTS
[19]
Online
About
[20]
REPORTS
Email
[21]
REPORTS
Feedback? [23]Email us at [24]mag@idrc.ca
Copyright © 1998 International Development Research Centre. Reports
online was conceived as a voice for Southern scientists and
researchers. The opinions expressed in articles found on the site
are those of the authors or the researchers. Publication on this
site is not an endorsement of research findings by the
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References
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Pogo 1 of3
Community Health Cell
"Caroline Bernier" <cbernier@idrc.ca>
"1DRC Reports Distribution List" <reportsFriday, November 17, 2000 11:00 AM
November 17 REPORTS-DL
From:
To:
Sent:
Subject:
The following news and feature articles are currently published on the
IDRC Reports web site at http://www.idrc.ca/reports/. To view an article, simply click on the matching
hypertext link shown at the bottom of this message.
If you do not have web access but are limited to e-mail, you can
request any of the articles present on this page by referring to the hypertext
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Simply send an e-mail to www4mail@unganisha.idrc.ca. leave the subject field blank, and type
the command GET http:// [followed by the requested URL (filename)] in the body of the message.
REPORTS
SCIENCE FROM THE DEVELOPING WORLD
November 17,2000
Preventing
[5]
Gully Erosion in Nigeria
November 17,2000 Once a densely forested region, southeastern Nigeria
is now sparsely covered with vegetation. And what is left of the land
could soon become largely unsuitable for cultivation and dangerous for
humans. The culprit is 'gully erosion’. Gully erosion takes place when
wear-and-tear on the surface land causes rainwater to accumulate in
one area, causing loss of vegetation cover, localized erosion, and the
formation of gullies. But this phenomenon can be prevented through a
combination of better engineering and changes in human behaviour, says
Dr Frank Simpson, one of the members of a Nigerian/Canadian research.
team funded by IDRC.
EEPSEA Case Study: Watershed Management: Paying for Conservation in
[6]
the Philippines
November 16,2000 One of the goals of environmental economics is to
facilitate the proper pricing of natural resources to promote their
sustainable use. Thanks to the joint efforts of several institutions
under the leadership of the Deputy Director of the Economy and
Environment Program for Southeast Asia Herminia Francisco of the
University of the Philippines, Los Banos this approach is being
successfully implemented in one of the Philippines' most important
nature conservation areas.
Whats
[7]
New at Cities Feeding People?
November 14,2000 Check out this website for
information about new publications and upcoming events related to
TDRCs Cities Feeding People program initiative.
r[8]pEPSEA Case Study: Integrated Pest Management in Indonesia: The Cost
ofChemicals
z
/
\
<'
November 13,2000 Excessive use of pesticides in Indonesia during the
1970s and 1980s created many serious environmental problems. These
included pesticide poisoning, the contamination of agricultural
products, the destruction of beneficial natural parasites and pest
predators, and the development of pesticide resistance in pests. In
response, the Indonesian government has actively pursued a strategy of
integrated pest management since 1989.
[9]Restoring Degraded Soils in India using Urban Wastes
November 10,2000 Canadian and Indian researchers are combining fly
ash from electricity generating plants, municipal sewage sludge, and
11/22/00
Page 2 of 3
in some cases the water hyacinth plant to produce a potent soil
replacement for Indian communities. Each of these, on its own, is an
environmental menace. Together, they could hold huge benefits for
worn-out soil.
[13JIDRC Web Site
[14]The Bellanet Initiative
[15]News from The Micronutrient Initiative
from The Model Forestry Secretariat
News
[16]
Pan
[17]
Asia
[18]
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Copyright © 1998 International Development Research Centre. Reports
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11/22/00
By the first of May 2001, we will be at our new office!
del primero de mayo 2001 estaremos en nuestra nueva oficina!
Le ler mai 2001, nous installer dans nos nouveaux locaux!
Women's Global Network for Reproductive Rights - WGNRR
Red Mundial de Mujeres por ios Derechos Reproductivos - RMMDR
Reseau Mondial des Femmes pour les Droits sur la Reproduction - RMFDR
Vrolikstraat 453-D
1092 TJ Amsterdam
the Netherlands
phone (31-20) 620 96 72
fax (31-20) 622 24 50
email office@wqnrr.nl
website http://www.wqnrr.org
and say goodbye to our old place after 12| years_______________________________
y decimos adios al lugar donde hemos trabajado por 12 anos y medio
douze ans et demi pour nous prendrons conge du bureau ou nous avons travaille pendant
file:///Untitled
Subject: [mfriendcircle] Draft Delaration on Human Rights and Health Practice
Date: Fri, OlJune 2001 23:57:36 +0530
From: "Amar Jesani" <jesani@vsnl.com>
Reply-To: mfriendcircle@yahoogroups.com
To: "MFC-eGroup" <mftiendcircle@yahoogroups.com>
Dear All,
There is an international effort on to draft a Declaration on Human Rights and Health practice. The first draft of it
is presently being circulated, with the following covering letter from Drs. lacopino and Marks, in order to get
comments and suggestions for changes from all concerned, and to get participation of more individuals and
organisations. The said draft declaration is attached herewith.
I suggest that those who can send their suggestions/amendments should send them directly to the
persons concerned at the email IDs given below the letter; and mark a copy to the eGroup. The last date for
pending comments on the first draft is June 15.1 do not know whether it would be possible for the MFC as an
Organisation to be a part of this international initiative -independently or through PHA However, if the convenor
and executive committee want to consider such possibility, then they may
directly contact lacopino and Marks. If you need help in such work, please do not hesitate in letting me
know.
Besides, the individual MFC members connected to organisation(s) may also consider this draft in their
own organisation(s) and if they want to be a part of such initiative, they should make contact as
mentioned above.
Amar.
THE FOLLOWING IS COVERING LETTER TO THE DRAFT DECLARATION
---- Original Message----From: Viacopino@aol.com
Subject: UPDATE: Delaration on Human Rights and Health Practice
May 10,2001
To: Participants of the Declaration on Human Rights and Health Practice
Project
From: Vincent lacopino and Stephen Marks
Re: Update on Project Issues
Dear Colleagues:
We would like to thank those of you who have confirmed your participation in
the international effort to draft a Declaration on Human Rights and Health
Practice and provided comments on the first draft of the text (see
attachment). We presented an outline of the project at the Global Assembly on
"Advancing the Human Right to Health" meeting in Iowa City on April 22nd and
it was well received. There are a number of issues we would like to bring to
your attention at this time:
1. Confirmation of Participation: If you have not confirmed your intention to
participate in this project, or are unable to do so, please contact Vincent
lacopino as soon as possible. We anticipate that participation will not
involve a major time commitment on your part. As indicated in the Preliminary
Timetable below, we will request participants to offer comments and
suggestions on several draft Declarations via electronic communications and
of 3
6/7/01 5:06 PM
file:///Untitlcd
to attend an international meeting sometime in 2002 to finalize the content
of the Declaration. If you expect your level of participation to be limited,
for example, to reviewing and endorsing the draft documents, please let us
know what to expect.
2. Comments on Draft # I: If you have not already provided your' comments on
the first draft of the Declaration (see attachment), please do so by June
15th. After receiving participant comments on draft #1, we will revise the
Declaration and circulate the comments and suggestions of all participants to
inform the second round of drafting. If you are unable to provide your
initial comments by June 15th, please indicate when they may be available.
3. Preliminary Timetable: A preliminary timetable is included for your
consideration; however, the schedule is likely to change based on our
collective productivity and funding for the international meeting. As you can
see, the plan calls for at least two rounds of drafting via electronic
communications and an international meeting in 2002 to finalize the content
the Declaration. The international meeting will also enable us to discuss
ategies for an endorsement process among health and human rights
organizations. The endorsement process will enhance the credibility and
relevance of the Declaration, while raising awareness among health and human
rights constituencies.
«
2001 June 15 Comments due on Draft #1
July 1 Distribution of Draft #2 and Participant Comments
July 15 Establish Planning Committee
August 1 Submit Funding Proposals for the International Meeting
September Planning Committee Meeting
October 1 Comments due on Draft #2
October 1 Distribution of Draft #3 and Participant Comments
Nov/Dec Plan International Meeting to Finalize Declaration and
Endorsement Process
. 2002 International Meeting
Endorsement Process (UN, WMA, WHO, NGOs, Others)
Dissemination and Advocacy
9
4. Drafting Process: Presently, we have invited approximately 65 individuals
from 35 different countries to participate in the project. The strength and
credibility of this project depends on consensus we develop and the extent of
representation among participants. If you have suggestions in this regard,
please let us know. Also, we are in the process of forming a Planning
Committee to deal with organization and administration of the project, and
later editing issues.
5. Funding: We are in the process of identifying possible sources of funding
for the international meeting. If you have any suggestions, please let us
know.
Thank you for your consideration of these issues. Please contact us if you
have any questions or concerns. In the meantime, We look forward to working
with you on this historic project.
Sincerely Yours,
6/7/01 5:06 PM
file:///Untitled
Vincent lacopino. MD. PhD
Senior Medical Consultant,
Physicians for Human Rights
Tel: + 702 547 1683
Fax: + 702 547 1684
E-Mail: viacopino@aol.com
Stephen P. Marks, Docteur dEtat. Dipl. IHEI
Franf ois-Xavier Bagnoud Professor and Director
Franfois-Xavier Basnoud Center for Health and Human Rights
Tel: + 617 432 0656
Fax: +• 617-432-4310
E-Mail: smarks@hsph.harvard.edu
Yahoo! Groups Sponsor
"o unsubscribe from this group, send an email to:
mfriendcircle-unsubscribe@egroups .com
Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
DRAFT Declaration on HR and H Practice.rtf
Name:
DRAFT Declaration on HR and H
Practice.rtf
Type:
Winword File (application/msword)
Encoding:
quoted-printable
.
i of 3
6/7/01 5:06 PM
Elements for a Draft Declaration onHealth-and Human Rights and.Health Practice
March 8, 2001
Preamble
We, physicians, nurses, health practitioners, health administrators, relief workers, human
rights professionals, ethicists, scholars, public officials, representatives of civil society,
and activists, from all regions of the world,
Recalling that health is a state of complete physical, mental and social well-being, and
not merely the absence of disease or infirmity,1
Recalling further that the recognition of the inherent dignity and of the equal and
inalienable rights of all members of the human family is the foundation of freedom,
justice and peace in the world,2
Reaffirming that everyone has the human right to the highest attainable standards of
physical and mental health, in accordance with the International Covenant on Economic,
Social, and Cultural. Rights,3
Noting with-saiiffaeiion-the-clarification-and-ampfificafion-on- the-scops-and-application
ef-that-right-providcdthe adoption by the Committee on Economic, Social and Cultural
Rights in itsof General Comment No.14, adopted on March ..., 2000,4NpJ_14 (2_000)_on
the rjght.to the.highe.s.t.attajn.abl.e. standard of health (art,. 12 of the.Intematipnal. Covenant
pnEconp_mic,_Spc_ial_and_C.ultural Rights),5.
Bearing in mind the Declaration on the Right and Responsibility of Individuals, Groups
and.Organs. of Society. to _Prpn.ipte.and Protect_Univers_ally_Reypg.n_i.ze_d Human Rights .and
Fundamental Freedoms.6
Considering also the World Medical Association Resolution on the Inclusion of Medical
Ethics and Human Rights in the Curriculum of Medical Schools World-Wide,7
1 WHO, Declaration of Ama Ata, 1978.
- Preamble, Universal Declaration cfHuman Rights, 1948.
3 International Covenant onEconomtc, Social and Cultural Rights, Article 12.
4. General Comment- No.14,.-.
mooo£2;Eyai2^
3.
•
6_ General ±^_s^HjirK_dutipn_53,!144 of9_p_ix_ember 1998,
1 WoiidMedcal Association Resolution on the Inclusion of Medcal Ethics and Human Rights in the
Curriculum of Med cal Schools World-Wide, Adopted by the 51st WoiidMedcal Assembly. Tel Aviv,
Israel, October 1999:1. Whereas Medcal Ethics and Human Rights fcmi an integral part afthe work and
culture of the medcal profession; and2. Whereas Medcal Ethics andHuman Rights form an integral part
of tire history, structure and objectives of the WoiidMedcal Association; 3. It is hereby resolved tliat the
WMA strongly recommends to Medcal Schools world-wide that tire teaching of Medcal Ethics and
Human Rights be included as an obligatory coirs? in their curricula.
|
Deeply concerned that human rights violations and umealizedunmet human needs cause |
profound human suffering, including the intolerably low health status of over one billion
P^^.epple.in the .world,
Noting .with, alarm .that .27.p.er .cent.p.f the..world’s..population _lacks .access. to..health
services,?
Convinced that health and well-being requires respect for all human rights consistent with |
the interdependent and interrelated character of human rights.
Convincedfurther that those who devote their professional lives as health professionals to
alleviating human suffering, have special responsibilities to include a human rights
perspective in all aspects of their work,
R-hsfiereby-Feselved-byihoiHtefHaiwMEd-CoHsoftmHr-OH-HeaMr-andA.dopt.tli.c .following |
Declaration on Human Ri gilts that-:-and Health Practice
j
Article 1
- General Commitment to Human Rights
Health practitioners have a duty to protect and promote human rights as
articulated in international human rights and humanitarian law7, and in .accordance.with
the.Declaration on. the. Right.and.Re.sp.onsibil.ity.p.f Individuals,.GroupsL_and.Organs.of
Society, to Promote .and. Protect. Universal ly Recognized. Human. Rights. and.Fundamental
Freedoms.
Article 2
- Interdependence of Human Rights
1. Human rights are interdependent and indivisible. Therefore, the realization of
any one right depends on the realization of other rights and cannot be considered in
isolation of other rights. These rights include, but are not limited to:9
a.
Freedom from racial and equivalent forms of discrimination
b.
Rights to. life, liberty and the security of the person
c.
Freedom from torture and cruel, inhuman or degrading treatment or
punishment
d.
Freedom from arbitrary arrest, detention exile
e.
The right to a fair and public trial
£ Freedom from interference in privacy and correspondence
g. Freedom of movement and residence, and to emigrate
h. Freedom of thought, conscience and religion
i.
Freedom of opinion and expression, peaceful assembly and association
^UNPP-Ji>mmDewl_o]xnent Report 2000,
171.
9 Principles of iiierdjpcndence andind visibility refer to all international liurnan rights provisions. The
ligjils outliiBdhere iiave been excerpted from both tire International Convention on Civil audPolilical
Rights and the International Covenant on .Economic Social and Cultural Rights for the purpose of
illustration.
|
j.
k.
1.
m.
n.
o.
p.
q.
r.
The right to participate in government, directly or through free elections.
The right to marry and found a family
Tiie right to social security
The right to work and protection against unemployment, to form and join
h ade Unions
The right to rest and leisure, including periodic holidays with pay
The right to standard of living adequate for the health and well-being of
self and family including food, clothing, housing and medical care and
necessary' social services
The right to education
The right to protection of one's scientific, literary, and artistic production
The right to a social and international order in which the above rights can
be fully realized
2. All the above rights are relevant to the promotion of the health of individuals
and populations and are, therefore, matters that fall within the competence of health
practice.
Article 3
- Duty to Avoid Human Rights Violations
Wherever health practice may, willingly or by coercion, be utilized in any way’
that participates in dr supports violations of human rights, health professionals shall
refuse any involvement whatsoever in acts or omissions that may result in human rights
violations, whether against the physical integrity of individuals or in support of policies
and practices that deprive populations of their internally recognized human rights.
.Article- 4 - Non-discrimination
Health practitioners have a duty to alleviate and prevent human suffering without
distinction of any kind, such as race, colour, sex, language, religion, political or other
opinion, national or social origin, property, birth or other status.
Article 5
- Advocacy for Human Rights as Part of Health Practice
1. Advocacy for human rights in the context of health practice should be non
partisans and consider the health ;and well-being of all members of the human family.
Health professionals who advocate for human rights shall "be fully protected from all
attempts to prohibit their legitimate activities for or to harass them in any way for their
activities in support of human rights.
2.- It is particularly appropriate for health practitioners to advocate publicly, as
non-partisans, for the protection and promotion of human rights without distinction of
any kind, such as race, colour, sex, language, religion, political or other opinion, national
or social origin, property, birth or other status.
i unvtv
- .oiiiii uuiu tic vii liuITian
1. Human rights may only be limited by the State for imperative reasons required
in a democratic society to protect public order, public health, public morals, national
security, public safely, and the rights and freedoms (reputation) of others. These
limitations may be applied only where explicitly recognized in applicable international
human rights texts.
2. It is part of health practice to assess the extent to which the conditions
required for the imposition of limitations have been met and to seek the lifting of
limitations where not justified.
Article 6
-Non-state Actors
While States commit most human rights violations, it is also necessary to hold
multinational corporations, civil society, and private individuals accountable. It is
therefore, incumbent on the health practitioner to seek opportunities to intervene in ways
that will deal with obstacles to the protection and promotion of human rights created by
non-state actors, whether coiporations or private individuals.
Article 7
- Bioethics
Because international principles of bioethics have focused primarily on codes of
conduct for health practitioners in individual encounters with patients, these principles
generally do not refer explicitly to relationships between health and human rights, nor do
they provide a mandate for the protection and promotion of human rights as conditions
for the health and well-being of individuals and. communities. The human rights
responsibilities of health practice, therefore, include preventing the medicalizing of social
causes of human suffering, and applying not only bioethics principles but also all relevant
human rights and humanitarian law standards.
Article 8
- Research and Documentation
Health practitioners possess the knowledge and skills of the medical and health
sciences to research and document the health consequences of human rights violations
and unmet human needs, to study and, where appropriate, to prescribe effective remedial
interventions for the health and dignity of individuals and communities.
Article 9
- Human Rights Education
1. Community based and non-fonnal human rights education as well as formal
education about human rights should be promoted in public and priyate education, as well
as throughout continuing professional education for health professionals.
. 2. The realization of rights ultimately depends on the development of a “culture
of human rights.” Human rights education is a long-term strategy for human
development; it is a proactive way of promoting the health and well-being of a global
civil society-.
?. Health practitioners have a duty to integrate human rights concerns in the
curricular studies of health practitioners as outlined in the World Medical Association
Resolution on the Inclusion of Medical Ethics and Human Rights in the Curriculum of
Medical Schools World-Wide (see Appendix below).
Article 10
- Environmental Issues
1. In accordance with the Ottawa Charter for Health Promotion, presented at the
first International Conference on Health Promotion in 1986, human rights, an
ecologically sound environment, sustainable development and human security are
interdependent and indivisible, and all pa-sons have the right to an environment adequate
to meet equitably the needs of present generations and that does not impair the rights of
future generations to meet equitably their needs. To this end, health practice should avoid
harming the health of individuals, protect the environment and ensure sustainable use of
resources, restrict production of and trade in inherently harmful goods and substances
such as tobacco and armaments, and discourage unhealthy marketing practices.
2. Il is therefore the responsibility of health practitioners to safeguard both the
citizen in the marketplace and the individual in the workplace though such instruments as
human rights impact assessments as an integral pail of health and development policies.
Article 11
- Poverty
Given the profound health consequences of poverty and increasing global inequity
between the rich and poor, health practitioners working in the context of development
have a special responsibility to apply their professional capabilities to understanding the
nature of this problem and prescribing effective remedial inter ventions.
Adopt an
Pondicherry Declaration on
Health Rights Responsibilities
holistic
approach to
health care.
This consensus statement and Charter on Patients
Rights and Responsibilities was adopted by the partici
pants attending a workshop on “Medicine, Media and
Consumer Education” held in Pondicherry, December
1-4, 1993. Thirty participants from three countries
attended the workshop, organised by the Educators for
Quality Update of Indian Physicians (EQUIP) with the
support of the International Organisation for Consum
ers Unions (IOCU).
2.
We call on Health Professionals to:
♦
Adopt an holistic approach to health care.
♦
Develop two way linkages between different levels
of health care.
♦
Promote prudent use of diagnostic aids and
therapy.
♦
Endorse and respect the Charter of Patients Rights.
♦
Acquire communication skills to interact with
patients, the mass media and the public.
This Workshops Evolved the Following Guiding
Principles :
♦
Periodically update their professional knowledge
and improve their skills.
♦
The work of rational drug use groups should be
expanded to include diagnostics and non-drug
therapy.
3.
We call on Professional Groups, Non-Govcrnmental and Voluntary Organisations to :
♦
The concept of continuity of care through the
family physician should be encouraged by con
sumer education and medical education.
❖
Promote the adoption of a Charter of Patients
Rights and Responsibilities.
♦
A Charter of Patient’s Rights and Responsibilities
should be widely adopted by professional and
consumer groups.
o
Establish networks at all levels in order to facilitate
health information, communication and education.
o
Encourage multi-and inter-disciplinary research on
health related issues.
Facilitate periodic updates for health knowledge.
1.
We call on Central and State Governments to :
♦
♦
Bring all issues pertaining to drugs under the
purview of Ministry of Health & Family Welfare.
4.
We call on the Mass Media to :
♦
♦
Enunciate and effectively implement a rational
drug policy.
♦
Promote the concept of essential drugs and ensure
their availability at affordable cost.
Recognize their far-reaching influence on the level
of public awareness and assume a more active and
responsible role in informing the public on health
issues.
♦
Use a resource network of competent health
experts to ensure objective and balanced reporting
of health issues.
♦
Promote use of generic names of drugs.
♦
Regulate and monitor all promotional measures
and advertising materials.
♦
♦
Establish a National Drug Authority of India
consisting of governmental, non-governmental
organisations as well as professionals bodies.
Establish regular communication with health pro-.
fessional and consumer groups.
♦
Establish and support a drug information and usage
monitoring system to facilitate and implement an
effective rational drug policy. This should include
systems for monitoring adverse drug reactions.
Participate in the screening of advertisements on
health- related issues of unsubstantiated claims and
unethical promotion.
5.
Wc call on the Health and Pharmaceutical
Industry to :
♦
Develop and enforce a code of marketing, promo
tion and dissemination of information, in partici
pation with governmental and non-governmental
organisations.
♦
Recognize their social responsibility to the public '
with regard, not only to the safety and efficacy of
their products and services but also to their cost
and societal impact; to devise and to disseminate
health information accordingly.
♦
♦ ' Integrate the concept of rational drug use, includ
ing drug information into health and medical
education.
♦
♦
Introduce within the formal and non-fonnal edu
cational system information on health related
issues.
Promulgate the Charter of Patients Rights and
Responsibilities and Physicians’ Rights and Re
sponsibilities.
Health for the millions
Patients Rights i
in lay terms of the proposed procedure and of
any available alternative procedure. Where applicable, the explanation shall include information on
risks, side effects, or after-effects, problems
relating to recuperation, likelihood of success,
and risk of death. Informed consent of the patient
must be obtained prior to the conduct of a treatment
or a procedure. In the case of a minor, consent has
to be obtained from die parent or guardian. If a
patient is incapacitated and any delay would be
dangerous, a doctor is entitled to carry\ out any
necessary treatment or operation after a second
opinion is obtained.
PART 1 : PATIENTS RIGHTS
Section-1: Right to Health Care and Humane
Treatment
I.
Every individual shall have access to adequate and
appropriate health care and treatment.
2.
Every patient shall be treated with care, consider
ation, respect and dignity without discrimination of
any kind.
3.
A patient has the right to be treated by fully
qualified health care professional in private or
public health care facilities.
4.
A patient has, wherever possible, the right to be
treated at a hospital of his choice and to be referred
to a consultant of his choice.
2.
5.
Every individual shall have the right to prompt
emergency treatment from the nearest government
or private medical and health facility.
3.
6.
Patients have the right to humane terminal care and
to die in dignity.
7.
A patient can be transferred to another health care
establishment, only after an explanation of the
need for this transfer and after the other establish
ment has accepted the patient.
8.
A patient has the right to have all identifying
information, results of investigations, details of his'
condition and his treatment kept confidential and
not made available to anyone else without his
consent.
Before any treatment or investigation, a patient
shall have the right to a clear, concise explanation
Explicit, informed consent is a prerequisite for
participation in scientific experimentation. Experi
mentation must not be carried out on a patient who
is unable to express his will.
Section-3 : Right to Information
1.
Information about health services (including recent
developments in (he field) and how best to use them
is to be made available to the public in order to
benefit all those concerned.
2.
Information may be withheld from patients in cases
where there is good reason to believe that this
, information would affect the patient’s health ad
versely but, however, the information must be given
to a responsible relative.
3.
A patient has (he right to know the identity and the
professional status of the individuals providing
Section-2 : Consent
1.
. A patient has the right to refuse treatment to the
extent permitted by law and to be informed of the .
medical consequences of his decision.
!
.
'
and Responsibilities
4,
5.
• -6.
service to the patient and to know which professional
• is primarily responsible for the patient’s care.
stands what a patient’s rights are and shall exercise
those rights responsibly and reasonably.
■ Patients should have the right to seek a second 2.
opinion from another physician.
The patient shall ensure that she understands the
purpose and cost of any proposed investigation or
treatment before deciding to accept it.
Patients should upon request, be able to obtain a copy
of a summary of their diagnosis, treatment and care
• including diagnostic results on discharge from a
hospital or other establishment. They shall also have
the right to authorize another medical professional to
obtain a copy of the same and to inform the patient
of the contents.
A patient shall have the right to examine and receive
an explanation of his bill after any treatment and
consultation.
Section-4 : The Right to Adequate Prescribing
Information
:
I.
While prescribing medication, the patient shall be
informed about the following : expected outcome,
adverse and after- effects, chances of success, risks,
cost and availability.
. 2.
All drugs dispensed shall be of acceptable standards
in terms of quality, efficacy and safety.
3.
All medicines shall be labelled and shall include the
pharmacological name of the medicine.
3.
The patient shall accept all the consequences of the
his own informed decisions.
4.
The patient shall provide accurate and complete
information which the heal th professional requires,
about his health and ability to ’pay for health
services.
5.
The patient shall.establish a stable relationship■
with and follow the treatment determined by the
health professional primarily responsible for the
patient’s care. ■
6.
The patient Shall inform the health professional if
he is currently consulting with or under the care of
another health professional, in connection with the
same complaint or any other complaint.
7.
The patient shall so conduct himself or herself so
as not to interfere with the well being or rights of
other patients or providers of health care.
8.
Every individual has a responsibility to maintainhis own health and that of society by refraining
from indulging in high risk behaviour, detrimental
to health.
9.
Every individual has a responsibility to accept all
preventive measures sanctioned by law.
Section 5: Right to Health Education
Every individual shall have the right to seek and obtain
advice with regard to preventive and curative medicine,
after-care and good health.
PART 2 : PATIENT’S RESPONSIBILITIES
1.
The patient shall ensure that she knows and under
Note: (For 'he' or *his
in this document, please read "he
or she’\ and 'his or her'.)
HeRWAI
Health Rights of Women Assessment Instrument
An instrument in development
January 2004 ©
The Humanist Committee on Human Rights (HOM), the Netherlands is developing an assessment
instrument for the human rights of women in development co-operation, based on human rights
instruments. The instrument will focus on women’s right to health. Six NGO’s from different parts of the
world participate in the development of the instrument1.
The Health Rights of Women Assessment Instrument (HeRWAI) is being developed for NGO’s in the
South and the North who are interested in women’s health. It aims to help them analyse the
interrelation between national and international policies and their combined impact on women’s health.
The analysis can focus on existing policy or policy under development. It can be health policy, or
policy which does not focus on health, but which can be expected to influence women’s health rights.
With the outcome of the analysis, NGO’s can lobby for measures that better protect women’s health
lights. First of all they would direct their lobby at their government. But they can also decide to
approach donor agencies or international organizations which influence the national policymaking.
HeRWAI further aims to bring together NGO’s working for development and health with those working
on human rights. The NGO’s will be stimulated to use human rights standards when analysing what
policies do to women’s health. Human rights add strength to the arguments of NGO’s, because they
are universal and not limited to a certain group or area. This means that NGO’s can hold their
government accountable. They can ask for changes not ‘just’ because they think it is important, but
also because their government is obliged to protect their rights. Most countries have ratified the
Convention on the Elimination of All forms of Discrimination Against Women and the Covenant on
Economic, Social and Cultural Rights. This means that they are obliged to protect women's health
rights. HeRWAI makes use of these treaties and other widely accepted texts describing women’s
health rights.
The instrument is still under development and far from completion. In its draft outline, the instrument
consists of two main phases. The first phase of HeRWAI is a so-called quick scan. A series of
questions guides the NGO’s to consider if HeRWAI is appropriate fortheir situation. If, on the basis of
the quick scan, the NGO’s decide to undertake the analysis, they start with the actual impact
assessment. The NGO’s will describe and analyse a certain policy, and suggest alternative strategies
with a better impact on women’s health rights. HeRWAI provides a structure for the collection of
information, which helps the NGO’s to look at the human rights aspects of health and at the
interiinkage between national and international policy. The results of the analysis may show that as a
result of the policy, women's health will deteriorate, or that the policy misses an opportunity to improve
women's health rights. In the lobbying process that follows the analysis, the NGO’s will not only focus
on the shortcomings of the policy, but also develop suggestions for improvement.
The draft outline of the tool needs to be developed further, especially the parts on indicators for
women’s health and the user guides. It may change according to further discussions and pre-testing.
HOM and its partner organizations will continue this process in the coming period. The aim is to reach
a pre-testing stage by the end of this year and to have a draft version of the tool ready by April 2004.
For more information, please go to http://www.hom.nl/enq/index.html or contact s.bakker@hom.nl
1 Naripokkho, Bangladesh; IWRAW-AP, Malaysia; Fida-Kenya, Si Mujer, Nicaragua; Wemos and WGNRR, the
Netherlands
Wemns Programme 2003-2005
November 2002
3402RAP62001/02
People’s Right to Health as a Global Concern
Health and International Policies
(402RAP02001>02
Programme /0i‘».V7ufiS
November 2G02
3402RAP020G1 /02
I X i KO0I CTION
Wemos was founded in 1981 by medical students who were of the opinion that too little attention was
paid to structural causes of ill health and international health issues. In the course of the past two
decades, Wemos has developed into a professional organization with twenty paid employees, working
on ihe imnr.n ament of people's health in developing countries from the office, in Amsterdam Tn 2002
the budget of.the organization amounted to 1.6 million Euros. The main funders of the 2002 activities
of Wemos sis lhe \eth.srl3iK!s N'linistry of Forcisi Affairs. (jordaid Hives the European.
Commission. Stichtiiig Doen, tne Nationals Commissie voor Inlet nationals Satnenwerking en
Duurzamc Ontwikkchng (the National Commission for International Collaboration and Sustainable
NCDO). as well as some private donations.
Health is a prerequisite for the alleviation of poverty. The improvement of people's health is
internationally recognized as one of rhe most important development goals. Health as a key factor in
the lives of all people in this world is reflected in the Universal Declaration of Human Rights, the
International Covenant on Economic, Social and Cultural Rights and in other human rights principles
and treaties such as the Convention on the Elimination of AU Forms of Discrimination Against
Women, in which it is stated that the highest attainable standard of health i* .nfm-i-..,,.. ,
i, the possibilities of men
arc increasingly determined b y international slaudaids,
is that these international polici es should protect, respect
rdllli Lie HiZr.i IO IL-HHll iilC; I21c '.v T1nos general objective therefor-j is: to contribute to the
teaiiZuiiuft uf ihe rixhi iu health uj ifieri tmd women in developing counitties through influencing
international policies. To achieve This o!bjective Wemos activities are and have always been
................... _ .
>nal and international policy irlakers, collaboration with
cvuiiiciii partners. and caiupaisninH amorig health professionals in the Netherlands in order to
Wemos considers itself to be part of international civil
Mx-irly and joins oihers in lhe fighl for i’no innnroveme.nl of people s lu-uilih iti ileve.loninu coi mines.
In 2001 an evaluation of Wemos was carried out en behalf of the Ministrv of Foreign .Affairs. The
outcome of this evaluation and the need felt within the organization to come to a more integrated wav
of working resulted in a series of discussions with stall members, the Wemos board, Southern partners
and a number of outsiders. The srrategv nt an 2002-2005 * see summary in Annex on page Error!
Bookmark not defined.), developed in 2001, is a reflection of this process. In this plan changes in the
organizational structure, the financial structure and the content of the projects are outlined and the
Wemos strategy is presented. Major changes concern, rhe transition from nine smaller nroieers rojbree
bigger ones, the appointment of a project co-ordinator responsible for the streamlining of the different
project activities, and the intention to obtain funding based on an integrated Wemos programme rather
than on separate projects.
The year 2002 has been used to make a start with the implementation of these changes. The nine
projects aiouud the themes baby food, access to medicines, oldet women’s health and the impact of
economic policy on health are being concluded or partly included in the new projects. Three project
teams were formed and expen advice was sought to further develop a rights-based approach to health
which includes a gender approach.1 In May a consultation with Southern partners was organized in
whtch major ihlematinn.-i! developments were discussed and ideas concerning the three new projects
were shared. The analysis of the most important developments in health and international policies in
recent years and other input from Southern partners, members of the Wemos board and some external
■ he staff trains: prccramtne cn a human rights approach to health and on gender, started in 2002 will further be developed in
November 2002
3402r\AP0200 i 702
readon; resulted in the. ronjniWion of three new projects: health mid trade, health and poverty
reduction strategies and health and global public-private initiatives.
I'hrough collecting information, collaboration with Southern partners and other NGOs, lobbying
rational and international policy makers and campaigning in the Netherlands, Wemos wants to
ruuuibnte to the fulfilment of the right to health of men and women in developing countries. The new
organizational structure and the three new projects will hopefully assist us in becoming more effective
n achieving this objective.
This document contains an overview- of what Wemos considers to be the most important trends in
iniernaiiona’ health issues and an introduction to a human rights aw! gender approach to health
Thereafter, the Wemos strategy is outlined and the three projects arc presented. The annex contains a
*Us of criteria for collaboration between Southern partners and v/emos a list of abbreviations
references and the stun maty of the strategy plan.
November 2002
V< t \ j t} S V i £ W
HEALTH
i 5 i t R A A T 1O X A i.
D | V E 5. () F M E N T S A 5 D
imiOii' C’l n'vixtcii. ii'icii nilu CnildfCil Hi ucv’ciuFiilS CviiiuTscS iS 3 iiihitcf vf STCSi CviiCcfn.
■op!e de not have access to sufficient food, safe drinking water and adequate housing,
hontliy environments. Furthermore, large numbers of people die. every day of I real able
main cause of rhis bad health situation is poverty ’ and at the same time this bad health is
!e for poverty alleviation. People deprived of their health are limited in their capabilities
g. to develop themselves and to contribute to society. Tire majority of the world's poor
nd arls. However, women not only sul-cr Irom poverty-rclaleci health problems.
ststus iii society. their kick of nuionoinv over their scxlih! snd reproductive lives, the
stribunon of toed within the household, and women’s limited control over resources
Health as a human right
'
a
’■ ing ’ is
; rial
to the highest at in bl
tandard of physical and mental
■'
conducive to living a life in dignity.’ The right to health does not imply the right to be healthy but
concerns the right to- me highest attainable standard of health. This right is one oi the fundamental
human rights and is closely related to and dependent upon the realization of other human rights.
including the rights to food, housing, work and education.'
Because human rights are legally binding, these bodies ate accountable for ensuring that these
entitlements cannot be reduced to mere privileges or luxuries or left to the whim of markets (see box
on page 5 for more information about the obligations of these different bodies).
* Hesltn ;S a sUie complete p.hysicgi, mental and social well-being and not merely the absence o? disease or infirmity.
loo;???-? :?y j?? 'r- it.:
•_
■i'j-77’ .jimp..
^.innftri r.n 7" Juiy iQZh hy Thft rF-nrR^ntatives of 61 State? (Official Rer.nrdq nf the vUnriri Hearth
Organisation, no
p i 00 sr.d entered into force on 7 April 1948 )
From a human rigHs perspective poverty constitutes the non-fulfilment of a person’s rights to a basic set or capabilities - to do
uHsicered basic s.n mnst suci«?i«s inciudina the capabilities of being adequately nourished and sheltered, having basic
J'- R'qhts CCESCR) nnd numerous other human rights documents,
’ This is consistent with the sc-csilec expansive interpretation of the right to health used by the UN committee on ESCR. (Hunt
vVe.rnns Programme 2fi0.3-200S
November 2002
3402RAPO2OOI/O2
The realities of the health crisis
For millions of people the enjoyment of the right to health remains a distant goal. In the least
developed countries over a third of the population is undernourished and of ever/ 1000 children bcm,
OR ('ie. before they reach ihc.ir firsl birthday Child immunizalion rales in Sub-Sahara Africa have fallen.
under 50%; by the end of 2000, 20 million people in the world had died of AIDS and 40 million were
living with HD' aIl'S. of which 75% were in Sub-Sahara Africa (UNDP 2002). Other communicable
diseases, such as maiana, tuberculosis, acute respiratory infections, diarrhoeal diseases, measles and
ctlier v&ccme preventable diseases also contribute to the high toil of illness and premature death
amona the poor, insufficient reproductive health, nutritional deficiencies and lifestyle-related illnesses.
gender in quality
ocess to affordable safe water and sanitation, and the increasing use of
peslicidej are other important factors affecting health negatively.
■' Fora fail description of the normative content of the right to health and of the obligations of states and ether actors, we refer to
Genera! Comment n‘jrnber 14 s'CESCR 20001.
Wemos Programme 2003-2005
November 2002
3402RAP02001/02
•? ui The ncriesr 20 countries is now 3 / rimes that in the poorest 20. This ratio has doubled in the
0 years. Similar increases in inequality are found within countries (World Bank 2002).
txpwdimres on health are. for roo iimired 10 conquer rhe present health crisis jhe median public
Svb-Saha-r .Mrica is onlv USD 6 nercaoita per year (World Dank 20000. The
World Health Organization (WHO) has calculated that an investment of USD 60 per capita is needed
io iinance a sustainable health system (WHO 2000). Concerted, efforts are required by both national
governments and donors to fight the health crisis. The WHO Commission on Macroeconomics and
Health calculated that about 27 billion US dollars of donor support is needed, amounting to 0.1 per
com oi die Gross Domestic Product (GDP) of donor countries, for a worldwide scaling up of health
*:
investment
tor the low-income countries. These concerted efforts would not only improv- people’s
health but 'would also translate into hundreds of billions of dollars per year of increased income in die
low-income coUutites (Commission on Macroeconomics and Health 2001)
in integral health systems which offer sufficient and accessible health
other determinants of health. Many of the public health systems in lowzero pressure. They receive few resources to implement preventive and
it hospitals often lack equipment, medicines and trained personnel, and
and water cuts. The strategy of primary health care, adopted by the
ation of 1978. can still make a major contribution to the objective of
his objective investments in other factors determining health such as
tducation are equally important. Special attention should be given to
trisis. The denial of reproductive rights, maternal deaths, high rates of
n are al! issues that can only be solved when special attention is paid to
r, transnational corporations and international
in developing countries f»nci fill pinv p role in
, eloping countries have the obligation to protect,
but often fail to do so because of lack of funds,
2rc spending monev in iisslib but as mentioned
hligalion to conlribufo io the right io health (see
lors is often absent and expenditures arc in many
church-related health institutions and other civil
nt health care providers in many developing
severely under funded public health sector. Civil
s actively lobby for the development and
icies which do include the fulfilment of basic
At the. international level, some, of die main factors affecting health arc trade policies, poverr
reduction strategy policies and the increasing influence of transnational corporations.
' The intoortanct of the strategy ?t PHC to ach:~7' haaith for all has been confirmed in the Ottawa Charter for Health Promotion
of 1886 (WHO ‘955: ond reaffirmed in n resolution of the 52th World Health Assembly in 1998 (resolution number WHA51.7).
1 c h t: 112 5 t i o n - h r ;.i 1 ( h a ii d irad
?
*
nee the 1980s a rapid integration of the world’s economy has taken place in which companies,
wernments and individuals make international transactions in goods, services, finance and
formation. Important features affecting the right to health are: increased foreign trade and
vestment, erowtfa «nd mcreasino power of transnarionaI corporations, the emergence of a alobai civil
ciety and the global spread of communicable diseases, such as HI v/AIDS.
■e increase in trade and foreign investments has consequences for rite right to health of people in
■.vclqping countries According to frcc-markct theory and nco-libcral thinking, trade and capital
ttmuy s initial income level. Al a veiy low average income level, it is only the itch who
mother problem m relation to the right to health of men and women in developing countries is rhe
ndem-xratic nature .-f the WTO. Within the WTO decisions are taken in small group meetings which
r < rtes>nV xiiiiUcaceu ov <.<A:awa, me Ijirropean t^inon (hOj, Japan and the fainted states of <\mertca
i s a : (iJNj n- /<;;.»/1 i hev primaritv defend their own interests, including the interests of the business
cctor. The vital ime-ett-of developing countries are often marginalized. It is ver.- difficult for these
countries u; go against the power of the developed world since they are in many way s dependent on
these countries lor ibreigh aid anti investment. Furthermore, non-compliance with WTO agreements is
Wemns Programme /t'uA-z’flfi.n
Moreover, despite the feet that couEiry ownership is one of the pillars, the needs of the people in the
countries concerned are still not at the core of these PRSPs. Because PRSPs are connected to debt
relief, soft loans and bilateral donor assistance, developing countries have to comply with what they
perceive as externally imposed conditions that reflect the worldview and interests of the creditors This
new foiin vi Cviiciittviisiii'v’ is partly due to power relations within the Vvorld Uank and the Lvli'.
Nearly half of the voting power in both institutions rests in the hands of seven countries. Informally
the F.I and die I.S exercise an even greater power, as in, for example, nomination of the heads of both
institutions. Within both institutions a new kind of division has developed between creditor countries
on the one hand and borrowing countries on the other. The creditor countries enjoy increased decision-
vVprnos Programme 2003-2005
November 2002
3402RAP02001 r'02
At the international level, TNCs are getting involved in what is called new global initiatives, in which
I "X bodies such 3S ;hc WHO Join forces witb privste companies
global standaid setting bodv in health and its supportive collaboration at country level, under pressure.
The current reality that a patchwork of separate and ad hoc alliances and partnerships in health has
developed, each having its own structures, procedures and goals, in addition, no rules and regulations
exist that ensure democratic decision making and public control.
n
Tliis chapter slarled with (he. slale.menl that (he health situation of women, men and children in
developing countries is a matter of great concern. We outlined the three major international trends
which, according to us, have consequences for the health of people in developing countries. We are
aware of the strong processes underlying these trends and how they are rooted m the persistent
inequalities bout in economic and political power, between North and South, hi addition we realize
how determining sender ineaualiries are for the differences in health, and access to health care.
between men and women. T. emos is of the opinion that only through a rights-uased approacn can
[UNDP 20021.
A combuiatkm oi' activ iiies required to effectively work on the achievement of the Wemos general
abjective • to
‘i the realization -of the right to health of men and women in developing
.
i-.
:.",r.':;vh mi’jwvinv inlfrnahomii poh.ne.s - and ibe related project purpose''
.strategy
th Southern partners and capacity strengthening
th other NGOs, networks and institutes
g and campaigning in tlte Netherlands among
health
The Wemos strategy consists of five elements (sec box) which arc mutually reinforcing and arc most
effective in combination. Lobby and advocacy activities are more successful coming irom a
profession?.! and weli-irtton'psd staff and when it is clear that the claims mads in ths lobbying follow
trorn the coltaiwation with Southern partners and have the support of other NGOs and networks and
Wemos closely monitors policy agendas to obtain in-depth knowledge about the relevant discussions
and beads regarding international policies and health. Activities undertaken are.
-
writing position papers on topical issues
-
attending international conferences to meet policy makers, relevant NGOs and others, and other
formal and informal contacts with relevant policy makers
organizing seminars
dissemination of the results of case studies, conducted to obtain information about the
ecn seonence? of internp.tinnat policies for the health of men and especially women in developing
•
•
countries
♦
press releases and letters to ministers members of parliament and directors and staff of the
relevant international institutions.
Wemos Programme 2003-5005
November 2002
luman rishis and health, tnlemaluinal agreements on women's rights and valuable initiatives in
he field oi women s right to health
in-denth analysis or international trends and their impact on health and of the outcomes of existing
impact assessment and evaluation studies
the deieiopiueui of methodologies io systematically gather data on local consequences of
In die "A’cmos documentation centre, which is currently being updated and improved, background
articles. development reports. publications ot other NGOs, policy papers, relevant academic studies
as wen as miormanon snout relevant weosnes, ust serves ana e-man
Both iPStiTunoDs
*
rind other partners can be supported in their lobby, advocacy and awareness raisin0
activities in their own countries. This support can consist of finances for die conducting of activities
by partners, it can also consist of and advice and guidance from Wemos, when requested. Other
important aspects of the collaboration with partners are the conducting of case studies about the
consequences oi international policies on the health situation of men and especially women, and
capacity strengthening in the form of training on specific issues and/or lobby activities. Institutional
strengthening is nan of the collaboration with institutional partners, in case other partners want to
Wfimos Programme 2003-2005
November 2002
3402RAP02001/02
work on ir.siilinional development, Wemos will assist these organizations in finding suitable advisers
and/or courses.
The intensification of the relations with Southern partners is described in detail in the three projects. In
the choice of new partners Wemos will pay special attention to their level of gender and human rights
senshhirc. Wemos will put gender systematically on the agenda during field visits and will facilitate
learning and exchange among partners by providing and collecting regular information on gender and
human rights developments.
two r ks and institutions
:s and makes sure it is heard. International networks such as the International Baby Food Action
KOik (IBrAhi >. the Health Action liiteiiialional (HAI). the People’s Health Movement (PHM) and
merrntional People's Health Council (TPHC) provide the opportunity to link with organizations
ver du v. orid v. erlang on similar issues. These networks also offer the possibility to coordinate
tons, develop loiut lobby strategies and ate important sources oi information.
number of European networks with which joint
EU donation project and EU baby food project).
n each others activities and to broaden the scope
ifessionals. Collaboration with European partners
Wemos is strongly embedded in the Dutch NGO sector, and joint lobby and campaigning activities
such as press conferences and seminars arc organized. Health NGOs arc members of a
‘kiankbordoroffn ’ /advisory board) and coalitions arc formed around specific camnaions such as the
Jubilee campaign in which Wemos played a leading role. In some cases these coalitions and platforms
are formed in response to topical issues. In other cases joint activities form part of a long-term
agreement between Wemos and a Dutch NGO which includes financial support and the undertaking of
joint activities.
Contacts with university departments and institutes will be intensified to link up with existing impact
assessment studies, to obtain knowledge about methodology for the case studies to be carried out as
part of the three projects and to be well aware of academic studies carried out about international
To broaden the expertise on human rights and gender in relation to health issues, in the coming years
Wemos will expand its present national and international network to include hew contacts with human
11 gning in the Netherlands
tical solutions that are. sustainable, it is necessary to
s raisin
*?
and carnpaiin9 Public opinion creates the
inns Io acl on these, issues
tvemos raises awareness among Dutch health professionals (doctors, paramedics and other health
workers), ?sGOs involved in health and development collaboration, politicians and policy makers at
rhe national and EJU level and the wider public. They will be informed about the fulfilment of the right
to health in developing countries.
Furthermore, national and international coalitions will "be built in order to strengthen advocacy efforts
and make stronger plea for policy changes. Individual health professionals will know about issues
Aii important pan of the campaign is to organize an event to show the collected support for policy
changes. Results in terms ol policy changes and effects for the enjoyment of the right to health in
developing countries will be communicated. The awareness raising activities will contribute to the
i'amn^ion~< development.
t he 'A emos campaign will be organized bv the Health and Poverty Reduction Strategy proj«
2003. the Health and Trade project in 2004 and the Health and Public-Private Initiatives in 2005.
the human rights and gender approach are also an integral part of the Wemos strategy'. Whenever
possible, activities, themes and messages will contribute to expanded chances and choices for women
and the enjoyment, of equal rights to health by women and men. During the period 2903-2005, further
human rights and gender staff training will be organized. Partner organizations with specific
knowledge and expertise on these issues will be asked io share then experiences with Wemos and its
Wemos Programme 2003-2005
November 2002
3402RAP62C01702
*• 6 ii 11 h ziiifl f? ! o t? 22 > H u b I i c - P r i v 2 t e Initiatives
' '
yHg countries do not have sufficient access to health care for several reasons.
In some more remote areas health care facilities are not available. Where health services axe available
user fees can form a major obstacle. Tn many countries privatization of parts of the health care sector
has resulted in a decrease in the accessibility of health care services. The finanems of a public health
care sector which provides services for all is one of lite major problems governments of developing
countries are facing. Low incomes in combination with high debt repayments cause national budgets
to be inadequate to guarantee a minimum level of health care, which is accessible for all. At the same
time, some Southern NGOs claim that their governments do not pay sufficient attention to health and
do not use scarce resources in an eliicieut manner. Furthermore, some governments make policy
choices which are not based on the basic needs of their own people.
Despite the increased attention for health during all kinds of international meetings, international
conEDitEocnTs such ss ihc allocation of 0.7% of ODP of developed cob nines to Official Development
Assistance (ODA) are nol mel and mlemalional budgets are far loo limited to improve the health of
women, men and children in developing countries. The WHO, responsible for the development and
implementation of international health policies that promote the richt to health has also very limited
resources and is unable to fulfil its obligations. One of die responses to the enormous health problems
in developing countries is the establishment of a number of so-called New Global Initiatives in recent
vears. These iniriarives include so-called Global Public Private-Initiatives (GPPIs). a form of
collaboration between a UN body or a government (as a public body) and private enterprises (the
private for profit bodies). The corporation between private and the public sector in health is not new.
What is new’ is rhe international dimension of these, initiatives.
The definition of GPPIs used in this proposal is:
Heath GPPis are collaborative relationships that transcend national, boundaries and bring together at
least forca
- atnong /few a corporation and/or industry association and an inter-governmental
organization -■ so as to achieve a shared health creating goal on the basis of mutually agreed and
explicitly defined division of labour (adoptedfrom Buse and Wall 2000).
At the global level, there are about 80 PPIs. Examples of these initiatives are the
International Aids Vaccine Initiative (IAVI), the Global Affiance for Vaccines and Immunization
(GAV1), and the Stop TH Partnership.
Building on previous work of Wemos and partners
Wemos has been involved in the area of public-private interactions within different projects. In the
pharmaceutical programme staff members initiated discussions on the role of the private sector in
combating the diseases of rhe poor and on corporate social responsibility (CSR) with Nefarma (the
organization of research based pharmaceutical companies in the Netherlands). Furthermore, ’ vemos is
a member of the Dutch platform of NGOs which has been working on a frame of reference for
corporate social responsible behaviour. Wemos investigated the operations of Philips medical systems
-a department of the Dutch multinational Philips- in the health care system in India. This work forms
the basis for the underlying project as its preliminary results give reason for a longer term involvement
to closely monitoi the activities of the public-private mix in the health area. The focus 011 global
public-private initiatives is, however, new for Wemos.
Since this is a new project the first period will be used to gather information and to find Southern
partners interested in the issue of GPPIs and able to conduct case studies in their countries about the
consequences of these global initiatives. So far, one of Wemos institutional partners is interested in
participating. Because of W emos activities within a number of international networks and the wide
Wemns Programme 2003-/005
November 2002
six partners
ibjective
Global Public-Private Initiatives in health -will contribute to the fulfilment ofthe right to health.
i/.s are of die opinion that GPPIs
systems and will con •ibuto to the fulfilment of the right
Inhilirt l<> lhe. rivni io health will in ihis nroiej
accountable m local and national govemments,
ces delivered within the framework of GPPIs should
ith the participation of the
liould approach health issues in an integral manner, taking into account the
Justification
meral Comment no. 14, States have the obligation to respect, protect and fulfil the
obligation is not only for the benefit of the states' own citizens, but also - by wav
:ollaboranon and assistance — for the beueiit oi citizens oi states whicn do not have
meet this obligation (amongst others, through ODA). This general comment
WHO in nrovidino technical assistance and collaboration at the international.
framework and agenda for health.
he lack of finances of the WHO. For the WHO.
ngs with it opportunities to set up programmes that
the WHO’s objective to achieve health lot all. The
established some guidelines for its staff members in
hips with commercial enterprises, WHO’s reputation
dity must not be compromised. Staff should always
it involve a real or perceived conflict of interest, either
roaniyation’ (EB107/20 2000, still in use). Some argue
as the lack of a clear definition on conflict of interests
ipendent evaluation of potential donors (Health Action
more quick
lountries GPPIs offer the opportunity to obtain funds to finance their
o obtain these funds are usually short and money is available much
e with other international or national funds, because procedures can be less
Wemos Programme 2003-2005
November 2002
3402RAP02001 /02
biireaucraiic The newly elected Dutch government attaches great, importance. io the role of the private
sector in international collaboration and is involved in a number of GPPIs as a donor.
Tile participation of pnvate enterprises in global initiatives is a reflection of their increasing power at
the world stage. For them. GPPIs offer the opportunity to assist in solving the major health problems
in this world, and to present themselves as corporate socially responsible companies. This corporate
soctal responsibility (CSR) is a frequently debated issue. Several companies such as Heineken have set
up HTV.e'JDS programmes for its workers in a number of African countries, while others are
participating in GPPIs. According to critics, companies 'use these partnerships as a marketing and
public relations device’ (Richter 2002). or have purely economic reasons for their involvement in
health. This has nothing to do with CSR behaviour.
According to Wemos it is important to obtain insight into the motives and role of the corporate sector
in GPPIs and we will continue to stress the importance of accountability’. Besides this, it is necessary'
io develop internationally agreed standards of CSR behaviour, with companies’ involvement, and to
ensure that corporations comply with them.
Wemos is convinced that an integrated approach to health is the only way to reach health for all. Do
GPPIs fit in this approach? This question still needs to be answered, and thorough research is needed.
Various articles highlight the following risks:
1) lack of transparency on how decisions are taken and who is responsible for the implemerration of
the GPP!
2)
the recipient’s attempts io please the donor when appnit!.'-’. ioi runus instead ol iocusing on their
2'
w?
: j-..;- recipient coimtrv in the design of the GPPI
tlie absorbing of scarce resources by national governments, for example, for the distribution of
vaccines provided through a GPPI.
If well designed, these initiatives may lead to improved health care systems. However, if these GPPIs
do not comply with the criteria mentioned under the project purpose, they may' result in a large number
of different initiatives leading to an even more fragmented care serving only small segments of rhe
population. These possible distorting effects of GPPIs on national health systems arc a concern, and it
is the duty' of civil society' to remind the states and the WHO of their obligation as stated in tire general
comment.
Expected results and indicators
In- depth case studies have been conducted in three countries by at least six NGOs on the effects of
GPPIs on national health systems.
Indicators:
e FOR for the case studies have been developed
• three repons of the cases studies are available and summary recommendations formulated
•
informalion from the case studies is used for lobby purposes
•
information is used on websites and in articles.
/ veil informed group ofat least six NGOs isformed, working closely on all aspects ofthe project.
Indicators:
® the group develops joint lobby papers and implements a joint lobby strategy for national and
international lobbying
•
several trainings on GPPIs and health and on capacity strengthening in lobbying have been
organized
•
information about 1'2 GPPIs is collected and exchanged and the GSR debates and discussions are
Memos Programme 2003-2005
November 2002
3402RAP02001/02
•
detailed knowledge, is available about health systems in the countries where the case studies take
place
e
at least one participant in the network has a gender-specific approach and makes its knowledge
available for other participants within the network.
National policy and decision makers in the participating countries are aware of the case studies and
developed a position based on the outcomes ofthe case studies.
Indicators:
« they accept and'or initiate dialogue with the NGO representatives
• the;, voice their opinion related to lite outcome of the case studies in their deliberations around the
GPPIs anti national health systems
4
they reflect their opinion in their participation at the WHA by making a statement coherent with
the dialogues with NGOs.
t he tVHO staff is aware ot the projects results and takes them into account tn the staff deliberations
on GPPIs.
Indicators:
• the WHA 2005 allows for presentation of tire case studies results in a workshop in which WHO
staff is involved
* dialogue with relevant WHO staff at head quarters is ongoing
• dialogue with WHO staff al nalional/local level is ongoing.
At the national level in the countries where the case studies will be conducted and in the Netherlands,
health professionals have a better understanding of the consequences <>/ (IPr'ls jar notional neann
systems.
Indicators for the Dutch ■.
\
• number of health professionals reacted
•
e
nmuwu.i cu.m ihurions to the campaign
increasing number of visils to the W emos website.
Indicators for awareness-raising work by Southern partners:
To be defined by partners in their work plans.
Strategy
Lobby and advocacy
Since this is a new project, the first eighteen months will be used to work towards common lobby
positions and strategy, based on rhe acquired general information (WHO, board of GPPI) and specific
information derived from the case studies. The project can only be successful in its lobbying if the
evidence for it is systematically gathered and based on a common position of all project partners. The
project will work from a team-spirit with Northern and Southern partners. The content of the lobby
will be guided by the analyses of the general debates and events and results from the case studies. The
focus of the lobby will always be linked to the effects of GPPIs on the national health systems and die
realization of the right to health. Do lhev make a contribution to integral national health systems? If
not: how can they be developed in order to support integral national health systems? Do they increase
the enjoyment of the right to health for men and women equally?
Ibis lobby position will highlight Io what extent GPPIs are effective, sustainable, empowering,
accountable, non-discriminatory. participatory, and integral. Emphasis in the lobby will also be placed
on the importance of co-ordination of the large number of different international initiatives. The lobby
November 2002
34G2RAP02001702
will be directed towards influential pliers at national and international decision-making levels, such
as politicians and the higher civil servants levels in the participating countries, the European Union,
GPP! boards and the WHO. It will also consist of contacts with other UN bodies involved in GPPIs.
Knowledge gathering
Information will be systematically gathered and analysed on national health policies and health
systems in the participating countries, on policies of the WHO and other relevant UN bodies regarding
GPPIs, on the policies of private actors in GPPIs and on the consequence of GPPIs for people’s access
to health, with a special focus on access of women. This information will be obtained:
* through contacts with government representatives and WHO officials
• bv collecting articles, reports and studies from relevant international bodies, universities and
®
*
during international meetings, events and seminars
from the results of the case studies conducted in the participating countries.
More specifically, information will be collected about the 12 GPPIs in wliich the WHO is involved.
Background documents as well as oilier sources will be used, for example. WHO Guidelines, the
WHO
actons documents about relations with private-for- profit partners. Attendance at the
debates at the V.orld Health Assembly and the txccutivc board meetings of the WHO will be
important in collecting information and building links with WHO staff. The outcomes of the GPPIs
board meetings and the interviews with some of the stakeholders will provide additional imonnation
from people closely involved tn the issue. The compiled information will be shared between all pro ject
partners (Through e-mail and websites) and used as a now of information to keep the project staff up
dated and the network involved in the project’s activities.
Southern partners anti capacity strengthening
Closely working with representatives from different continents can be fruitful and inspirational for all.
Through the consultations with a few partners with whom Wemos has worked for a couple of years, it
became clear that such a model is effective and satisfactory' to ail. In this project, between six tolO
partners (in three countries and the Netherlands) will participate: two in each country, who arc assisted
by an expert. These partners must therefore be located in countries where the GPPIs under study arc
implemented. The Netherlands will be approached as a donor country and is therefore an important
player and policy seller
The Southern partners and Wemos together, will form the core group of the project. Some experts
from universities in the South as well as in the Netherlands will be asked for advice and guidance in
the research indicators and assist in design, implementation and interpretation of the case study. In
collaboration with experts in the area of international health issues they will form the advisory board
of the project. In each of the three Southern countries and in the Netherlands such a board will be
formed.
In one country. two organizations will assess the impact of one or two GPPIs. These GPPIs will also
be investigated in two other countries (in a different continent), by two organizations. Through this
system, the two paiiueis in a country will support each other. The South-South exchange will be
encouraged through regular e-mails and conference calls. A form of communication which is working
for all will be developed. This will guarantee similar approaches in the different countries. Field visits
will take place at least once every six months. In each of the countries the effects of GPPIs on the
national health systems will be closely followed and will be used as input for the lobby.
Wemos and ns Southern partners will:
- work towar-is capacitating each other and establish a division of roles based on specifics in
condition and location
•
pul. in place a system to check progress, based on agreements belween all project partners
Wemos Programme 2003-2005
November 2002
3402RAP02001702
all project partners will be members of national'regional/'intemational networks and therefore can
disseminate the intomatiott. These partners will be members from networks such as IPHC, PHM.
HAL Consumers International (Cl), the Women's Global Network on Reproductive Rights
(WGNRR), and others. At least two of the partners have expertise in gender issues which will
serve as aii input prvvi<icr ior Trie otiicr organizations.
*'
■N
iw. cHrreni partner hax shown interns I in participating in the. project. Diwtissions with this
partner on further selection are ongoing. Since this project is just taking off, and selection of good
partners is essential for the results, that part of the work is described as one of the crucial activities to
start with For Wemos itself and the Southern partners the aspect of Strengthening each other’s
capacity is of crucial importance. The project’s work should lead to more credibility for all NGOs
involved and has an added value at least ar the national level. For all NGOs the knowledge obtained
wtii increase its expertise in the area of health.
Collaboration with other organizations and networks
Wemos will continue its collaboration with Cordaid and Farmacie Mondiaal in the dialogue with
Nefarma (the umbrella organization of research-based pharmacetttical companies in the Netherlands).
Wemos will also continue its activities in the platform of NGOs working on CRS issues and will
follow the debates in the Netherlands and elsewhere. In November 2002 a seminar is organized about
public-private collaboration in health in which a number of organizations will sit together to discuss
ihe risks 2nd cppomHiities of GPPIs.
At the European level Wemos will continue to participate tn the European health consortium with
ivifam from Germany and Prosaius from Spain. Tills consortium can provide the European link of the
project. Discussions about the form of collaboration will be concluded in 2002.
forne of the NGOs in international networks of which Wemos is a member are also interested in the
ssue or GPPIs. Further links will be established with these organizations and networks.
Awareness raising and campaigning in the Netherlands
The project team will inform Dutch health professionals about the possible consequences of GPPIs on
iiattouai uealth systems through the 'A emos newsletter aud website. Articles will also be written and
workshops will be organized. Joint activities with rhe platform of NGOs m the Netherlands working
on CSR arc also a possibility to inform a wider audience.
The assessment process will lead to a Wemos campaign which will take place in 2005. Dutch health
nroiessmr.ais wul gel insight into the trend to secure access to certain parts of health care through
GPPIs and its effect on overall health policies. Through the case studies of the consequences of a GPPI
in different countries, the advantages and risks will be presented in an accessible and action oriented
manner.
Activities
Lobby anti advocacy
»
•
*
preparatory’ meetings with national delegates for the WHA and WHA EB 2003-2005
establish and maintain contacts with WHO and UN staff and government officials
prepare position papers and develop lobbvino messa°es based on case studies
•
organize workshop at the. WHA -2004/2005
•
prepare common positions for the WHA, PPI board meetings.
November 2002
3452RAP02001/02
•
•
gather and analyze information, on 12 GPPIs
saiher and analyze information on GSR in the Netherlands and Europe
«
invcstioatc -he health policy in three.Southern countries
=
analvzc outcomes of V-T1A and EB for ns impact on the GPPIs processes
•
discuss GPPIs with experts from universities
•
vain knowledge about specific consequences of GPPIs for access io health of women.
Collaboration with Southern partners and capacity strengthening
« select new Southern partner's
* work visits to participating countries
• select regions in the participating countries for case studies
•
develoo method fra the studies baseri on the seven criteria
«
e
•
•
develop electronic method for easy communication; organize chats, conference calls
select members for project advisory board
organize regional conferences in the South for sharing results in three regions
write report on case, studies with the Southern partners
♦
organize training on GPPIs and on capacity strengthening based on partners’ needs.
Coilabornrion with other NGO. networks and institutes
« dialogue with partners at the national level and Nefarma
•
and/or orsanizc hU incetinss with consortium partners
• liikc up wnh the broader networks IPHC. HAI and women's and health organizations
•
seek advice uoiu experts and ibini national advisuiy boaids
-
select and interview GPP1 stakeholders government officials.
Awareness raising and campaigning in the Netherlands
•
publish articles in the press and media, including international ■
•
*
*
•
develop a leaflet about GPPIs and health
continuous update of website
participate in fairs with booth, materials and messages from the project
speak at events covering broader health issues
•
organize campaign year, with several highlights and campaign day (2005)
•
organize workshops in the ?<etherlands.
Fw: restrictions to foe
Subject: Fw: restrictions to foe
©ate: Sun, 12Mar2000 13:11:59 +0530
From: "Pradeep Joshi" <pjoshi@giasdl01.vsnl.net.in>
To: <il-rti@ilban.emet.in>
---- Original Message-—
From: Maja Daruwala <majadhun@giasdl01 ,vsnl.net.in>
To: CHRI INDIA <chriall@oiasdl01 ,vsnl.net.in>: Abha Joshi <abha@vsnl.com>
Date: Saturday, March 11,2000 3:38 PM
Subject: FW: restrictions to foe
STEPH AND ABHA DO YOU THINK THIS IS SOMETHING WE CAN JOIN ART 19 ON?md
>---- Original Message---> From: debra@oln.comlink.apc.org [mailto:debra@,oln comlink.apc.org]
> Sent: 10 March 2000 11:32
> To: maiadhun@giasdl01.vsnl.net.in
> Subject: TZA: restrictions to foe
>
>
> Edited/Distributed by HURINet - The Human Rights Information Network
> ## author : ifex@web.apc.org
> ## date
: 28.01.00
> IFEX- News from the international freedom of expression community
> PRESS RELEASE - TANZANIA (ZANZIBAR)
> 26 January 2000
>
> Zanzibar treason trials challenged; call for removal of
> restrictions to freedom of expression
> SOURCE: ARTICLE 19, London
> (ARTICLE 19/IFEX) - The following is an ARTICLE 19 press
> release:
>
> 26 January 2000 - for immediate release
> ZANZIBAR TREASON TRIALS CHALLENGED BY INTERNATIONAL RIGHTS
>GROUP
>
> As the politically-motivated treason trial of 18 members of
> the Civic United Front (CUF) resumes in Zanzibar on Thursday
> 27 January, ARTICLE 19, The International Centre Against
> Censorship, adds its voice to those calling for the
> immediate and unconditional release of the defendants and an
> end to official harassment against the political
3/13/00 8:27 PM
Fw: restrictions to foe
> opposition. 1
>
> A court hearing of this case last week saw a heavy police
> crackdown against demonstrators, with at least 40 people
> arrested. There were also house-to-house searches for
> others, including raids on the homes of CUF public office
> holders. ARTICLE 19 today cautioned that international
> efforts to end the long-running political crisis before this
> year's elections will fail unless the authorities change
> their approach.
>
> Andrew Puddephatt, Executive Director of ARTICLE 19 said:
>
> "The Attorney-General of Zanzibar has had over two years to
> investigate the alleged offences of these CUF members and
> prepare the case against them. Instead, the authorities have
> repeatedly requested adjournments. It is becoming obvious
> that the government is spinning out the trial process in
> order to deny the accused, who include four members of the
> House of Representatives, the right to participate in the
> general elections in October."
>
> The trial arises out of the CUF's initial refusal to
> recognise the results of the very closely contested 1995
> elections in Zanzibar - elections which were also questioned
> internationally. To break the political deadlock which
> resulted, the Commonwealth brokered discussions which led to
> an agreement in April 1999. Under the terms of the
> agreement, the ruling Chama Cha Mapinduzi (CCM) and CUF
> agreed to work out a process of reforms which would build
> respect for human rights and lay the groundwork for
> elections in 2000 where the outcome was recognised and
> respected by all parties. To date, progress on the terms has
> been slow.
>
> Mr Puddephatt added:
>
> "It is urgent that diplomatic efforts are intensified to
> ensure rapid implementation of the reform process. Essential
> steps towards this are an end to these politically-motivated
> trials, and recognition by the authorities that citizens
> have a right to freedom of association and peaceful
> protest."
> ARTICLE 19 is also calling for reform of the Constitution
> and archaic laws which restrict freedom of expression as
> part of a wider package of measures to ensure that Zanzibar
> fully upholds its obligations under international law.
> Contact: Rotimi Sankore on +44 20 7278 9292 or
> press@articlel 9,org
2 of 3
3/13/00 8:27 PM
Pondicherry Declaration
on Health Rights and
Responsibilities
’establish a National Drug Authority of India
consisting of governmental, non-governmental
organisations as well as professionals bodies;
1.7
establish and support a drug information and
usage monitoring system to facilitate and
implement an effective rational drug policy.
This should include systems for monitoring
adverse drug reactions;
1.8
integrate the concept of rational drug use,
including drug information into health and
medical education;
'
1.9
introduce within the formal and non-formal
educational system information on healthrelated issues;
1.10
promulgate the charter of patients rights and
responsibilities and physicians' rights and
responsibilities.
1.6
This consensus statement was adopted by the
participants attending a workshop on "Medicine,
Media and Consumer Education” held in Pondi
cherry. India December 1-4. 1993. Thirty partici
pants from 3 countries .attended the workshop
organised by the Educators for Quality Update of
I^Lan Physicians with the support of the-lnter^Ponal Organisation of Consumers Unions.
THIS WORKSHOP EVOLVED THE
FOLLOWING GUIDING PRINCIPLES
• the work of rational drug use groups should
be expanded to include diagnostics and non
drug therapy.
• the concept of continuity of care through the
family physician should be encouraged by
consumer education and medical education.
• a Charter of Patients’ Rights and Responsi
bilities should be widely adopted by profes
sional and consumer groups.
1.
1.1
1.3
1.4
1.5
We call on CENTRAL AND STATE
GOVERNMENTS to:
bring all the issues pertaining to drugs under
the purview of Ministry of Health and Family
Welfare; 1
enunciate and effectively implement rational
drug policy;
promote the concept of essential drugs and
ensure their availability at affordable cost;
promote the use of generic names of drugs;
regulate and monitor all promotional measures
and advertising materials;
2.
2.1
2.2
I
i
2.3
2.4
2.5
2.6
3.
3.1
3.2
3.3
3.4
We call on HEALTH PROFESSIONALS to:
adopt an holistic approach to health care;
develop two way linkages between different
levels of health care;
promote prudent use of diagnostic aids and
therapy;
epdorse and respect the charter of patients
rights;
acquire communication skills to interact with
patients: the mass media and the public;
periodically update their professional knowl
edge and improve their skills.
We call on PROFESSIONAL GROUPS. NON
GOVERNMENTAL and
VOLUNTARY ORGANISATIONS to:
promote the adoption of a charter of patients'
rights and responsibilities;
establish networks at all levels in order to
facilitate health information, communication
and education;
encourage multi- and inter-disciplinary research
on health related issues;
facilitate periodic updates for health knowl
edge.
We call on the MASS MEDIA to:
recognise their far-reaching influence on the'
level of public awareness and assume a more
active and responsible role in informing .the
public on health issues;
4.2
use a resource network of competent health
experts to ensure objective and balanced
reporting of health issues;
4.3
establish regular communication with health
professionals and consumer groups;
4.4
participate in the screening of advertisements
on health-related issues for unsubstantiated
claims and unethical promotion;
4.
4.1
5.
5.1
5.2
We call on the HEALTH AND
PHARMACEUTICAL INDUSTRY to:
develop and enforce code of marketing, pro
motion and dissemination of information in
participation with governmental and non
governmental organisations;
recognise their social responsibility to the
public with regard not only to the safety and
efficacy of their products and services but
also to their cost and societal impact and to
devise and to disseminate health information
accordingly.
PAT! ENT’S RIGHTS AND
RESPONSIBILITIES
PART 1: PATIENT’S RIGHTS:
Section 1: RIGHT. TO HEALTH CARE AND
HUMANE TREATMENT:—
Every individual shall have access to adequate
and appropriate health care and treatment
2.
Every patient shall be treated with care, con
sideration, respect and dignity without discri
mination of any kind.
1.
A patient has the right to be treated by fully
qualified health care professionals in private or
public health care facilities.
4.
A patient has. wherever possible, the right to be
treated at a hospital of his choice and to be
referred to a consultant of his choice.
5.
Every individual shall have the right to prompt
emergency treatment from the nearest govern
ment or private medical and health facility.
6.
Patients have the right to humane terminal care
and to die in dignity.
.7. A patient can be transferred to another health
care establishment only after an explanation of
the need for this transfer and after the oth«
establishment has accepted the patient.
8. A patient has the right to have all identifying
information, results of investigations, details of
his condition and his treatment kept-confidential
and not made available to anyone else without
his consent.
3.
Section 2: CONSENT:—
Before any treatment or investigation, a patient
shall have the right to a clear, concise explana
tion in lay terms of the proposed procedure and
of any available alternative procedure. Where
applicable, the explanation shall include informa
tion on risks, side effects, or after-effects.
problems relating to recuperation, likelihood of
success, and risk of death. Informed consent of
the patient must be obtained prior to the con
duct of a treatment or a procedure. In the case
of a minor, consent has to be obtained from the
parent or guardian. If a patient is incapacitated
and any delay would be dangerous, a doctor' i^
entitled to carry out any necessary treatment or
operation after a second opinion is obtained.
2.
A patient has the right to refuse treatment to the
extent permitted by law and to be informed of
the medical consequences of his decision.
3.
Explicit, informed consent is a prerequisite for
participation in scientific experimentation. Experi
mentation must not be carried out on'any
-patient who is unable to express his will.
1.
Section 3: RIGHT TO
INFORMATION:—
1- Information about health services (including
recent developments in the field) and how best
to use them is to be made available to the public
in order to benefit all those concerned.
2 Information may be withheld from patients in
cases where there is good reason to believe that
this information would □>..
die patient's health
adversely but. however, the information must
given io a responsible relative.
3.
A^bent has the right to know the identity and
fri^rofessional status of the individuals provid
ing service to the patient and to know which
professional is primarily responsible for the
patient's care.
4.
Patients should have the right to seek a second
opinion from another physician.
5.
Patients should upon request, be able to obtain
a copy of a summary of their diagnosis, treat
ment and care including diagnostic results on
discharge from a hospital or other establish
ment. They shall also have the right to authorise
another medical professional to obtain a copy of
the same and to inform the patient of the
contents.
6.
A patient shall have the right to examine and
receive an explanation of his bill after any treat
ment and consultation.
Section 4: THE RIGHT TO ADEQUATE
ESCRIBING INFORMATION:—
«
prescribing.medication, the patient shall
be informed about the following: —
Expected outcome, adverse and after'effects,
Chances of success, risks, cost and availability.
2. All drugs dispensed shall be of acceptable
standards in terms of quality, efficacy and safety.
3. All medicines shall be labelled and shall include
the pharmacological name of the medicine.
___________________
Section 5: RIGHT TO REDRESS
GRIEVANCES:—
1.
A patient shall have access to appropriate
redressal procedures.
2.
A patient shall have the right to legal advice as
regards any malpractice by the hospital, the
hospital staff or by a doctor or other health
professional.
Section 6: RIGHT TO HEALTH
EDUCATION:—
1. Every individual shall have the right to seek and
obtain advice with regard to preventive and
curative medicine, after care and good health.
F ART 2: PATIENT'S RESPONSIBILITIES:
.
1. The patient shall ensure that he or she knows and
understands what a patient's rights are and shall
exercise those rights responsibly and reason
ably.
2. The patient shall ensure that he or she under
stands the purpose and cost of any proposed
investigation or treatment before deciding to
accept it.
3.
The patient shall accept all the consequences of
the his/her own informed decisions.
4.
The patient shall provide accurate and complete
information which the health professional requires
about his or her health and ability to pay for
health services.
5.
The patient Shall establish a stable relationship
with and follow the treatment determined by
the health professional primarily responsible for
the patient's care.
6.
The patient shall inform the health professional
if he or she is currently consulting with or under
■ the care of another health professional in con
nection with the same complaint or any other
complaint.
7.
The patient shall so conduct himself or herself
so as not to interfere with the well being or
rights of other patients or providers of health
care.
8.
Every individual has a responsibility to maintain
his or her own health and that of society by
refraining from indulging in high risk behaviour
detrimental to health.
9.
Every individual has a responsibility to accept all
preventive measures sanctioned by law.
*
Pondicherry
Declaration on
Health Rights
and
Educators for Quality Update of
Indian Physicians (EQUIP)
Address: Dr. S. CHANDRASEKAR, M.D.
Chairman
Society of EQUIP, 5, RUE SUFFREN,
PONDICHERRY-605 001, INDIA.
TEL: (0413) 36252 FAX: (0413) 38132
(Attn:C.H.SHASHINDRAN)
EQUIP-IOCU WORKSHOP ON
MEDICINE. MEDIA and
CONSUMER EDUCATION'
DEC 1-4, 1993, PONDICHERRY, INDIA
- Media
RF_L_2_SUDHA.pdf
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