Right to Health in West Bengal, India

Professor Pranab Kr Bhattacharya MD(Path) Cal, FIC path (Ind.),  Professor&HOD , Dept. of pathology,Clcutta School of Tropical Medicine  108 CR Avenue  KOlkata-73; W.B India, EX professor And HOD pathology RIO Kolkata-73 and EX professor of Pathology  In charge of histopathology Unit , in charge of Cytogenetics,  Ex-In charge of  24 hours Ronald Ross Malaria clinic, Technical Supervisor In charge of Blood Bank& VCTC, In charge of Post Graduate Studies in Pathology, Institute of Post Graduate Medical Education& Research (IPGME&R) 244A AJC Bose Road, K0lkata-700020, West Bengal , India

 Email= profpkb@yahoo.co.in phone no- 91- 9231510435

2)Mr. Rupak Bhattacharya Bsc(Cal),Msc( JU)

7/51 Purbapalli, PO-Sodepur,Dst-N24 Pgs

West Bengal, India. zip-kolkata-110.

3) Mr. Ritwik Bhattacharya Bcom (Cal),

7/51 Purbapalli, Po= Sodepur Dist=24 parganas ( West Bengal)

Zip-kolkata-110. India

4)Miss Upasana Bhattacharya

 Student  Well and Goldsmith School ,  Mahamyatala, NSC Bose Road, Garia, Kolkata-84

 4a) Miss Rupsa Bhattacharya 7/51 Purbapali Sodepur Dist 24 parganas(North) Kol-110

5) Dr. Anindya Chakraborty MBBS(cal)

 Medical Officer, Dept. of Surgery (surgery)

Institute of Post Graduate Medical Education& Research (IPGMER)

244A AJC Bose Road, K0lkata-700020, West Bengal , India

E mail-  anindyachakraborty@yahoo.com

6) Mr.Debasis Mukherjee Bsc(cal)

Swamiji Nagar; south Habra 24 parganas(north) West Bengal’ India

7)Dr. Rejaul Karim MD(cal) DMRD(cal)

   Professor, Dept. of Radiology, College of Medicine Sagar Dutta Medical College Panihati Email- karim_rex@yahoo.co.in

8)  Dr. Jayanta Dasgupta MD(cal) DM(Gastro)

 Professor, Dept. Of Gastroenterology,

Institute of Post Graduate Medical Education& Research (IPGMER)

244A AJC Bose Road, K0lkata-700020, West Bengal , India
E.mail= jayanta_dasgupta@yahoo.co.in

9)Dr. Sukumar Ghosh MD(cal)  dip card, DM cardio(cal)

 professor dept of cardiology, ICVS,

Institute of Post Graduate Medical Education& Research (IPGMER)

244A AJC Bose Road, K0lkata-700020, West Bengal , India

10) Dr. Hriday Das MD(cal) Trop. Medicine, DTM&H(cal)

 Medical officer, Dept. Of Nephrology

Institute of Post Graduate Medical Education &research

244A AJC Bose Road, KOlkata-20, West Bengal, India

E mail -jagga.seni@yahoo.com

11) Mrs. Dalihia Mukherjee BA (Hons).Cal. university, of Swamizi Nagar, south Habra ;24 parganas (North) , West Bengal, India

12) Mr. Soumyak Bhattacharya BHM MSC student PUSHA New delhi  7/51 Purbapalli PO Sodepur Dist 24 Parganas(north) W.B Kolkata-110

 All Future Correspondences to be done = Professor.  DR. Pranab Kr. Bhattacharya MD(Cal) FIC path(Ind)

Corresponding Address= Professor &HOD Dept. Of pathology, 2n^nd floor, Room No[10]C, Convener and In charge DCP course &DLT course of WBUHS

Email= profpkb@yahoo.co.in phone no- 91- 9231510435

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  By Declaration

                                            Sd/   Professor Pranab Kumar Bhattacharya

Abstract- Right to health is not respected till days in many countries including in India. The right to health requires the states to respect, protect and fulfill basic health needs. It is the right for a standard  health that encompasses free public medical care, access to safe drinking water, adequate sanitation for every family, sufficient food for the minimum required calorie,  free education up to graduation level, health related other determinants  which includes freedom such as Right must be free from  any discrimination , involuntary  free medical treatment and entitlements such as right to primary health care through a government health free system particularly for the disadvantaged people including those living with poverty in a state or a country. A right has a meaning only if it is enshrined in law. The right to health covers “triple AQ”–availability (of functioning effective public-health facilities, goods, services, and programmes), accessibility (physically and financially), acceptability (gender sensitive, culturally appropriate, and respectful of confidentiality), and high quality. The right to health is anchored in the principles of equality and non-discrimination. Indian constitution did/does not give right to health of its people as casting a vote in election is my right and no awareness programme for it exists on my Right to health. Can health be a right in West Bengal/ India, as there is no binding legislation in West Bengal, or in India? Health must be a fundamental human right and government responsibility to maintain it by public primary health care. Indeed, WHO's annual report in 2008 focused on primary health care and its role in strengthening health systems. Question remains how much health right is feasible in West Bengal state? Can a state ensure of it’s population that everyone of 8.5 cores population to provide a good Quality health?. I think, we first have to consider a minimum equity to be established in west Bengal, Indian health care system, as a right first,

Health for all by2K, a myth?

 In 1978, 30 years ago, all health experts, world leading specialists of all disciplines in medicine, health policy makers from 134 WHO member countries in an international  conference on primary health care held at USSR signed Alma Ata declaration “ health for all by 2000”. So far the authors recollect his memory; approximately 2000 million people over the world, had then no accesses in adequate health care. There existed then a wide gap between rich, middle socioeconomic class and poor and poorest people. The message in that Alma Ata deceleration were very clear before all world countries 1) People have right to participate individually and collectively in planning and improvement of their own existing health care in their state/country 2) government of a state has responsibility for the health of its people through mainly primary health care and attaining this target as a part of development in the spirit of social justice 3) all state governments of any country must lunch and sustain and improve existing primary health care 4) most important that inadequate and unequal health care is unacceptable; economically, socially &politically 5) health must be a fundamental  human right and government responsibility to maintain  it by public primary health care.

The strategy followed

The first strategy had emphasized some of systemic approaches for health improvement. In the late 1970s when we were students, West Bengal/India embarked on a major effort to strengthen its health systems from the bottom [subsidiary health centers] up to [ tertiary health care or  state medical colleges], through the primary health-care movement. The movement used an integrated multi sectoral approach to health development by loan from international monetary funds, with special attention to disadvantaged rural and poor populations in country (?) This was known to us as a horizontal approach. In 1983, the India’s National health policy adopted the alma- Ata definition of primary health care to mean the provision of curative, preventive and rehabilitative health services and accesses of health services to rural areas. A large three tire health care system developed in all provinces including in state west Bengal. Primary health centers are units that provide integrated health care in rural villages [30,000 populations] and provide referral to secondary and tertiary care in an almost non effective referral system. But problem of PHCs still remained, are unavailability of human resources [doctors, nurses, pharmacists], essential medicines, gazettes and forcing poor people to get treatment in private chambers and often before quack doctors, on whom villagers depends on much. The problems were particularly severe in west Bengal, India, sub-Saharan Africa, and in many countries because of “low government financing of health systems in budget, bad health sector governance, the crisis of human resources for the public health system, the high level of poverty of the people, the debt burden, the emergence of new diseases and the deterioration of their social system.  With the 30th anniversary of the Alma Ata Declaration in 2008, calls had arisen for renewed attention to primary health care. Indeed, WHO's annual report in 2008 focused on primary health care and its role in strengthening health systems. The second strategy emphasized disease-specific approaches to health improvement. The Okinawa Infectious Disease Initiative, announced by Japan at the G8 summit in 2000, led to strengthened global efforts on several diseases, in particular HIV/AIDS, tuberculosis, and malaria, but also poliomyelitis, parasitic diseases, and other neglected tropical diseases. These efforts contributed to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as other single-disease control programmes, ushering in a new era in global health cooperation. These programmes represent the vertical approach to health improvement.

 What is definition of health?

As per definition of  WHO “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity which  WHO defined it  however 60 years ago. According author’s health however must not be confused with health care only. Health’ like all words varies with the utilization of modern technologies. Health to a public health practitioner differs then in the perception of a clinician in a private health institute. Medically untrained people again define health by its absence and so seek intervention when they are not in that state. The WHO definition now appears to be constructed to promote mental health in those countries where it is not considered and to boost preventive activities again[3] Mental health is the largest inequity of health for women particularly in pre natal period

 What is Right to health & how it is practiced in West Bengal?

Right of a man ? Jeremy Benthen described the 1789 French declaration of Right of a man as ‘non sense”. Since a Right had to be, he argued legalized and must be a child of Law[2]  But there is a long tradition of thinking of Rights in forms of Social ethics: what good society must have indeed when the American Declaration of Independence invoked “ certain inalienable Rights” That every one led, the idea of human Rights human rights served not as a child of Law in guiding Legislation”[1]

 What is the Right to health? To us, it is the right for the highest standard of health that encompasses medical care, access to safe drinking water, adequate sanitation for every family, sufficient food for the minimum required calorie,  free education up to graduation level, health related other determinants  which includes freedom such as Right must be free from  any discrimination , involuntary  free medical treatment and entitlements such as right to primary health care through a government health free system particularly for the disadvantaged people including those living with poverty in a state or a country. The Right to health so requires an effective responsive integrated health system of good quality that is accessible thus to all. A right has a meaning only if enshrined in law. Health depends on much more than a health services. The right to the highest standard of attainable health is now enshrined in international court of law — in the International Covenant on Economic, Social, and Cultural Rights (1966) ,(2) and the Convention on the Rights of the Child (1989).(3) Very importantly the United Nations in 2000 defined what was meant by the  right to health in a statement called General Comment 14.[5]  To implement the right to health the right covers “triple AQ”–availability (of functioning effective public-health facilities, goods, services, and programmes), accessibility (physically and financially), acceptability (gender sensitive, culturally appropriate, and respectful of confidentiality), and high quality. And the right is anchored in the principles of equality and non-discrimination .In an attempt to operationalise the right to health Gunilla Backman, Paul Hunt (former UN special rapporteur on the right to health), and others defined 72 indicators and tried to measure them for 194 countries.[4] The most important indicators includes having a national health plan,  compulsory registering births and deaths, primary cause of death, providing clean and safe water and access to essential medicines, financing health care to at least a minimum level, and promoting awareness of the right to health. Many of the indicators reflect commitments that are in the various international codes and one important finding was that many countries don’t have data on many of the indicators, a severe deficiency in itself. Eighty eight countries, for example, do not collect data on maternal deaths, and 18 of the indicators were not available globally for any of the countries. Generally—and unsurprisingly—the results show huge problems in many countries, but the mapping of the deficiencies is a huge achievement and shows a clear route forward state

Health Scenario in India Vs West Bengal

The annual health budget in India is when 0.9% of gross domestic product of India, and  it is expected to raise 2-3% by 2010. The state of Heath care is thus growing at a rapid pace. Health care is expected to increase from$21 billion in 2005 to $45 billion in 2011. Public spending is anticipated to grow from the present amount of 0.9% of GDP to 2% in 2009. Per capita Per person Income  in India is Us$ 820 in 2008. India carries a mixed pattern of disease burden like much age old infectious diseases, reemergence of diseases like tuberculosis, malaria, dreaded diseases like AIDS, cancer, lifestyle diseases of upper class people like Cardio vascular diseases, hypertension, chronic renal failure, diabetes, depression. Public money expenditure in health budget in the West Bengal  is 0.09%[ net state domestic product Rs189489 cores when total health budget for 2006-07 is Rs175 cores] and per capita income is <US $62/month & GDP spent by Indian government for health care in 2009 is<2-3% ,despite gross domestic product growth rate of India is 9% in2007. In west Bengal Provinces of India out of 8.5 cores population 27.09% population is bellow poverty line( Rs 1500/= pm I.e. < $1-1.5 per day per person) and 62% population is at poverty line (Rs 1500/=)even after 61 years of Independence! . In India, tuberculosis kills 364,000 people and diarrhea disease and other infections kills 3 million people every years .700-800 million people in India lives with daily income<us$1-1.5. These poor bears disproportionate burdens of illness, psychiatric illness, Suicides and various under nourishments, infectious diseases including T. B, HIV,  sanitation & sewage disposal problems, water borne infections, mosquito borne diseases then upper middle class, middle class and rich people[300 millions in India]. The poor suffers from ill heath due to mainly of causes of poor nutrition that reduces their ability to perform works due to weakness, due to threaten Tuberculosis, their defective immunity and resistance for diseases, frequent treatment expenditure, frequent doctors fee, nursing home charges and loss of economic forces. Poor families thus exhaust their earnings, their savings, their assets and take re curse of borrowing leading to more poverty, poor health status & drop in school & colleges.

There always remained inequalities between rich and poor population within a state within a country or between rich and poor countries.  In case of state of West Bengal, in India, the same is also true. No doubt there happened a systemic (in hands of few percentage <20% population) economic growth and number of middle class economic families or people increased in the state. In India, now< 300 millions people may be classed in middle class to upper strata economy. Their physical or labor contribution for economic growth of the state is negligible and their life style is really most unhealthy one, that they are eating too much of fat, eggs, milk products, cheese, packed dry foods, meat, consume much cooking oil & carbohydrates, drinks alcohol, consume filtered cigarettes and tobacco products, but they are reluctant to burn their calorie by physical labor. They lost all their physical activities including daily one hour walking. City middle class and upper middle class population mostly drive their cars every where they go. As a result, I think, they suffer from obesity, high BMI, metabolic syndrome, diabetes mellitus type-2, high blood pressure, renal failure, atherosclerosis and cardiovascular diseases

Right to health in West Bengal provinces of India What is a right to health in West Bengal provinces of India for the low socioeconomic class & poor people? The right to health requires the states to respect, protect and fulfill basic health needs. This demand at least the bare minimum to ensure services including quality medicine, safe portable drinking water & food for most vulnerable poor and poorest  unemployed sections of  state population. The health infrastructure in India and in West Bengal is however  so variable, with high mansions five stars Hotel like medical  business houses[ sources of corruption in health sectors], to unequipped nursing homes in  populous cities and towns of the country where as in semi urban, rural areas lacks the basic sanitation facilities.

Public awareness about health a Right? How many people of disadvantaged class are aware here for his/her key rights? How many people in Kolkata even are aware of their health status? The rights to health are broad demands that go beyond legislating good health care of a state or a country [1] (important as that is). They need political, governmental, social, economic, scientific, and cultural actions [4]. Can health be a right here, as there is no binding legislation in West Bengal, or in India? Indian constitution did/does not give right to health! We some service doctors are demanding and just that is? According me, Right to health means coverage of equal but quality health cure & care for all people of a state [including the pavement dwellers, beggars, unemployed, low socioeconomic poverty laden class people, schizophrenic &mental patients, olds,] at free of cost by state government. Every patients must have sufficient accesses to safest and highest quality of health care regardless how much do they earn, where they live and how much seek they are!- Hopelessly majority in countries where human rights are non existent including those affluent countries where "so called" human rights are upheld but human health is being also neglected. Millions die here due to pollution of our environment by carbon emissions resulting COPD[ my dad suffered and expired 0n 16^th April 2009], bronchitis, asthma, Lung cancer, CAD, unsafe drinking water and even our food, we are consuming that is genetically modified mostly? Terminator seeds make life miserable for farmers in many poor countries where they have to be at the mercy of multinationals companies for their next crop![6] Large scale farmers in India and also in West Bengal state ,many unemployed  and recent jobless suicides due to their poverty, resulting from faulty economic policies of the governments. Even medical science gets today twisted to help the powers that be in preference to the powerless through privatization of health care in this world .All kinds of dangerous chemicals are being permitted in cosmetics, foods, cleaning agents and other house hold necessities in open market competition and survival. The pro- estrogens in some make up materials are known to produce changes in female breast size and possibly will increase the risk of breast cancers in future.  How good are dried powdered baby milk products sold in the market of West Bengal?

Health right is feasible in West Bengal state or in India?:    

Question remains how much health right is feasible in West Bengal state or in India? By government level: Can a state ensure of it’s all population that everyone of 8.6 cores population will have a good Quality health? Be it public or in private? Or through PPP model? My dad  late Mr Bholanath Bhattacharya, 84 years old, of 7/51 purbapalli, po=sodepur, 24 parganas(north), KOl-110 (first authors) who was an eminent personality in local area{His name is in Sodepur article of Wikipedia in History section] for fighting  for the  refugees of Indo Bangladesh war and their economic development in village of Purbapalli, Bankimpalli ,Natagarh areas of Sodepur, had  a sudden onset severe breathing trouble on 15^th April 2009, at 14-30 hours at his home and he was immediately admitted at Panihati state General hospital, a secondary level public health care institution , Sodepur, under an in charge Medical officer Physician on duty[ it was his admission day as physician and bed holder]. . Only one Emergency Medical officer was on duty in250 bedded hospital. No surgeon  was posted then. The physician on duty came to visit my dad at night 23-50 hours[ almost after 8 hours, finishing his private practice at various near by local nursing homes, and medicine shops]  and  looked at my dad’s BHT- took ultra short history by emergency MO, put his litmus stethoscope on his chest at 2-3 points and not exactly cared to listen S1& S2 or doing or asking for a ECG and declared me confidently that my dad has problem of acute infection on COPD and we must not have any worry as he will be cured with antibiotic,  inhaler steroid and aminophylin drops in saline bottole. But in spite, I told him that my dad had a  large emphysematous bulla on his middle lobe of left lung and to exclude him possibility of any Emphysematous bullas rupture resulting sudden onset pneumothorax as his  high  grade dyspnoea and heavy ness in chest  is very acute in onset and respiration abdomino thorax and myself requested the physician for a water seal drainage or at least to give a needle at my dad’s left pleural space if there is pneumothorax or doing an ECG urgently, he did not pay heed or bothered at  my words and told me he is very busy with other patients round, and he can refer him to my institution if I want it so where I can have all such facilities I am demanding , at night 21 hours  and I am a  histopathologist, not a clinician; neither he advised  an emergency X ray or a simplee ECG  nor monitoring,{ if at all were available in hospital?} at that state general hospital and went for his night sleep prescribing “repit all antibiotic, oxygen, normal saline drip, deriphyline and decadron prescribed by EMO during his admission 9 hours back and ordered his assistant PA not to disturb his night sleep by me. My dad though had a  temporary sense of a psuedo relief of his breathing difficulty due to oxygen, deriphyline, decadron etc and talked with me, my youngest brother  and his wife but his dysponea got worst from 4 am next morning and he breath his last breath at morning 6-30 AM from increasing tension pneumothorax of his chest or AMI. His tension pneumothorax  or AMI  What ever it was gave this hospital healthcare providers 12 hours to be treated by a water seal drainage or by streptokinase for my dad’s relief and survival. But my dad did not get it in spite his son is a professor of pathology at the state of art tertiary hospital of the state IPGMER  then  and Hon Professor at West Bengal State university  in spite of his presence and he reminded the in charge MO physician possibility of it and a water seal drainage. And my father was an important personality of local area at Sodepur and his name is in WIKIPEDA at Sodepur article. What happens then for others? For lay common people? What happens in Private Hospitals when the patients are transferred in ITU,ICU,RCU, NCU for  minimum symptoms to raise up the bills in few lakhs? No  patient party is  allowed there to stay before patients. NO Bed head tickets are maintained properly there. History are incomplete. Bed side clinic is minimum. Only thing is sophisticated Investigations every hourly unnecessarily with exorbitant charges and fees. Majority of private care hospitals are run by young staffs who had no Medical council of recognized post graduate or doctoral or National board certified degrees. My experiences are that. They are not well trained doctors who are not absorbed in Health department services through PSC or UPSC or walk on Interview and written examination system This is the quality of health services in West Bengal!. A state general 250 bedded hospital not equipped with24 hours  X ray, ECG, minimum biochemistry facility neither provided with a skilled health care provider doctor who can give minimum time to examine a patient clinically thoroughly after his/her admission and does  not wait for 8 hours to visit and can diagnose a patient by bed side clinic. In fact to diagnose tension pneumothorax one must not wait for an x ray or a CT when it is not available in hospital. It can be diagnosed clinically if clinical examination is  done.  But Bedside clinic is almost obsolete practice in West Bengal particularly in kolkata and in sub urban areas and diagnosis rests on investigation, no importance for Hutchison or Macleod’s clinical medicine. Who will question all these? Laymen,Poor people of west Bengal has no knowledge about the diagnosis, therapy, diagnostics, and medicine. They never think to ask/interrogate a doctor?  Doctors also think “why the public will ask me?” They do not ask; do not question why his/her relative/keen dies even when there is negligence from the part of health care providers? They consider it a fate and treated by a doctor who tried? Whether his clinical judgment is correct one or wrong who will judge?  Who cares for quality diagnosis and treatment here? What a quality health really means?  Quality is here always defined by the journalists of daily news papers in west Bengal, various electronic Medias & politicians and by ISO. But according us, quality of health must be defined by only patients rather than by any journalists, electronic Medias, policymakers, politicians, or healthcare professionals or any health institutions.  And this is only possible when majority population has a standard level of education and awareness of health as a right by legislation from the country. Health care decisions must be and truly controlled by patients, local people. In West Bengal that is a dream. There is a long way for west Bengal to go before patients comes to control their important decisions about their health care

West Bengal, India is today challenged by huge poverty, discrimination and equity including high mortality and morbidity & high presence of avoidable illness and death in people who are so poor. The land of West Bengal is today a land of extreme disparity & inequity between those haves and haves not, between salaried and non salaried people. I think, we first have to consider a minimum equity to be established in west Bengal, Indian health care system, as a right, since the health care system in West Bengal province is mostly under the control of policy making by politician, Indian civil services people, state government health administrative officials. Of course Health care system does never reflect the actual state of health of the people. What a good dignified society should have?. The acceptance of health, education &employment as a right for all - a justified demand to take into action and to promote that goal, such as we have the right to vote[1] . Health human rights, and development of state economy are complementary and synergistic, so are human rights and social justice. But does good health depend only on health care &cure?. It also depends on employment, nutrition purchase capacity, lifestyle, education, and the extent of inequality and un freedom in a society. The basic problem in West Bengal state is poverty, political unwillingness, to have a pro poor quality health care delivery system and corruption. we have a poor or a broken health system today. We lack important human resources as family practitioners, good general practitioners doing practice in rural west Bengal, suburban, subdivisions, villages and primary  health care

What can be done when a health system is so poor or a broken system—ie, when a health system is unable to deliver its services effectively, or efficiently, or fairly? Governments around the world (in both rich and poor countries) had struggled much with this question for decades. One conclusion is however clear: there are no easy solutions to the problems that arise in health systems. National efforts aimed at reforming such systems have achieved mixed results. Many countries have adopted broad reforms of their health systems (eg, Ghana, Colombia, Mexico, China, Thailand, and eastern European nations). Others have pursued more narrow agendas like reforming social insurance systems (Taiwan) or changing hospital payment systems (Kyrgyzstan). Rich countries have also struggled with new strategies to improve the performance of their national health systems. All these countries have encountered difficulties: an inability to secure political support for the needed reforms (as in the USA), or uncertainty about the likely consequences of alternative policies in a nation's particular context, or problems in effectively implementing a reform once adopted. US has the most expensive health care system in the world, but 47 million Americans remain uninsured with both life expectancy and infant mortality falling well short compared to other developed nations. Dissatisfaction with the status quo is widespread but there is little agreement about how to change it. Mental health care always struggles to get attention until, of course, cases of gross neglect such as that of Esmin Green come to light.

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References

1) A. Sen. Why & how is health a Human right; The Lancet Vol 372, 2008;2010

2) Benthan. J Anarchcal Fallaces Being an Examination of the declaration of rights issued during the French revolution(1792), Republished in Bowring. J Ed The works of Jerney Benthan Volii Edinburge; Willion Trait 1843-523

3) David Brookman response on BMJ group Blog’ a Global conversation on Defining the Health by Alex Jadad and Laura O grady on 10^th December 2008  response published by BMJ on December 12th, 2008 at 8:24 am

4)      Backman G,  Hunt P, Khosla R, et al. Health systems and the right to health: an assessment of 194 countries. Lancet 2008; 372: 2047-85. doi:10.1016/S0140-6736(08)61781-X 

5).Richard Smith on Right to health BMJ group Blogs15 Dec, 08 | by BMJ Group

6)BM Hegde, Editor in Chief, Journal of the Science of Healing Outcomes. Mangalore-575 004, India Brilliant Concept but, a qualified success Rapid Responses to: Fiona Godlee Health is a human right EDITOR'S CHOICE:BMJ 2009; 338: b136

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