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We the people of India, stand united in our condemnation of an iniquitous global
system that, under the garb of "Globalisation" seeks to heap unprecedented
misery and destitution on the overwhelming majority of the people on this globe. This system has systematically
ravaged the economies of poor nations in order to extract profits that nurture a handful
of powerful nations and corporations. The poor, across the globe, as well as the
sections of poor in the rich nations, are being further marginalised as they are displaced
from home and hearth and alienated from their sources of livelihood as a
result of the forces unleashed by this system. Standing in firm opposition to such a
system we reaffirm our inalienable right to and demand for comprehensive health
care that includes food security; sustainable livelihood options including secure
employment opportunities; access to housing, drinking water and sanitation; and
appropriate medical care for all; in sum - the right to Health For All, Now!
The promises made to us by the international community in the Alma Ata declaration
have been systematically repudiated by the World Bank, the IMF, the WTO and
its predecessors, the World Health Organization, and by a government that functions
under the dictates of International Finance Capital. The forces "Globalisation"
through measures such as the structural adjustment programme are targeting our
resources - built up with our labour, sweat and lives over the last fifty years - and placing
them in the service of the global "market" for extraction of super-profits. The
benefits of the public sector health care institutions, the public distribution system
and other infrastructure - such as they were - have been taken away from us. It is the
ultimate irony that we are now blamed for our plight, with the argument that it is
our numbers and our propensity to multiply that is responsible for our poverty and
deprivation. We declare health as a justiciable right and demand the provision
of comprehensive health care as a fundamental constitutional right of every one of
us. We assert our right to take control of our health in our own hands and for this
the right to:
A truly decentralized system of local governance vested with adequate
power and responsibilities, provided with adequate finances and responsibility
for local level planning.
A sustainable system of agriculture based on the principle of land to the
tiller – both men and women – equitable distribution of land and water,
linked to a decentralized public distribution system that ensures that no
one goes hungry
Universal access to education, adequate and safe drinking water, and
housing and sanitation facilities
A dignified and sustainable livelihood
A clean and sustainable environment
A drug industry geared to producing epidemiological essential drugs at
affordable cost
A health care system which is gender sensitive and responsive to the people's
needs and whose control is vested in people's hands and not based on market defined concept of
health care.
Further, we declare our firm opposition to:
Agricultural policies attuned to the needs of the "market" that ignore
disaggregated and equitable access to food
Destruction of our means to livelihood and appropriation, for private profit,
of our natural resource bases and appropriation of bio-diversity
The conversion of Health to the mere provision of medical facilities and care
that are technology intensive, expensive, and accessible to a select few
The retreat, by the government, from the principle of providing free medical
care, through reduction of public sector expenditure on medical care and introduction of user fees in public
sector medical institutions, that place an unacceptable burden on the poor
The corporatization and commericialization of medical care, state subsidies
to the corporate sector in medical care, and corporate sector health
insurance
Coercive population control and promotion of hazardous contraceptive
technology which are directed primarily at the poor and women
The use of patent regimes to steal our traditional knowledge and to put
medical technology and drugs beyond our reach
Institutionalization of divisive and oppressive forces in society, such as communalism,
caste, patriarchy, and the attendant violence, which have destroyed
our peace and fragmented our solidarity
In the light of the above we demand that:
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The concept of comprehensive primary health care, as envisioned in the
Alma Ata Declaration should form the fundamental basis for formulation of
all policies related to health care. The trend towards fragmentation of health
delivery programmes through conduct of a number of vertical programmes
should be reversed. National health programmes be integrated within the
Primary Health Care system with decentralized planning, decision-making
and implementation with the active participation of the community. Focus
be shifted from bio-medical and individual based measures to social,
ecological and community based measures.
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The primary health care institutions including trained village health workers,
sub-centers, and the PHCs staffed by doctors and the entire range of
community health functionaries including the ICDS workers, be placed
under the direct administrative and financial control of the relevant level
Panchayati Raj institutions. The overall infrastructure of the primary health
care institutions be under the control of Panchayats and Gram Sabhas and
provision of free and accessible secondary and tertiary level care be under
the control of Zilla Parishads, to be accessed primarily through referrals
from PHCs.
The essential components of primary care should be:
Village level health care based on Village Health Workers selected by
the community and supported by the Gram Sabha / Panchayat and the Government health services
which are given regulatory powers and adequate resource support Primary Health Centers and subcenters
with adequate staff and supplies which provides quality curative services at the primary health center
level itself with good support from referral linkages.
A comprehensive structure for Primary Health Care in urban areas
based on urban PHCs, health posts and Community Health Workers under the control of local self government
such as ward committees and municipalities.
Enhanced content of Primary Health Care to include all measures
which can be provided at the PHC level even for less common or noncommunicable
diseases (e.g. epilepsy, hypertension, arthritis, preeclampsia, skin diseases) and integrated
relevant epidemiological and preventive measures.
Surveillance centers at block level to monitor the local epidemiological
situation and tertiary care with all speciality services, available in
every district.
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A comprehensive medical care programme financed by the government
to the extent of at least 5% of our GNP, of which at least half be disbursed
to panchayati raj institutions to finance primary level care. This be
accompanied by transfer of responsibilities to PRIs to run major parts of
such a programme, along with measures to enhance capacities of PRIs to
undertake the tasks involved.
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The policy of gradual privatisation of government medical institutions,
through mechanisms such as introduction of user fees even for the poor,
allowing private practice by Government Doctors, giving out PHCs on contract,
etc. be abandoned forthwith. Failure to provide appropriate medical care to a citizen by public health
care institutions be made punishable by law.
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A comprehensive need-based humanpower plan for the health sector be
formulated that addresses the requirement for creation of a much larger
pool of paramedical functionaries and basic doctors, in place of the present
trend towards over-production of personnel trained in super-specialities.
Major portions of undergraduate medical education, nursing as well as
other paramedical training be imparted in district level medical care
institutions, as a necessary complement to training provided in medical/
nursing colleges and other training institutions. No more new medical colleges
to be opened in the private sector. No commodification of medical education. Steps to eliminate illegal
private tuition by teachers in medical colleges. At least a year of compulsory
rural posting for undergraduate (medical, nursing and paramedical) education be made mandatory, without
which license to practice not be issued. Similarly, three years of rural
posting after post graduation be made compulsory.
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The unbridled and unchecked growth of the commercial private sector be
brought to a halt. Strict observance of standard guidelines for medical and
surgical intervention and use of diagnostics, standard fee structure, and
periodic prescription audit to be made obligatory. Legal and social mechanisms
be set up to ensure observance of minimum standards by all private hospitals, nursing/maternity homes
and medical laboratories. Prevalent practice of offering commissions for
referral to be made punishable by law. For this purpose a body with statutory powers be constituted,
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which has due representation from peoples organisations and professional
organisations.
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A rational drug policy be formulated that ensures development and growth
of a self-reliant industry for production of all essential drugs at affordable
prices and of proper quality. The policy should, on a priority basis:
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Ban all irrational and hazardous drugs. Set up effective mechanisms
to control the introduction of new drugs and formulations as well as
periodic review of currently approved drugs.
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Introduce production quotas & price ceiling for essential drugs
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Promote compulsory use of generic names
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Regulate advertisements, promotion and marketing of all medications
based on ethical criteria
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Formulate guidelines for use of old and new vaccines
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Control the activities of the multinational sector and restrict their
presence only to areas where they are willing to bring in new technology
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Recommend repeal of the new patent act and bring back mechanisms
that prevent creation of monopolies and promote introduction of new drugs at affordable prices
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Promotion of the public sector in production of drugs and medical
supplies, moving towards complete self-reliance in these areas
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Medical Research priorities be based on morbidity and mortality profile
of the country, and details regarding the direction, intent and focus of
all research programmes be made entirely transparent. Adequate government
funding be provided for such programmes. Ethical guidelines for research involving human subjects
be drawn up and implemented after an open public debate. No further experimentation,
involving human subjects, be allowed without a proper and legally tenable informed consent and
appropriate legal protection. Failure to do so to be punishable by law. All
unethical research, especially in the area of contraceptive research, be
stopped forthwith. Women (and men) who, without their consent and knowledge, have been subjected to
experimentation, especially with hazardous contraceptive technologies to
be traced forthwith and appropriately compensated. Exemplary damages to
be awarded against the institutions (public and private sector) involved
in such anti-people, unethical and illegal practices in the past.
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All coercive measures including incentives and disincentives for limiting
family size be abolished. The right of families and women within families
in determining the number of children they want should be recognized. Concurrently,
access to safe and affordable contraceptive measures be ensured which provides people, especially
women, the ability to make an informed choice. All long-term, invasive,
systemic hazardous contraceptive technologies such as the injectables
(NET-EN, Depo-Provera, etc.), subdermal implants (Norplant) and anti
fertility vaccines should be banned from both the public and private sector.
Urgent measure be initiated to shift to onus of contraception away from women and ensure at least equal
emphasis on men's.
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Responsibility for contraception. Facilities for safe abortions be provided
right from the primary health center level.
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Support be provided to traditional healing systems, including local and
home-based healing traditions, for systematic research and community
based evaluation with a view to developing the knowledge base and use
of these systems along with modern medicine as part of a holistic healing
perspective.
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Promotion of transparency and decentralization in the decision making
process, related to health care, at all levels as well as adherence to the
principle of right to information. Changes in health policies to be made only
after mandatory wider scientific public debate.
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Introduction of ecological and social measures to check resurgence of communicable
diseases. Such measures should include:
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Integration of health impact assessment into all development projects
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Decentralized and effective surveillance and compulsory notification
of prevalent diseases like malaria, TB by all health care providers, including
private practitioners
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Reorientation of measures to check STDs/AIDS through universal sex
education, promoting responsible safe sex practices, questioning forced disruption and displacement
and the culture of commodification of sex, generating public awareness
to remove stigma and universal availability of preventive and curative
services, and special attention to empowering women and availability
of gender sensitive services in this regard.
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Facilities for early detection and treatment of non-communicable diseases
like diabetes, cancers, heart diseases, etc. to be available to all at appropriate
levels of medical care.
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Women-centered health initiatives that include:
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Awareness generation for social change on issues of gender and
health, triple work burden, gender discrimination in upbringing and
life conditions within and outside the family; preventive and curative
measures to deal with health consequences of women's work and violence against women
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Complete maternity benefits and child care facilities to be provided
in all occupations employing women, be they in the organized or unorganized sector
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Special support structures that focus on single, deserted, widowed
women and minority women which will include religious, ethnic and women with a different sexual orientation
and commercial sex workers; gender sensitive services to deal with all the health problems
of women including reproductive health, maternal health, abortion,
and infertility
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Vigorous public campaign accompanied by legal and administrative
action against sex selective abortions including female feticide, infanticide
and sex pre-selection.
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Child centered health initiatives that include:
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A comprehensive child rights code, adequate budgetary allocation for
universalisation of child care services
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An expanded & revitalized ICDS programme. Ensuring adequate
support to working women to facilitate child care, especially breast
feeding
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Comprehensive measures to prevent child abuse, sexual abuse\prostitution
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Educational, economic and legal measures to eradicate child labour,
accompanied by measures to ensure free and compulsory quality elementary
education for all children.
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Special measures relating to occupational
and environmental health which focus on:
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Banning of hazardous technologies in industry and agriculture
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Worker centered monitoring of working conditions with the onus
of ensuring a safe and secure workplace on the management
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Reorienting medical services for early detection of occupational disease
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Measures to reduce the likelihood of accidents and injuries in different
settings, such as traffic and, industrial accidents, agricultural injuries,
etc.
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The approach to mental health problems should take into account the social
structure in India which makes certain sections like women more
vulnerable to mental health problems. Mental Health Measures that promote a
shift away from a bio-medical model towards a holistic model of mental
health. Community support & community based management of mental
health problems be promoted. Services for early detection & integrated
management of mental health problems be integrated with Primary Health Care and the rights of the mentally
ill and the mentally challenged persons to be safe guarded.
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Measures to promote the health of the elderly by ensuring economic security,
opportunities for appropriate employment, sensitive health care facilities
and, when necessary, shelter for the elderly. Services that cater to the special
needs of people in transit, the homeless, migratory workers and temporary settlement dwellers.
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Measures to promote the health of physically and mentally disadvantaged
by focussing on the abilities rather than deficiencies. Promotion of
measures to integrate them in the community with special support rather than segregating them; ensuring
equitable opportunities for education, employment and special health care including rehabilitative
measures.
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Effective restriction on industries that promote addictions and an unhealthy
lifestyle, like tobacco, alcohol, pan masala etc., starting with an immediate
pan on advertising, sponsorship and sale of their products to the young, and provision of services for
de-addiction.
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