Time for a deeper debate on the topic
Some time back a doctor friend, who works at a large public hospital, called us to ask if we could spare some money for a patient of his. A young man, with multiple fractures in his right leg, had been brought to the hospital by his father. When the doctors had told the father that they could put the leg right but they would need to put in some plates and bolts to make sure the bones get set in the right place, and a few thousand rupees would be needed for these bolts/plates, the father had said that he had spent all the money that he had with him or that he could have borrowed in getting his son to the hospital from his village. He had no more.
When the doctors told him that without the operation and the plates they would not be able to save his son’s leg and would have to amputate. The father had cried, but had pleaded to save the son’s life, even if it cost a leg, but he just did not have the money to pay for the parts that were needed. The doctors, being at the public hospital, were not charging fees of course, but they did not have any budget for the plates/bolts. In the end the money was pooled and the young man’s leg was saved. But how many other people suffer? And it is not from ignorance or lack of understanding. The father was desperate to save his child. It was sheer lack of resources.
Another time we found out that our chowkidar’s son, living in the village, had broken his arm. We asked him if all was well. He said it was. They had taken the child to the local pehalwan and he had set the arm. We asked if an x-ray had been done. He said no. So we asked him to bring the child to the city. We took him to a hospital in Lahore. The doctors had to operate and re-set the arm as it had not been set right by the pehalwan.
I asked the father if there were no hospitals in the village. He said that there were. But the private ones were expensive and the public ones were underfunded/understaffed. The doctors told us that if the arm had not been reset it would have gotten weaker than the other arm and would have remained painful for the rest of the child’s life. The father said he was aware of the danger as a number of people in his village had suffered similar outcomes, but with limited resources, he could only afford the pehalwan.
Article 25 of the Universal Declaration of Human Rights, adopted by the United Nations General Assembly on December 10, 1948, says. “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services…” This does not need further comment. It is interesting that though we did a very significant amendment to our Constitution as recently as two years ago, the Eighteenth Amendment, which added the right to fair trial, right to information and right to education in the basic rights section of the 1973 Constitution, the lawmakers did not make access to health services a basic right. And there has not been much discussion on the issue either.
But the evidence from the field seems to suggest that the issue definitely deserved to be discussed. Our nutrition surveys are showing high levels of malnutrition across significant areas of the country. Social surveys are showing that a major cause of vulnerability of people is the fear of losing their health. A person who has to depend on his/her labour to make a living for survival will be very vulnerable to poverty and deprivation in case he/she loses her health. Health shocks are tough not just for the poor but for many of the non-poor too who depend on work for keeping themselves out of poverty. Offering health insurance and access to decent quality health care to these groups becomes one of the major ways of addressing their vulnerability.
In some of the surveys we have conducted we have also found that a lot of times lack of timely access to even basic health services can create large and debilitating deficits, especially in children, that are difficult to cover later. Poor eyesight where a child cannot see the board from the back of the class can get the child labelled as slow and/or as a poor learner and can lead to drop out from school. Same thing if a child’s hearing is poor. Sometimes children with poor hearing are labelled as mentally challenged and allowed to drop out of schools. In all of these cases a basic health check-up and corrective, glasses or hearing aids, could easily allow the child to thrive. Children run around and are prone to accidents and breaking bones. Access to basic orthopaedic services, as most of these breaks are fairly easy to fix, would take care of lots of deformities. But access to these services has to be very cheap or free and they have to be widely available.
The current government, through the Benazir Income Support Programme (BISP), has been working on a health insurance scheme for the poor. Other political parties, some of them in coalition with the PPP and others in power in the provinces, have also talked of health insurance schemes every so often or have, at least, been very aware of the need to ensure better health care services for the people. But still the 18th Amendment did not include the right to health as a basic right. This, as mentioned, despite the inclusion of 25A regarding the right to education. Do people feel that the right to health is any less urgent or basic than the right to education? Or any less needed? It would be hard to argue that one of these rights is more basic than the other. Did legislators feel that functionally, for reasons of economic growth and our future, the right to education was more important? But this too would be hard to establish. From vulnerability data we have it would seem that access to health services scores very high as a source of vulnerability for people, apart from being correlated with poverty. Maybe it is time to have a deeper debate on the need for a basic right to decent health services.
The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at [email protected]
