FUNCTIONING OF JSB CIVIL HOSPITAL CHIRANG Conducted By Human Rights Law Network 576 Masjid Road, Jangpura Bhogal New Delhi-110014 Contents 1. Introduction: ................................................................................................................ 3 2. Public Health: a right based approach ......................................................................... 4 (a) International legal framework on public health: ....................................................... 4 (b) Constitutional Provisions and Supreme Court Guidelines relation to public health: 7 3. Maternal Health situation in Assam: ......................................................................... 10 4. Methodology: ............................................................................................................ 17 5. Indian Public Health Standards Guidelines: an introduction .................................... 18 (a) Sub Centre (SC):...................................................................................................... 18 (b)Primary Health Centre (PHC) .................................................................................. 19 (c) Community Health Centre (CHC) ........................................................................... 19 6. Evaluation of Implementation of IPHS standards for District hospital in Chirang District, Assam:................................................................................................................. 22 a) District Profile: ......................................................................................................... 22 b) Findings: ................................................................................................................... 23 1. Physical Infrastructure: ............................................................................................ 24 2. Departmental Lay out Clinical Services: .................................................................. 26 3. Intermediate Care Area ............................................................................................. 29 (Indoor Patient Department): ........................................................................................ 29 4. Pharmacy (Dispensary) ............................................................................................. 29 5. Delivery Suite Unit ................................................................................................... 31 6. Post Partum Unit ...................................................................................................... 32 7. Other Amenties: ........................................................................................................ 32 8. Hospital Transport Services: ..................................................................................... 33 9. Manpower Requirements: ......................................................................................... 33 7. Major issues of concerns: .......................................................................................... 35 8. Conclusion: ................................................................................................................... 37 1. Introduction: Indian Constitution provides right to health as one of the fundamental rights in corollary to right to life. Thus, denying basic health care means violating right to life. State being the guardian of the citizens’ rights has the duty to protect their legal and fundamental rights. Therefore, it is the basic duty of the state to provide basic health care services to the people in order to protect its citizens from mortality/mobility and lead a healthy life. Right to health was first articulated in the World Health Organisation (WHO) Constitution in 1946 which states that: "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being... And then in 1948 ‘health’ was introduced in Universal Declaration of Human Rights as a part of the right to an adequate structure of living (Article 25).”1 WHO has given a very comprehensive definition of the term “health” “Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion and political belief, economic or social condition.” Though there is no distinction between men and women for the availability of right to good health and access to medical assistance, women are disproportionately impacted by States' failures to ensure the right to health. One of the leading causes of death for young women in India and the world is maternal mortality. The WHO also defines maternal death as, “the death 1 Right of everyone to the enjoyment of the highest attainable standard of physical and mental health (Right to health): World Medical Association (WMA) of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Further, WHO reported that over 90% of all maternal deaths are preventable where women receive access to basic antenatal care, skilled delivery assistance, and post-partum services. When governments fail to provide adequate maternal health care, they violate women’s rights to survive pregnancy, to health, to dignity, and to life. 2. Public Health: a right based approach Public health enters in right based discourse on the basis of few international convention and constitutional provisions. (a) International legal framework on public health: There are many international conventions which relate to health rights and India being a party of those conventions India has an obligation to fulfill the provisions of those conventions. The relevant conventions which provides for right to life and good health include the Universal Declaration of Human Rights (UDHR), Declaration of Alma-Ata, International Covenant on Civil and Political Rights (ICCPR), International Covenant on Economic Social and Cultural Rights (ICESCR), Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). Article 25 (1) of Universal Declaration of Human Rights (UDHR): “The Universal Declaration of Human Rights (UDHR), which was adopted by the UN General Assembly on 10 December 1948, was the result of the experience of the Second World War. With the end of that war, and the creation of the United Nations, the international community vowed never again to allow atrocities like those of that conflict happen again. World leaders decided to complement the UN Charter with a road map to guarantee the rights of every individual everywhere.”2 Art. 25(1) of UDHR provide that everyone has the right to a standard living with a right good health it includes the food, house and medical care with necessary social services and the right to security in the event of sickness, disability old age etc.. So India being a party should ensure and protect the right to health without any discrimination. Deceleration of Alma-Ata: International Conference on Primary Health Care was held in Alma Ata, in 1978 express the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It urges governments, WHO and UNlCEF, and other international organisations, as well as multilateral and bilateral agencies, nongovernmental organisations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in the developing countries. The Conference calls on all the aforementioned to collaborate in introducing, 2. Universal Declaration of Human Right(UDHR), 1948 developing and maintaining primary care in accordance with the spirit and content of this Declaration.3 International Covenant on Civil and Political Rights (ICCPR): United Nation (UN) adopted ICCPR in 1966 and came to force in 1976. Under article 11 (3), 19 3(b), 21, 22 (2) every member state has the special responsibilities to protect the public health. Article 12 of International Covenant on Economic Social and Cultural Rights (ICESCR): The ICESCR was adopted by the United Nations General Assembly on 16 December 1966 and entered into force on 3 January 1976. Article 12 of ICESCR: Article 12 establishes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The article lists some of the steps to be taken by States parties such as: the reduction of stillbirths and infant mortality; ensuring the healthy development of children; improving environmental and industrial hygiene; the prevention, treatment and control of diseases; and access to medical care for all. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW):4 It was adopted in 1979 and came into force in 1981 and it deals with women’s health and particularly reproductive rights Article 10 (h) states that women have the right to "specific educational information to help to ensure the health and well-being of families, including information and advice on family planning. 3. Declaration of Alma Ata, 1976 4. Reproductive Health and CEDAW: Bustelo Carlota: National