Consumer's Right to Quality Healthcare
By: Bejon Misra, Founder, The Partnership for Safe Medicines India
On 15 March, 1962, US President John F. Kennedy delivered an historic ad- dress to the US Congress in which he outlined his vision of consumer rights. This was the first time any politician had formerly set out such principles.
'Consumers by definition include us all,' Kennedy said in his Congressional Statement, 'They are the largest economic group, affecting and affected by almost every public and private economic decision. Yet they are the only important group... whose views are often not heard.'
This statement is most appropriate in the context of healthcare delivery system in India. Unfortunately the consumers are rarely consulted on policies concerning healthcare and are also not involved in the delivery system. I fondly recollect the six inter-governmental negotiations that I attended on behalf of Consumers International in Geneva in early twenties, which lead to the signing of the first global health treaty on Framework Convention on Tobacco Control (FCTC) The WHO Framework Convention on Tobacco Control is the first treaty negotiated under the auspices of the World Health Organization. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It has since become one of the most widely embraced treaties in UN history and, as of today, has already 171 Par- ties. The WHO FCTC was developed in response to the globalization of the tobacco epidemic and is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. The Convention represents a milestone for the pro- motion of public health and provides new legal dimensions for international health cooperation. This was made possible only because the UN member States realized that the benefit of involving the consumers while framing the language of the treaty and considered the rights of the consumers as the centre point of the negotiation.
The Convention represents a milestone for the promotion of public health and provides new legal dimensions for international health cooperation.
Similarly in my view, to tackle the prevention and reduction of non-communicable diseases (NCDs) around the world with a focus on countries like India and other developing countries, involvement of consumers is paramount and should be structured while working on the policies and regulations. In 2000, the global strategy for prevention and control of NCDs was adopted by the WHA (WHA 53.17). The results of community - based NCD Prevention programmes implemented in developed countries clearly demonstrated that even modest risk factor reduction through adoption of healthy lifestyles brings significant public health benefits. However, the applicability and effectiveness of population - based strategies focused on risk avoidance and risk reduction remain to be proved in the context of developed countries. In order to collect evidence on the feasibility and effectiveness of community-based integrated NCD prevention programmes, demonstration projects are being implemented with WHO support in Bangladesh, India, Indonesia, Maldives and Sri Lanka. This demonstration project is being conducted in urban Ballabgarh, about 35 km away from New Delhi.
The population covered is around 150 000. The goal of the project is to empower the community to take over NCD prevention and control as part of the routine activity. This is being done in four phases:
- Identification and sensitization of stake- holders;
- Evolving a feasible model based on discussion among stakeholders;
- Implementation of the model; and,
- Evaluation of both the process and the impact of the intervention.
A baseline survey of NCD risk factors was completed in December 2003. It will serve as a baseline for assessing the impact. A citizens' initiative called "Friends of City" has been formed with the aim of making the city healthy. Based on the request of community members, cleanliness and environment issues have also been identified as priority areas for intervention. A series of meetings have been held with all stakeholders and the sensitization process completed. The roles of each stake- holder as also the possible barriers have been identified.
The present focus is on preparing necessary background papers, manuals and materials for use by stakeholders. It is proposed that the intervention be evaluated after a minimum period of two years, as the process of involving stakeholders takes time while behavioural change is a lengthy process. This model in my view is the challenge before all of us today. We have to ensure its success by designing effective mechanisms of transparency and accountability. The rights of the consumers have to prevail and at every step we must remember them and they are as follows:
- The right to satisfaction of basic needs
- The right to safety
- The right to be informed
- The right to choose
- The right to be heard
- The right to redress
- The right to consumer education
- The right to a healthy environment
We have to take a strong decision to prevent chronic disease which could save the lives of 36 million people who would otherwise be dead by 2015 as stated by the World Health Organization (WHO) report, 'Preventing Chronic Diseases: a vital investment'. Today, chronic diseases are the leading cause of deaths worldwide and their impact is steadily growing. Approximately 17 million people die prematurely each year as a result of the global epidemic of chronic diseases. Faced with the prospect of millions of people dying prematurely and suffering needlessly from heart disease must be stopped. Low and middle in- come countries share 80% of deaths caused due to chronic diseases while only 20% occur in high-income countries. In the South-East Asia Region, 51% of all deaths are due to chronic disease, and 89 million people are likely to die in the next 10 years. 60 million such deaths are likely to occur in India alone. Obesity, an important cause of chronic disease, is predicted to increase in both men and women in the region in the next decade. The problem has a serious economic impact. The estimated accumulated losses to China from 2005 to 2015, for example, are US$ 558 billion, for India US$ 236 billion, and US$ 303 billion for the Russian Federation. Can we be silent spectators any longer is the question I ask you all? It is high time we all got together and developed a strategy to tackle this menace.
Chronic diseases can be prevented and controlled only if we can involve the community and the consumer groups in India. The rapid changes that threaten the health of the Indian consumer require a rapid response that must above all be forward looking. The great epidemics of tomorrow are unlikely to resemble those that have previously swept the world, thanks to progress in infectious disease control. While the risks of outbreaks, such as a new influenza pandemic, will require constant vigilance, it is the “invisible” epidemics of heart disease, stroke, diabetes, cancer and other chronic diseases that for the foreseeable future will take the greatest toll in deaths and disability. India has the potential to make significant improvements in chronic disease management practices within the healthcare delivery system by efficiently utilizing the existing resources, which will enable us with large benefits at the least costs. Leadership is essential, and will have far more impact than simply adding capital to already overloaded Indian health systems.
Finally I would like to stress on the need to involve the stakeholders in an equitable manner and it has to be lead by the consumers as it has shown world over that all such initiatives conducted by the community have always proved successful and most cost-effective. Several success stories are there as evidence in India, where quality healthcare has been made accessible to the poor at the most affordable price only because it has a true face of the consumer in its policies and strategies. I am confident, consumer education and awareness can lead us to preventing increase in non-communicable disease and lead towards consumers’ right to quality healthcare.