he Pakistan Tehreek-i-Insaf (PTI) government has taken a key step towards better healthcare provision to the underprivileged by introducing health insurance cards and preparing a package of essential health services in some districts. Although experts consider it an important step towards improving healthcare access, they demand that the government also make health care a fundamental constitutional right.

The national health card and essential health services package, are two of the flagship policies of the government to provide better healthcare to the poor. More than fifty per cent of all Pakistanis are believed to be living below the poverty line.

Since the late forties, more than 130 countries have included the right to health in national constitutions. Pakistan is not among those countries. It has a roundabout reference to “medical aid” but no explicit right to health.

The constitution recognises the need for medical aid for the people but does not recognise health as a basic right. The matter needs the government’s attention. Article 24 of the constitution indirectly calls for providing education and medical aid to all. Right to education is also acknowledged in Article 37 of the constitution: “the state shall promote, with special care, the educational and economic interests of backward classes or areas; and remove illiteracy and provide free and compulsory secondary education within minimum possible period.” In 2010, Article 25-A was introduced. It says: “the state shall provide free and compulsory education to all children of the age of five to sixteen years in such manner as may be determined by law.”

“Right to health is one of the fundamental human rights. It is linked to the right to life, right to education and right to food and shelter. Right to health is also the basis for universal health coverage as it establishes entitlement to health care and medical care. It is part of the Universal Declaration of Human Rights and WHO constitution,” Dr Zafar Mirza, the former special assistant to prime minister on health affairs, says. He points out that Pakistan is a signatory to both these documents.

Globally, the first expression of the right to health was in the World Health Organisation constitution in 1946. It reads: “The state parties to this constitution declare, in conformity with the Charter of the United Nations, that the following principles are basic to the happiness, harmonious relations and security of all peoples. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO recognises that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

According to Article 25.1 of the Universal Declaration of Human Rights (1948), “Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services”. Globally, a majority of countries have recognised health provision as a constitutional and basic right.

“There is a need to amend our constitution to add the right to health and create a constitutional entitlement for healthcare for the citizens of Pakistan regardless of their economic status, creed, caste, colour or age and location,” Dr Mirza asserts

The UN says the right to health is inclusive and is beyond access to health care and the building of hospitals. It includes a wide range of factors that can help people have a healthy life.

The UN Committee on Economic, Social and Cultural Rights, the body responsible for monitoring the International Covenant on Economic, Social and Cultural Rights, says, safe drinking water and adequate sanitation; safe food; adequate nutrition and housing; healthy working and environmental conditions; health-related education and information; gender equality are the main determinants of health. Universally, the right to health contains freedoms that include the right to be free from non-consensual medical treatment, such as medical experiments and research or forced sterilisation; and free from torture and other cruel, inhuman or degrading treatment or punishment.

The right to health contains entitlements too. These include the right to a system of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health; the right to prevention, treatment and control of diseases; access to essential medicines; maternal, child and reproductive health; equal and timely access to basic health services; the provision of health-related education and information; participation of the population in health-related decision-making at the national and community levels.

It urges that the health services, goods and facilities be provided to all without discrimination. Non-discrimination is a key principle in human rights and is crucial to the enjoyment of the right to the highest attainable standard of health. All services, goods and facilities must be available, accessible, acceptable and of good quality. Functioning public health and health-care facilities, goods and services must be available in sufficient quantity within a state, and they must be accessible physically (in safe reach for all sections of the population, including children, adolescents, older persons, persons with disabilities and other vulnerable groups) as well as financially and on the basis of non-discrimination.

Accessibility also implies the right to seek, receive and impart health-related information in an accessible format (for all, including persons with disabilities), but does not impair the right to have personal health data treated confidentially. The facilities, goods and services should also respect medical ethics and be gender-sensitive and culturally appropriate. In other words, they should be medically and culturally acceptable. These facilities must be scientifically and medically appropriate and of good quality. This requires, in particular, trained health professionals, scientifically approved and unexpired drugs and hospital equipment, adequate sanitation and safe drinking water.

Experts say the right to health provided in the constitution can also be applied to specific groups and can protect them. These special groups include women, children, migrants, transgenders and HIV/AIDS patients, among others.

“There is a need to add the right to health and create a constitutional entitlement for healthcare for the citizens of Pakistan regardless of their society-economic status, creed, caste, colour, age and location,” Dr Mirza asserts. He says he hopes that all political parties can agree on such a constitutional amendment. During his advisory role with the PM, he says, he campaigned to make right to health a constitutional provision.

A number of health experts and health journalists at a recent workshop on Pandemic and Health Governance in Pakistan arranged by Trust for Democratic Education and Accountability (TDEA) with the support of the Foreign, Commonwealth and Development Office (FCDO) of the government of the United Kingdom, also urged the government to acknowledge health as a basic and fundamental right in the constitution.

There is a dire need for lobbying and advocacy to highlight the importance of this subject and press the parliamentary parties to take up this issue in the parliament. Political parties should make right to health a constitutional provision a priority agenda in their election manifestoes.

The author is a staff reporter. He can be reached at vaqargillani@gmail.com Twitter: @waqargillani