Violation of people’s right to health in Sierra Leone
In an article published in Awareness Times on 9 February 2011, it was reported that “The continual neglect on patients as being demonstrated by health workers including doctors, nurses, midwives and specialists, has become a general cause for concern among the citizens.” The article further “reported “that “patients and their relatives are complaining that despite the over one hundred percent salary increment of health workers, which was made by President Ernest Bai Koroma, in order to enhance efficiency in health service delivery, the health workers are still sabotaging the good intention of the President”.
According to the article “ the patients consider the poor treatment meted on them by the health workers as a total violation of their right to health and called on the various authorities to intervene and right the wrongs”.
Indeed, the people are right to think thus. The president has during his first term in office taken steps to improve the health sector in Sierra Leone. He has increased the salaries of health practitioners and introduced Free Medical Care for under-fives, pregnant and lactating women. These steps have undoubtedly improved the lives of this group of people. However, little or no firm actions have been taken against malafide health practitioners whose negligence and indiscipline have jeopardized the lives of Sierra Leoneans.
In the past years we have witnessed pregnant women, under-fives and lactating women meeting their untimely death as a result of the arrant negligence of doctors, nurses and pharmacists. On one occasion a pregnant woman and her unborn child passed away because the doctor refused to treat “them” simply because he could not work on Sunday.
This insufficient action or inaction by the government is a violation of not only the people’s right to health but also to their right to life.
Human beings consider their health and the health of those they care about as a matter of daily concern. Irrespective of our age, gender, socio-economic or ethnic background,” we consider our health to be our most basic and essential asset. Ill-health, on the other hand, can keep us from going to school or to work, from attending to our family responsibilities or from participating fully in the activities of our community”. No wonder we are willing to make many sacrifices if only that would guarantee us and our families a longer and healthier life.
The right to health is a “fundamental aspect of our human rights and of our understanding of life in dignity”. The right to the enjoyment of the highest attainable standard of physical and mental health has been recognized in various international human rights instruments.
It was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The preamble further states
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.” The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living. The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights. The Committee on Economic, Social and Cultural Rights has also stressed that “States have a core minimum obligation to ensure the satisfaction of minimum essential levels of each of the rights under the Covenant. While these essential levels are, to some extent, resource-dependent, they should be given priority by the State in its efforts to realize the rights under the Covenant.” With respect to the right to health, the Committee has underlined that States must ensure:
The right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups; access to the minimum essential food which is nutritionally adequate and safe; access to shelter, housing and sanitation and an adequate supply of safe drinking water; the provision of essential drugs; equitable distribution of all health facilities, goods and services.
Moreover, “the right to health is recognized, inter alia, in article the International Convention on the Elimination of All Forms of Racial Discrimination of 1965, in the Convention on the Elimination of All Forms of Discrimination against Women of 1979 and in the Convention on the Rights of the Child of 1989. Several regional human rights instruments also recognize the right to health, such as the European Social Charter of 1961 as revised, the African Charter on Human and Peoples’ Rights of 1981 and the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights of 1988. In like manner, the right to health has been proclaimed by the Commission on Human Rights, as well as in the Vienna Declaration and Programme of Action of 1993 and other international instruments.”
The definition of right to health is not confined to the right to health care but it also acknowledges that the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment.
The right to health is not the same as right to be healthy. According to the General Comment No.14, “the right to health contains both freedoms and entitlements. The freedoms include the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free from torture, non-consensual medical treatment and experimentation. By contrast, the entitlements include the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health”.
According to the Committee on Economic, Social and Cultural Rights health care should be available, accessible (physical and economic), acceptable and of quality.
Availability: Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the State party. The availability of health services that will cater for the majority of Sierra Leoneans is not there.
Accessibility: Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Health facilities, goods and services must be physically and economically accessible.
Physical accessibility means that health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS. In most part ofSierra Leone, especially the remotest parts, there is no physical access to health. Pregnant women, children, the invalid and the aged have to do long distances before accessing a health center.
Economic accessibility means health facilities, goods and services must be affordable for all. Payment for health-care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households. In Sierra Leonea large part of the populace cannot afford a good health care because they are financially strapped.
As well as being culturally acceptable, health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation. The quality of health facilities, goods and services inSierra Leone leaves a lot to wish for. Most of the health practitioners are not qualified to perform the duties that they are supposed to carry out. Furthermore, little efforts have been made to stop the importation of unsafe drugs. These fake drugs augment the health hazards that Sierra Leoneans are facing.
All health facilities, goods and services are acceptable when they are respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.
The right to health, like all human rights, imposes three types or levels of obligations on States parties: the obligations to respect, protect and fulfill.
The obligation to protect requires States to take measures that prevent third parties from interfering with this right. Under this obligation government should amongst others ensure that privatization of the health sector does not constitute a threat to the availability, accessibility, acceptability and quality of health facilities, goods and services. The emergence of the numerous private hospitals in our country has led to the neglect of patients in government hospitals where health care is cheaper. Almost all health practitioners, especially doctors, have or are attached to a private hospital. In pursuit of their greedy intentions, they abandon patients who go to government hospitals, where health care is completely in the doldrums. Firm actions should be taken against these greedy health practitioners who only pursue profit at the expense of their fellow Sierra Leoneans.
In addition, in order to protect the people’s right to health the government should ensure that medical practitioners and other health professionals meet appropriate standards of education, skill and ethical codes of conduct. To a very large extent the government is not doing much to achieve this because a large group of the health practitioners do not do their work properly as many patients suffer humiliation, neglect and death.
The obligation to fulfill requires States to adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures towards the full realization of the right to health. The obligation to fulfill contains obligations to facilitate, provide and promote. The Free Medical Care for pregnant women, under-fives and lactating mothers is a very good initiative. However, due to the insufficient action or inaction by the government, many health practitioners are sabotaging this noble intention of the president. Sierra Leoneans fervently hope that the ratification of the Sierra Leone Health Service Commission will help remedy this health malaise that claims a lot of lives everyday. This Commission should not be another “window-dressing” solution to the numerous problems that we are facing inSierra Leone.
The obligation to respect requires States to refrain from interfering directly or indirectly with the enjoyment of the right to health. The obligation to respect include the prohibition of marketing of unsafe drugs.Sierra Leone is fighting a long battle with importers of “fake drugs.” The government is losing this battle as the country is now replete with unsafe drugs that are dangerous to the health.
Health is a fundamental human right indispensable for the exercise of other human rights. The absence of respect, protection and fulfillment of the right health can impede the enjoyment of the right to life. The government should therefore take immediate actions, efficient and effective, to improve the health of Sierra Leoneans.
Last Friday the right to health was topic of discussion on Salone Radio Amsterdam. We were joined by two guests from London to discuss the health problems inSierra Leone. If you want to listen to the radio programme, you can go to this link:
Part one: http://www.salto.nl/streamplayer/ondemand_razo.asp?y=11&m=11&d=04&t=2000&s=1800
Part two: http://www.salto.nl/streamplayer/ondemand_razo.asp?y=11&m=11&d=04&t=2100&s=0
Mohamed Kunowah Kiellow, Amsterdam, The Netherlands
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