The variance in understanding of the health rights of

vulnerable groups in the Sundarbans, India

Upasona Ghosh,Shibaji Bose, Sabyasachi Mondol

HSR Cape Town

3rd October 2014

Right to Health to which India is a signatory

Article 12 “The right to the highest attainable standard of health” of

the International Covenant on Economic, Social and Cultural Rights

General Comment 14 of the Committee stated right to health requires

availability, accessibility, acceptability, and quality of health care.

Community interprets Right to Health extending not only to timely and

appropriate health care but also to the underlying determinants of health

Alma Ata Declaration

right of access to health facilities, goods and services on a non-discriminatory

basis

ensure access to the minimum essential food which is nutritionally adequate

and safe

provide essential drugs

Citizen Charter on Hospital Care

Providing general information

Casualty and Emergency Services

Out-patient care

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Guiding logic behind the research

Who are the vulnerable of the

vulnerable?

What extent they are more vulnerable?

How health rights of these people are

getting violated?

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The Sundarbans

Geographical

barriers

Frequent

climatic shocks

Sundarbans‟ Health System

Challenges of Accessibility, Affordability

Acceptability and Parallel Health Market

5

Accessibility Affordability

Acceptability

Parallel health

Market

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Objectives

To Explore:

The most vulnerable groups within the

already geo-climatically vulnerable

context

Extent of their health vulnerability

Violation of their health rights

Methodology

Census of Public

health infrastructures

in Patharpratima

Block

Ethnographic observation for

two months

Six FGDs with communities

21 Case studies

Three villages in

Patharpratima

Block with

varying

geographical

locations:

Completely

Deltaic

Partly Deltaic

Non-deltaic

Findings

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Who are more Vulnerable

among the Vulnerable

Women with out-

migrant husbands

Crab

collectors

People living on the

embankment„Meen dhara‟

Extent of Health Vulnerability (self

perceived)

MothersDirect health impacts

Skin infections

Gastro-enteric diseases

Vaginal infections

Body ache

Animal attacks

Psychological stressors

Impacts on social determinants

Livelihood

Shelter

Food security

ChildDirect health impacts

Gastro-enteric diseases

Acute Respiratory infections

Malnutrition and related

morbidity

Drowning

Insects and snake bite

Impacts on social determinants

Food insecurity

Lack of psycho-social care

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Availability of health workforce and facilities in

Patharpratima block (actual compared to IPH Standards)

Do I have right?

“Doctor comes and goes as he wishes. We simply do not

know how many days he is require to stay”.- Respondent,

Non-deltaic village

“ we are unsure of what kind of treatment is available in

different Govt. health facilities. Can you give me a list”? –

Respondent, - partly deltaic village

“Every year people in my village dies out of snake bite.

May be this is our fate”- Respondent, Deltaic village

Violation of Health Rights of the

Mothers

Basic Rights

Right to receive equitably distributed

functioning health care facilities, medicine and

services

Right to receive emergency medical care

Right to receive treatment from skill and

trained medical personnel

Right to receive information regarding out-

patient care

To what extent it is violated

18 out of 21 respondents reported non-

availability of Doctors and medicine

during time of need

All respondents reported no emergency

care facilities in times of like animal

attack, snake bites or injuries and during

climatic disasters

All respondents reported RMPs are the

first point of care for general and

emergency health issues

17 out of 21 respondents do not have

concrete knowledge due to frequent

changes in out-patient care timings

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Basic Rights

Right to born in a safe hand

Right to receive care during the 1st month

followed by full preventive care

Right to fed according to the universally

accepted good feeding practices

Right to receive treatment from qualified

provider when fall sick

Right to receive regular supplementary

nutrition

To what extent it is violated

All the respondents delivered at home

16 out of 21 didn't receive any supervision

from any health worker

Initiation of breast feeding just after birth

was done by all the respondents.

Exclusive breast feeding has been done by

11 out of 21 respondent

Children of all respondents receive care

from RMP at a first point

12 respondents out of 21 reported ICDS

centers are far off

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Violation of Health Rights of the Child

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More in-depth understanding on need

of the vulnerable groups- felt or unfelt

Perception of Supply side regarding

special need of these vulnerable groups

Perception of decision makers

regarding the health rights of the

vulnerable groups

Scope of further research

Conclusions

The vulnerable groups are unaware

about their health rights as an

entitlement

Concept of health rights are more

supplier determined

No plans or provisions for specific,

targeted and tailor maid health care

supply for the vulnerable groups

Thank You

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