Daily Times

There common notion that fundamental rights are only confined to person’s education and financial sustainability is wrong and misleading; freedom of expression and healthcare are also fundamental rights of individuals living in any society. Perhaps it is due to this misconception that not much emphasis has been given to the constitutional provisions that guarantee health rights of citizens. Since the influential and affluent segment of society prefers to acquire treatment from the private sector, the public healthcare system is meeting the health demands of the under privileged and poor strata of the community.

The quality of life of the vulnerable strata is compromised accentuated by the fact that this strata is not in a position to agitate through the press and electronic media and its potential is not realised and productivity compromised which reduces its earning capacity. Hitherto the enabling provisions for guaranteed health care by the state to its citizens have not been debated at length nor recognised and invoked by the public health community.

Article 3 of Part-I of the Constitution provides “The State shall ensure the elimination of all forms of exploitation and the gradual fulfillment of the fundamental principle, from each according to his ability to each according to his work”. The Constitution in Article 3 emphasises that every citizens ability and productivity is distinguishable and distinct from others and the ability of a person with disability may differ from a person who has no disability or infirmity. The Objectives resolution of the Constitution states ‘So that the people of Pakistan may prosper and attain their rightful and honored place amongst the nations of the World and make their full contribution towards international peace and progress and happiness of humanity.’

The Constitution specifically refers to health and disability. Chapter I, Part II of the Constitution dealing with Fundamental Rights of the citizens states in Article 25 (3) ‘Nothing in this Article shall prevent the State from making any special provision for the protection of women and children.’

It is significant to note that women and children have been categorised together. Article 25A of the constitution states ‘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’. This being an obligatory duty of the state any child not being in good health, suffering from an infirmity or having a disability may be deprived of his constitutional protection embodied in Article 25-A of the Constitution. Article 35, Chapter-II of the Principles of Policy gives credence to the proposition the mother and child are categorised together wherein it is stated ‘The State shall protect the marriage, the family, the mother and the child’.

It can be inferred that Article 25(3) and Article 35 of the Constitution revolve around the obligation of the state towards women and children and also mother and child and obligations would be focused necessarily on health and nutrition in line with recognised developmental milestones of newborns. Article 38 states ‘The State shall (d) provide basic necessities of life, such as food, clothing, housing, education and medical relief, for all such citizens, irrespective of sex, caste, creed or race, as are permanently or temporarily unable to earn their livelihood on account of infirmity, sickness or unemployment’. Article 38 thus extends the concept of medical relief to such citizens who are suffering from infirmity or sickness and at the same time acknowledges medical relief as a basic necessity of life.

The abysmal state of health affairs is indicated by a report of the World Bank highlighting, which states that in Pakistan, the average expenditure on the healthcare of an individual does not exceed USD 37 per capita, which is significantly lower than that recommended by the World Health Organisation at USD 44 for an individual

For some, the distinction between obligation of the state in terms of health care and health rights of the citizens of Pakistan is blurred in the Constitution. The segment of the populace which is encountering difficulty in moving along or participating in the developmental process is a vulnerable class. A progressive approach is to declare healthcare a legitimate right of all citizens, especially children who are not vocal enough to promote their own interests. The state bound to address the special needs of citizens who are suffering from any sort of disease or disability and to rehabilitate such persons at an early stage.

Unless a child is healthy, he/she cannot acquire age appropriate academic skills and eventually enter a profession or vocation to exploit his or her potential and become a productive citizen to enable the country to contribute meaningfully to international peace and development.

An individual has to be physically and mentally fit and healthy to realise his or her potential. Women are especially marginalised as any woman suffering from any disability or disease is not accorded due priority in our patriarchal society and her quality of life is compromised with an adverse effect on the nutrition and health of her children. The present level of expenditure on public health is almost Rs 133.9 billion or 0.45 percent of Pakistan’s GDP.

The abysmal state of health affairs is indicated by a report of the World Bank highlighting, which states that in Pakistan, the average expenditure on the healthcare of an individual does not exceed USD 37 per capita, which is significantly lower than that recommended by the World Health Organisation at USD 44 for an individual.

The productivity of labor is lower as compared to other countries in Asia and a significant cause is lack of good nutrition, stunted growth, frequent illness with the malnourished population being susceptible to disease and individuals suffering from any disease or disability facing discrimination at the time of seeking employment or admission in educational institutions. With the visibly improved law and order situation, a perceptible shift from security to development paradigm can be felt, which gives credence to the demand for an appreciable enhancement in the budgetary allocation for public health. The need of the hour is for attaching priority towards improvement of the existing public healthcare system to improve the quality of life of citizens who can contribute towards the development of the country.

The writer is PhD in Rehabilitation Sciences, and has done Fellowship in Clinical & Research Neuro Rehabilitation, Department of Rehabilitation Medicine from Seoul National University Hospital, South Korea. She has several publications in academic journals

Published in Daily Times, April 2^nd 2018.