Let’s talk about our human rights to healthcare
Where is our human right to healthcare?
Waking up in every morning, we think, how and where we can have access to quality and affordable healthcare if we someday are falling sick severely and unexpectedly or due to our hard work for feeding our beloved family.
While looking at current healthcare sector in Cambodia, we could see some improvement. It is much better than that of Sangkum Reast Niyum (People’s Socialist Community Regime), Democratic Kampuchea (Khmer Rouge), and Khmer Republic (Marshal Lon Nol’s Regime). We see numerous emergences of new and modern hospitals and clinics which are equipped with luxurious facilities, equipment, and medicines. But wait!, if we observe critically at current development, most of them are operated by and belonged to private sector. This means that, it is a “must to pay for every healthcare service”. Money equals to Services!
When we look at public healthcare, we see that the state keeps actively operating its services, and there is also a lot of improvement although there is steadily increased private health operators. Noticeably, there is an increased number of new buildings for referral hospitals and health centers at the provincial, district, and commune levels. Currently, there are 9421 health centers located across Cambodia. While at national level, several national hospitals have been transformed to be more luxurious in term of having new buildings expansion, more modern facilities and equipment, and more skillful staff. Those hospitals include Preah Kossamak or Lok Song, Khmer-Soviet hospital or Russia, and National Pediatric hospital or Komar Chaet, and Kalmette hospital; whereas the rest is still under development. These differences and transformation may result from public administration reform, a form that is similar to privatization or autonomy. It means that fees or financial collection from users, clients or patients will be managed and used for increasing of service delivery, maintaining and expanding its operations. In addition, the incomes from user fees are independently managed by each hospital management rather than relying on the Ministry of Health.
Seeing public healthcare have been prettily developed, we ordinary people feel happy with this improvement while at the same time we also have a grave concerns around our access to healthcare, and these concerns are understood just as a simple issue. However, it is not so simple. It happens every day and becomes more severe while there are no proper and effective coping mechanisms or solutions in place yet. Most of all healthcare services delivered by both private and state are costly. The expense on healthcare becomes a burden for the poor, low, and middle-income populations.
Frequently we have heard people and patients who experienced using public healthcare and health treatment services on user fees, especially the pre-pay requirement before treatment, high cost of health services and medicines. Patients have to use their own money to pay for treatment and some of them have sold their properties including poultries, land, and house while some families fall into debt.
Article 72 of the Constitution of Kingdom of Cambodia states clearly the human rights to healthcare: “The health of the people shall be guaranteed. The State shall give full consideration to disease prevention and medical treatment. Poor citizens shall receive free medical consultation in public hospitals, infirmaries and maternities”. Beside this, the Global Health Declaration in 19982 also clearly states about the commitment to achieve significant goal on a new global health policy “Health for all in the 21st century”.
Though human rights to free healthcare services for the poor are stated in the above mentioned laws, the spending on healthcare per capita keeps increasing. In 2007, the spending on healthcare per capita was USD3 37 (including USD 25 is out-of-pocket spending from patient which is accounted 68%, and USD 4 is a pay shared by government which equals to 10% of the total spending), and the spending on healthcare per capita in 2012 is USD 52 (including USD 31.72 is out-of-pocket spending from patients which equals to 61%, and USD 7.8 is a pay shared by government which equals to 15% of the total spending).
A result from research on “Understanding Debt Situation and Access to Healthcare among Rural Households in Cambodia” in two provinces: Prey Veng and Kampong Chhnang provinces by Social Action for Change shows that 76% of 132 respondents are indebted and 56% of them experienced indebtedness for spending on health and medical treatment in the last two years.
Some questions are raised up: why do people have to pay a lot on healthcare? Why is there widespread of healthcare services provided or operated by private sector and more private hospitals are establishing, while some public hospitals are operating similarly to private hospitals? Why cannot government function its role to guarantee the rights to access to free or affordable healthcare for its poor people?
Having been supported by or received official development assistance or foreign aid from great donors including the World Bank, the Asian Development Bank (ADB), the International Monitory Fund (IMF), and as being a member of World Trade Organization (WTO), the Royal Government of Cambodia are advised and required to reform its administration a lot. The reform started with and illustrated clearly in the Poverty Reduction Strategy Papers (PRSP) and National Strategic Development Plan (NSDP). It includes the plan to promote or improve some public services, including healthcare, by encouraging and motivating the engagement from private sector to work in partnership with the state to provide services, and to transform some public services and administration to be operated similarly to private sector in order to increase state ability and investment on facilities and services providing through the collection of fee from users, or it is called as the contribution from people.
In the health strategic plan 2008-2015, the vision of Ministry of Health is to “enhance sustainable development of the health sector for better health and well-beings of all Cambodians, especially of the poor, women and children, thereby contributing to poverty alleviation and socio-economic development” and among the 15 points of directions of health strategic plan 2008-2015 incudes: making services more responsive and closer to the public throughimplementation of a decentralised service delivery function and a management function guided by the national “Policy on Service Delivery” and the policy on “Decentralisation and Deconcentration”; promoting effective public and private partnership in service provision based on policy, regulations, legislations and technical standards; and implementing pro-poor health financing system, including exemption for the poor and expansion of health equity fund, in combination with other forms of social assistance mechanism.
In community workshops on “Understanding Healthcare System and Access to Healthcare in Cambodia” and “Trade Intellectual Property Rights and Access to Medicines” with participants from the Forum of Networks of People Living with HIV and Most At-Risk Populations (FoNPAMs), United Sisterhood Alliance, community representatives of key populations TB and Malaria network, factory workers, social activists, health and legal experts, which were organised and co-organised by UNAIDS, UNDP, and United Sisterhood Alliance in October, and following series of workshops in Novembers and December 2014, it has found some main issues around communities’ access to healthcare, the use of health equity fund to access to healthcare, and concerns on costly health expenditure and medicines. There is a lot of discussion on health equity fund. Most of patients cannot access to quality services, and/or they cannot access to various needed services since most of health equity fund or exemption programs focus mainly on HIV/AIDS, Malaria and Sexual Transmitted Diseases. These programs are mainly supported by both international donors and none-governmental organisations, and this for implication is not a sustainable mechanism for ensuring sustainable healthcare providing and accessibility.
Medicines for treatment and prevention from diseases are necessary for human’s life. Being a member of World Trade Organization, Cambodia has to accept and ratify many trade agreements including Trade Related Intellectual Property Rights (TRIPS). Under TRIPS, Cambodia is required to draft and ratified the law on Intellectual Property Rights or “Patent”. This law includes the patent on medicines. It means that if there is a company has found new type of medicine to prevent or cure a specific disease, within a particular period the company will become monopoly, and has the exclusive rights in producing, distributing, and selling this medicine at their own set price if the company puts patent on it. Cambodia became a member of WTO in 2004, and since it is a least developed country, Cambodia is exempted from adopting intellectual property rights for a specific period of time. By 2016, the exempted period is finished, and Cambodia has to start to implement patent law until 2020.
Thus, Cambodia and its population cannot produce or import generic drugs or medicines that has cheaper price and has the same quality as the patented ones.
What can we do in order to ensure that our rights to healthcare are guaranteed and respected?
Some recommendations have been raised by communities in the workshop on “Understanding Healthcare System and Access to Healthcare in Cambodia, Understanding Patent Law and the draft Law of Compulsory Licensing for Public Health”. The CL Law uses the TRIPS’s flexibilities to facilitate states for having abilities to produce, import, and distribute generic medicines that are necessary for people; this is to allow people to have access to medicines for both prevention and treatment.
People’s mobilisation and organisation, and participation in sharing and disseminating information, understanding the human rights to healthcare, understanding the threats on public health and access to medicines which are resulted from above international and national policies, laws, and regulations. Hence, it is very important and necessary that the government have and organize the discussion and consultation with people in the process of making laws and policies for public health, and we support and need the government to disseminate and inform people around the drafting of and the use of the Compulsory Licensing Law for Public Health, and to review the existing Patent Law and other TRIPS related policies to ensure that these laws will respect and protect the rights of people and put the public health as the priority.