- Let-them-die policy contravenes WHO constitution
- “Removal from medical cover for self-inflicted harm” homicidal
- WHO says they were not consulted-seek clarity
- It is inhuman and degrading- Ndadi
- Local human rights organisations silent
The World Health Organisation (WHO) -a United Nations agency which specializes in health issues has expressed reservations with the Botswana government’s controversial new health policy which seeks to deny people with “self-inflicted harm”, including those injured during alcohol related activities, suicide and smoking related diseases, such as lung cancer- free medical cover.
The policy will affect drunken drivers, motorbike riders without helmets, failure to use seat belts for self or children as passengers, participation in riots and mass gatherings involving violence leading to injury, lung cancer associated tobacco and tobacco products- as well as attempted suicide related to alcohol or drug abuse.
WHO has a commitment to human rights in respect of healthcare programmes and policies on both national and regional levels. By looking at underlying determinants of health as part of a comprehensive approach to health and human rights, government’s policy is seen as a contravention to the organisation’s hard-earned goals and gains.
The new policy is also a violation of the WHO Constitution, which enshrines “…the highest attainable standard of health as a fundamental right of every human being.” According to WHO, the right to health includes access to timely, acceptable, and affordable health care of appropriate quality.
The controversial policy will make that goal difficult to attain as it advocates against treating some patients before their payment, in order to facilitate governments cost recovery processes.
WHO’s position is that “health policies and programmes have the ability to either promote or violate human rights, including the right to health depending on the way they are designed or implemented.” The organisation indicates that “Taking steps to respect and protect human rights upholds the health sector’s responsibility to address everyone’s health.”
In their report on human rights and health- WHO says “violations or lack of attention to human rights can have serious health consequences. Overt or implicit discrimination in the delivery of health services violates fundamental human rights. A human rights-based approach to health provides strategies and solutions to address and rectify inequalities, discriminatory practices and unjust power relations, which are often at the heart of inequitable health outcomes.”
The goal of a human rights-based approach, WHO advices, is that all health policies, strategies and programmes are designed with the objective of progressively improving the enjoyment of all people to the right to health.
Non-discrimination, the organisation says “seeks to guarantee that human rights are exercised without discrimination of any kind based on race, colour… or other status such as … health status or economic and social situation.”
Accessibility is accordingly in line with the dictates that health facilities, goods and services should be accessible to everyone, “Accessibility has 4 overlapping dimensions: non-discrimination, physical accessibility and economical accessibility (affordability),” says WHO.
The reasons behind the controversial policy amendment is that those responsible for causing injury to themselves should meet the medical cost of their treatment to reduce the burden on government.
In a brief interview with this publication on the issue, Moagi Gaborone, WHO’s national professional officer on health information’s and promotion said WHO standards are that everyone should be treated timeously and indiscriminately.
He revealed that they are still seeking clarity from the government in relation to the issue. Asked on whether they were consulted as an important stakeholder and development partner, Gaborone said NO! “We read through the newspapers but like I said we are still engaging with the authorities on the issue,” he reiterated.
The policy amendment is also likely to go against Botswana’s promises and vows on universal coverage. Universal coverage is to expand coverage in three way: the breadth of the coverage, length and height.
Botswana’s public health sector is organized into approximately 29 health districts through district health management teams. Each district is responsible for taking stock of its population to ensure accessibility of health services to all, according to a WHO report seen by this publication.“Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted,” reads Botswana’s past WHO report.
Human rights lawyer Uyapo Ndadi heavily criticized the policy stating that it was very regressive and not well thought-out. “We are punishing people thrice, by making them pay a levy, denying them treatment and stealing from them because we are not affording them rehabilitation facilities or even recreational; at the very least, it is inhuman and degrading,” he said.
Ndadi said that it was shocking that the state is now punishing those who attempted suicide: “Are we saying they should have just died? They need support even from government.”
Legal eagles argue that failure to provide medical treatment is the refusal to provide healthcare to a patient who requires it and may attract countless legal actions against the government.
Doctors and hospitals generally have a duty to provide appropriate care for their patients, and an omission may breach that duty except where an adult patient of ordinary capacity terminates the duty by refusing consent.
There however is a conflict in public policy. Research shows that the policy of patient autonomy enshrines a right of self-determination—patients have a right to live their lives how they wish, even if it will damage their health or lead to premature death. Society’s interest is in upholding the concept that all human life is sacred and should be preserved if at all possible.
The policy takes on more ominous overtures when one considers its effect on those that work in health adverse environments, such as mines. The choice to engage in work that may be hazardous to one’s health out of economic necessity would, taking the current policy to its logical conclusion, deny such a person the right to access health benefits.
While Ditshwanelo- Botswana Centre for Human Rights has not issued any statement on the new policy, efforts to contact them went futile and their public information platforms do not carry any comment on the matter.
Efforts to reach the Ministry were futile as the Permanent Secretary, Shanaaz El Halabi did not take our calls.