Essential surgical care is our right to health

IN a rights-based approach to health, the provision of essential surgical services is not a luxury, but a critical component for the “highest attainable standard of health”. Considering the fact that approximately 5 billion people have no access to basic surgical care, it needs to be considered as a human right. 

Millions of people around the globe die each year or suffer lifelong disability from easily correctible conditions like obstructed labor or appendicitis. Being an operative procedure, essential surgery in medical science is contemplated to be vitally necessary for treating a disease or injury. There is a possibility of a patient's death or permanent impairment in case of postponing or deciding against an essential procedure. The right to essential and emergency surgery can bypass most of these procedures since the right to health already exists in major international human rights treaties. Such treaties are: article 25(1) of the Universal Declaration of Human Rights (UDHR), article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), article 24 of the Convention on the Rights of the Child (CRC) and article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), article 5(e)(iv) of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD).

On January 29, 2015 the World Health Organization (WHO) Executive Board unanimously adopted a draft resolution on 'Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage'. Similarly on 22 May 2015, the 68th World Health Assembly (WHA) passes the resolution A68/15 for strengthening emergency and necessary surgical service as a constituent of global health care. This resolution is expected to help the countries adopt and implement policies which will integrate safe, quality and cost effective surgical care into the health system as a whole. 

The WHO has recognised the importance of surgery in global health service and has begun to identify low-cost essential operations that significantly reduce the burden of disease. In 2005, the WHO established the Global Initiative for Emergency and Essential Surgical Care, which strives to strengthen the capacity to deliver effective emergency surgical care, as well as reduce death and disability from road traffic accidents, trauma, burns, pregnancy related complications and other disasters.

Surgery has the potential to reduce child mortality and improve maternal health by treating obstetrical complications. Surgery can also help to tackle infectious diseases, including HIV through male circumcision. Bangladesh has reduced the maternal mortality ratio by three-quarters between 1990 and 2015, but the rate of decline needs to speed up over the next decade. The Government of Bangladesh must initiate free essential surgical services for pregnant woman who need caesarian operation. Needless to say, obstructed labour, haemorrhage and infection often cause harm to a woman patient. Obstetric fistula isolates women from society, resulting in unemployment and makes power loss. Hence, access to essential surgical care can promote women empowerment and gender equality.

Article 15(a) of the Constitution of Bangladesh mandates that “it shall be a fundamental responsibility of the State to attain, through planned economic growth, a constant increase in productive forces and a steady improvement in the material and cultural standard of living of the people with a view to securing to its citizens the provision of the basic necessities to life, including food, clothing, shelter, education and medical care”. Moreover, article 18 provides for the raising of the level of nutrition and the improvement of public health as the primary duties of the State. 

The Government of Bangladesh has developed the National Health Policy and the National Population Policy respectively in 2011 and 2012 for strengthening the health care sector to ensure that access to health is a fundamental right of every human being. It guarantees the standardised and quality health services, and protects the people's right to gain access to health services. Now it is time to consider essential surgery as one of the national health priorities for including it in the National Health Policy and relevant laws. 

The world is starting to acknowledge the importance of embedding essential surgical services as a part of the primary health care assurance in order to address the current need for surgical heath services. To that end, essential surgical care should be considered an essential component of the basic human right to health in Bangladesh. 

The writer is pursuing LL.M. in International Law, Faculty of Legal Studies, South Asian University, New Delhi.