The Clients' Charter of Rights of Bangladesh
Mohammad Shahidul Islam
In Bangladesh, almost 50% of the total population lives under the poverty line. Most people are deprived from receiving basic services including health. The poor do not avail health services due to a number of barriers to access including fees and other associated costs. Although it is mainly the responsibility of the government to ensure adequate health services for its citizens, and ensure favourable environment for properly exercising their rights to healthcare, such an objective would need concerted efforts from the entire range of stakeholders. Some initiatives that have been taken so far are not adequate to establish the health rights of the citizens and a lot of works need to be done in this regard.
Existing regulatory framework
The existing regulatory framework for monitoring health service delivery either in the public or private sector remains weak. There are 45 laws related to various aspects of health. For example, laws related to specific diseases/health situations such as Epidemic Disease Act (1897), Prevention of Malaria Ordinance (1978), Eye Surgery (Restriction) Ordinance (1960); laws related to breast milk substitute, quality of food, quality of drugs, use of narcotic, women and children's health, health of labourers, environmental pollution and so on. None of these laws deal directly with patients'/health consumers' rights.
The country adopted a National Health Policy in 2000 with fifteen aims and objectives. These objectives include: development of nutrition and public health, accessible health services for the poor and rural population, primary healthcare for the Upazila and Union Council, reduction of material mortality, development of reproductive health, up-gradation and modernisation of health services, introduction of family planning methods for the ultra poor, special provision for the mentally and physically handicapped population etc.
Formulation of CCR
Health is a basic need and it is protected in the constitution of the government of the People's Republic of Bangladesh5. Ministry of Health and Family Welfare (MoHFW) formulated the Clients' Charter of Rights (CCR) in 1998. The promulgated CCR is only a first step in emphasising the individuals right to health. The charter was developed by MoHFW without the broad participation of civil society, other government departments or other stakeholders. The result was a CCR without the institutional and legal mechanisms in place for it to be used as a tool by clients or the Government and it is limited only in displaying the messages of the charter.
Basic features of CCR
*Right to information about what are the services available from providers
*Right to safe and continuous services
*Right to choose the form of treatment and family planning methods
*Right to receive services on priority basis in emergency situation
*Right to confidentiality
*Right to be informed about the services received
*Right to be respected, express opinion and feel at ease
*Right to receive client's own copies of treatment/health related reports
*Right to inform relevant authorities and get redress, if the clients' rights are hindered or compromised for any reason.
Recommendation for furthering Clients' Charter of Rights
Right to receive client's own copies of treatment/health related reports
The client has the right to receive her/his own copies of treatment materials/documents in case of necessity. The defective medical record may mislead further treatment of the patient and thus aggrieved to have redressed, therefore, the patient should have the right to take recourse at law.
Rights to ensure participation on decision-making level, including development of health related policy, strategy, project implementation and evaluation
It is important to ensure the voices of the users in developing policy, strategy and guidelines on health related issues with the healthcare providers and other stakeholders. Such practice would provide opportunities to take into account the different perspectives of different stakeholders, specially the end users/health consumers and ensure transparency and to build the legitimacy of the policy for the people.
Right to make complain and get redress for denying the rights of the client
Making complain and redress in case of wrong treatment or neglect infringing the rights of the service recipients.
Rights to get compensation in case of wrong treatments
Patients should have their rights to be compensated for negligence or wrong treatment. One mistake may cause nothing to the physicians or other concerned persons, however it can be a massive disaster for the patient and his/her family. Therefore, the physicians and all others concerned have to share the responsibility for the consequence of the wrong treatment.
Rights to learn about the clients' charter of rights
Consumers have the rights to be educated about their rights. The government should take initiatives and actions to disseminate the clients' charter of rights among the consumers about their rights and responsibilities.
There has a need to design a client/patient centred healthcare mechanism in order to ensure health consumers' rights in Bangladesh. 'Patient Centredness' can be defined as a state where everything is converged around the patient, the focal point of the whole system. Although the term is widely used, it is poorly understood in the medical practice7. The process for developing such mechanism and implementation among the mass would depend on political commitment and accountability and transparency to the consumers, which is their constitutional right. The political commitment should be based on popular opinion so that it is not impeded with the change of the government. The local government framework has to be effectively integrated in this respect.
There are considerable commonalities as well as differences among the nationally and internationally introduced documents on clients' charter of rights. The Health Consumers' Rights Forum (HCRF) had taken different initiatives along with member organisations and individuals to formulate a comprehensive document on clients' charter of rights in the context of Bangladesh.
Some of the changes/additions recommended in the existing charter to transform it to a more wholesome national document, are as follows:
Rights to non-discriminatory health services
Every citizen has the rights to receive health services irrespective of their sex, religion, economic and social status. The marginalised peripheral and transgender should not be excluded from national health services as the citizens of the country.
Rights to receive accessible, affordable and appropriate health services
This is the responsibility of the State to ensure optimal accessible and appropriate health services for all citizens. People should not be barred from receiving services due to location of the service facilities and costs of treatments.
Rights to information about where, how and which services are available
The information pertaining to the services offered, respective costs and other facilities should be displayed and make available for health consumers. Relevant charts have to be prepared about what a patient has to do, what kind of services a patient can suppose to buy and other minimum to be done for treatment after admission of a patient.
Right to choose types, family planning methods and health service providers
A patient should have the right to choose a convenient health services provider in terms of type, method and individual. They can choose services from any government recognised healthcare system i.e. allopathic, ayurvedic/unani or homeopathy.
Rights to give consent on information presented for health services
Practitioners in our country usually neither take consent of the client nor provide sufficient information about her/his treatment. The patient has right to learn about diagnosis, treatment options and the potential risks involved in the treatment.
Rights to respect, confidentiality and privacy
The client has the right to receive respectful behaviour from the service provider. The health and medical reports should be treated as confidential and are subject to disclose with prior permission of the client or legal reasons to divulge the information to a court.
Rights to receive pathological tests in fair price
There is no government control over the prices for pathological tests in Bangladesh. There should be a standard price list developed by the government, which would be affordable to the customers.
Source: Marie Stopes, Dhaka.