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Honourable Minister of Health and Child Care, Dr David Parirenyatwa
Chairperson of the Zimbabwe Association of Doctors for Human Rights (ZADHR), Dr. Rutendo Bonde
The Chairperson of the Zimbabwe Doctors’ Association, Dr. Fortune Nyamande
Commissioners from Zimbabwe Human Rights Commission
Senior Government Officials in the Public Health Delivery Sector here present
Distinguished delegates from the Health Sector in Zimbabwe
The Acting Executive Secretary, Mr. Vengesayi Erick Mukutiri and other members of the ZHRC Secretariat here present
The Director of ZADHR, Mr. Calvin Fambirai and ZADHR Staff in attendance
Members of the Media Fraternity
Ladies and gentlemen
All protocol observed
Good morning to you all. It gives me great pleasure on behalf of the Zimbabwe Human Rights Commission (ZHRC) to be accorded this opportunity to address you, human rights duty bearers, advocates and service providers, within both the public and private healthcare service delivery sector in Zimbabwe.
May I begin by expressing, our gratitude as ZHRC, to our partners, the Zimbabwe Association for Doctors for Human Rights (ZADHR), the Zimbabwe Human Rights NGO Forum and Zimbabwe Human Rights Association (Zimrights) for partneringwith the Commission on this initiative to promote and protect the right to health through the work of our combined efforts. This breakfast meeting is an interactive platform to enable you Honourable Minister of Health and Child Care as well as all other duty bearers and health service providers, to appreciate the mandate and work of the Commission while at the same time according an opportunity to the Commission to present to you some of its observations and concerns regarding the fulfilment and enjoyment of the right to health in our beautiful country. It is our hope and that of our partners, ZADHR, NGO Forum and ZimRights that such an engagement forum as this one will contribute to mapping out a collaborative strategy for combating violations of the right to health, real or perceived.
This is the first major opportunity for the Commission to interface with players in the health delivery system as represented here and therefore let me briefly appraise you on the establishment, mandate and work of the ZHRC. The ZHRC was created in terms of Section 100R of the Lancaster House Constitution which has since been repealed and is currently established in terms of Sections 232 and 242 of the Constitution of Zimbabwe as one of the five Chapter 12 Independent Commissions Supporting Democracy in Zimbabwe. ZHRC became fully operational in June 2014 upon the recruitment of members of the Commission’s secretariat. The mandate of the Commission is to promote, protect and enforce human rights.
The ZHRC is therefore the National Human Rights Institution (NHRI) for the country whose activities are directed at deepening our democratic sphere by promoting and protecting human rights in the country. So far, three departments have been established to execute the mandate of the Commission namely; Complaints Handling and Investigations; Education, Promotion and Research as well as the Monitoring and Inspections Department.
Honourable Minister, ladies and gentlemen, it is worthy noting that this meeting comes three years after the adoption of a Constitution which enshrines an expanded Bill of Rights under (Chapter 4) comprising of both civil and political rights as well as environmental, social and economic rights. While civil and political rights are enforceable at law, environmental, economic, social and cultural rights are to be progressively realised depending on the availability of resources but the State is required at law to take all steps necessary to ensure the enjoyment of all rights.
May I draw your attention, Honourable Minister to the principle of indivisibility and interdependency of human rights which makes the right to healthcare, one of the most fundamental rights, since one has to be alive and in good health to be able to exercise and enjoy all other rights such as freedom of movement, association, assembly, freedom to demonstrate and petition, freedom of expression and media freedom as provided for in our Declaration of Rights.
Enhancement of the right to health care, as enshrined in Section 76 of our Constitution, is therefore, the main purpose of this gathering. The right to health means that everyone does not just have a right to basic health care services but the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment. Section 76 should therefore necessarily be read in conjunction with Section 77 which provides for the right to food and water as well as Section 73 on Environmental rights, all of which are underlying determinants of health.
Furthermore, Zimbabwe is party to a number of international human rights treaties that guarantee the right to health and health care or make reference to the need to guarantee health as a precursor for the right to life, for example, the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, Convention on the Rights of the Child, Convention on the Elimination of All Forms of Racial Discrimination, the Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of Persons with Disabilities.
The human right to health care means that hospitals, clinics, medicines, and doctors’ services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis. As you may be aware, the design of a health care system must be guided by key human rights standards which include but are not limited to the following:
- Universal Access: That access to health care must be universal, guaranteed for all on an equitable basis, affordable and comprehensive for everyone, and indeed physically accessible. Section 76 of the Constitution guarantees access to basic health care and services, including reproductive health services to every citizen and permanent resident including those living with chronic illnesses. No person may be refused emergency medical treatment in any health – care institution. Section 81 (1)(f) guarantees healthcare services for children, while Section 83 (d) accords persons with disabilities the right to access medical, psychological and functional treatment.
- Availability: That adequate health care infrastructure (e.g. hospitals, community health facilities, trained health care professionals), goods (e.g. drugs, equipment), and services (e.g. primary care and mental health care services) must be available in all geographical areas and to all communities.
- Acceptability and Dignity: That health care institutions and providers must respect human dignity, provide culturally appropriate care, be responsive to needs based on gender, age, culture, language, and different ways of life and abilities. They must respect medical ethics and protect confidentiality. The right to human dignity is guaranteed in Section 51 of the Constitution whilst Section 52 protects the right to personal security including the need for informed consent if one is to be involved in medical or scientific experiments. The right to privacy as guaranteed in Section 57 (e) includes the right for one’s health condition not to be disclosed.
- Quality: All health care must be medically appropriate and of good quality, guided by quality standards and control mechanisms, and provided in a timely, safe, and patient- centred manner.
The human right to health also entails the following procedural principles, which apply to all human rights:
- Non-Discrimination: Health care must be accessible and provided without discrimination (in intent or effect) based on health status, race, ethnicity, age, sex, sexuality, disability, language, religion, national origin, income, or social status. The right to equality and non - discrimination is guaranteed in Section 56 of the Constitution.
- Transparency: That health information must be easily accessible for everyone, enabling people to protect their health and claim quality health services. Institutions that organize, finance or deliver health care including Medical Aid Societies must operate in a transparent manner.
- Participation: That individuals and communities must be able to take an active role in decisions that affect their health.
- Accountability: That private companies and public agencies must be held accountable for protecting the right to health care through enforceable standards, regulations, and independent compliance monitoring.
We are happy as your National Human Rights Institution with the mandate to promote, protect and enforce human rights to note that most of these principles and standards, if not all, are Constitutionally protected, when one considers Chapter 9 of our Constitution, in particular, Section 194 on Basic Values and Principles Governing Public Administration and Section 196 on Responsibilities of Public Officers and Principles of Leadership. But all these noble provisions on the right to health and health care, have to be practically realised beyond being provided on paper by fostering a culture of human rights promotion, protection and enforcement in both public and private health delivery sectors represented at this gathering.
May I take this opportunity to acknowledge the sterling efforts of the Ministry of Health and Child Care and all in the health delivery sector for the significant strides achieved towards realisation of some of the Millennium Development Goals, in particular, Goal 4 on reduction of child mortality, Goal 5 on improving maternal health and Goal 6 on combating HIV and AIDS, malaria and other diseases. We take note of our national economic blue print, the Zimbabwe Agenda for Sustainable Socio – Economic Transformation (ZIMASSET) crafted to achieve sustainable development and equity, to be of direct relevance to the enjoyment of the right to healthcare deriving from the clusters on food security and nutrition and social services and poverty reduction.
The Commission however, notes with some degree of concern, and is in fact saddened by the challenges some people continue to experience in accessing healthcare in Zimbabwe, in particular vulnerable groups due to extreme poverty resulting from the prevailing socio economic problems. One of the functions of the ZHRC as provided for in Section 243 (a) of the Constitution is to promote awareness of and respect for human rights and freedoms at all levels. We are geared to ensure that everyone is aware of their fundamental rights.
To that end, the Commission and its Civil Society partners represented here have been to communities in different parts of the country since beginning of April 2016 conducting roadshows for the purposes of ‘taking the ZHRC to the people’. From the road shows people in various districts have lamented a high prevalence of health rights violations related to maladministration, negligence, inaccessibility of healthcare centres not only in terms of location but also due to high user fees and continued detention of mothers and their neonates after delivery in hospitals due to failure to meet hospital bills among other violations.
During a visit to Harare Central Hospital’s Maternity Unit in September 2015, in fulfilment of its functions as provided for in Section 243 (1) (d) to do with receiving and considering complaints from the public and Section 243 (1) (e) on protecting the public against abuse of power and maladministration, the ZHRC noted with concern the numerous challenges being faced by one of the country’s referral hospitals which include a shortage of skilled professionals and health-care staff as well as an eroded infrastructure with ill-equipped wards which lack essential medicines and provisions. This is therefore a call for urgent action to remedy the situation if the country is to conform to international health standards and realisation of the health related rights provided in our Constitution, some of which I have referred to in this presentation.
In addition, the ZHRC in fulfilment of its mandate provided in Section 243 (i)(c) and (k) monitors and assesses the observance of human rights and inspects prisons, places of detention, refugee camps and related facilities, including places where mentally handicapped people are kept to ascertain conditions under which these various groups of people live and to make recommendations if any regarding the improvement of their living conditions. The Commission has visited over 13 prisons and relevant reports are available. At the time of the various visits, before the recent Presidential Amnesty, most of the facilities, especially for male inmates were overcrowded and some aspects of the prison facilities did not comply with the United Nations Standard Minimum Rules on the Treatment of Prisoners (UN rules), with regard to provisions on personal hygiene, clothing and bedding, food, medical services, to mention but a few.
The Commission also conducted mission visits to the Internally Displaced Persons (IDPs) in Chingwizi and Tsholotsho and has produced reports recommending that in such disaster affected communities, the State should provide for special protection and assistance to the elderly, the disabled, people living with HIV/AIDS, expecting mothers, mothers with young children and other vulnerable groups in accordance with article 9(2)(c) of the Kampala Convention on IDPs. Most recently, some members of the Thematic Working Group on Special Interest Groups visited the San community in Tsholotsho and some of the key observations made were that health facilities in that severely disadvantaged community are located far away from the areas they occupy forcing the communities to resort to traditional medicine due to inaccessibility of modern health facilities.
The ZHRC also made monitoring and inspection visits to Ingutsheni Central Hospital and more recently to Ngomahuru Psychiatric Hospital in Masvingo and to Parerinyatwa Annex. With reference to the Ingutsheni visit report which has been adopted by the Commission, ZHRC observed that resource constraints being experienced by the hospital impacted very negatively on patients’ rights to food, access to water and anti-psychotic drugs severely affecting the welfare and health of such patients. The right to dignity is also compromised by inadequate clothing, bedding and other essentials. At the time of the visit to Ingutsheni Central Hospital in June 2015, there was critical shortage of psychiatrists, with the hospital having only 6 instead of 24 psychiatrists, was overcrowded as its holding capacity is 390 but the population of patients was 541. An issue of concern was the failure of the Mental Health Tribunal to meet regularly to hear applications and appeals resulting in patients being detained unnecessarily for lengthy periods of time without any alternative recourse.
Having gathered such information, such platforms as this one are important avenues for interaction of the Commission with duty bearers and healthcare service providers to facilitate an appreciation of the human rights situation within our health care delivery system. We need to strategize on ways of enhancing the right to health care which impacts and reinforces every other right as provided for in our Constitution and other human rights instruments.
We urge a speedy resolution of the impasse between the Association of Healthcare Funders and the Zimbabwe Medical Association (ZIMA) and alignment of all Acts and related pieces of legislation such as the Public Health Act, Health Services Act, Mental Health Act (1996) in promotion of the right to health care.
I thank you for your attention.