Securing rights of patients in India: Lessons from rapid surveys on the Patient’s Rights Charter and COVID-19 vaccination drive
The report presents the findings of two rapid surveys undertaken by Oxfam India in January 2021. The first survey studies the implementation of The Charter of Patient’s Rights (adopted by the National Human Rights Commission in the year 2018) while the second documents the experiences of people during the Covid-19 vaccination drive. The authors of the report are public health researchers Shriyuta Abhishek, Anjela Taneja and Nitin Jadhav from Oxfam India, and independent researcher Ankit Vyas.
The report states that various rights of patients were violated during the Covid-19 pandemic in India: they were denied essential healthcare services and forced to pay inflated hospital bills in the private sector. Citizens from marginalised communities such as Dalits, Adivasis and Muslims, experienced “new forms of violence and discrimination” in public and private hospitals.
The two surveys were carried out in 28 states and five union territories through self-administered questionnaires. The one on The Charter of Patient’s Rights – a 27-page document listing 17 rights – was undertaken between February and April 2021, receiving around 3,900 responses. On the other hand, the survey on the Covid-19 vaccination drive was undertaken from March to May 2021 and received about 11,000 responses.
This 57-page report is divided into two parts: Rapid Survey Of Experiences Of Patients Based On Patients’ Rights Charter (Part 1); and Is India’s COVID-19 vaccination drive equitable and pro-people? (Part 2).
The Charter of Patient’s Rights lists the right to information; to records and reports; to emergency medical care; to informed consent; to confidentiality, human dignity and privacy; to second opinions; to transparency in rates and – where relevant – care according to prescribed rates; to non-discrimination; safety and quality care according to set standards; to choose alternative treatment options if available; to choose the source for obtaining medicines or taking tests; to proper referral and transfer; to protection for patients involved in clinical trials, or biomedical and health research; to be discharged, or receive the body of deceased from hospital; to patient education; and to be heard and seek redressal.
As high as 35 per cent of the women respondents, contacted as part of the survey on The Charter of Patient’s Rights, stated that they have had to go through physical examination by a male practitioner without any other female present in the room. This is in contravention of the right to confidentiality, human dignity and privacy listed in the Charter.
A third of the respondents – who were hospitalised in the past ten years, or had their relatives hospitalised – stated that their doctor did not allow them to seek a second opinion. About 30 per cent of those earning Rs. 100,001–200,000 per month were denied this right, as compared with the 42 per cent of those earning less than Rs. 10,000 per month.
Roughly 33 per cent of the Muslim respondents felt that they were discriminated against in a hospital or by a healthcare professional. Similarly, 22 per cent of respondents belonging to Scheduled Tribes, 21 per cent of the respondents belonging to Scheduled Castes and 15 per cent of those belonging to Other Backward Classes felt discriminated on the basis of their caste.
The report discusses cases where healthcare workers were seen to have “anti-migration sentiments.” About 28 per cent of the respondents from Karnataka, 24 per cent from Gujarat and 21 per cent from Maharashtra felt discriminated against by healthcare professionals on the grounds of their language.
About 80 per cent of respondents reported being asked to take medical tests or avail of diagnostics services at specific centres. This points to the growing trend of ‘referral fees’ in India, which denies patients the right to access more affordable options.
The government of India launched its Covid-19 vaccination programme on January 16, 2021. About 27 per cent of Indians were fully vaccinated by November 17. The survey conducted by Oxfam India on the Covid-19 vaccination drive finds that 80 per cent of the respondents believed that it was far more difficult for a daily wage worker to get the vaccine as compared to a “salaried, middle-class person.”
As high as 61 per cent of respondents felt that the government did not provide adequate information about “how and when to get vaccinated.” About 74 per cent of those earning less than Rs. 10,000 per month reported they were inadequately informed, as opposed to the 27 per cent earning over Rs. 100,000 per month.
Over 80 per cent of the respondents believed that the government must make sure that vulnerable groups – such as beggars, migrant workers, immigrants, refugees and asylum seekers – can get the vaccination without having to provide any documentation.
The report notes that the cost of vaccines in private hospitals in India remains quite expensive – only six per cent of all the vaccination in the country has been carried out in the private sector. In a private hospital, a family with three adults will be required to pay Rs. 3,600 for a full course of the Covishield vaccine or Rs. 7,200 for Covaxin.
About 55 per cent of the respondents believed that imposing a one-time tax of one per cent on the net-worth of the richest 1,000 families in India would be helpful in funding the vaccination drive against Covid-19.
Focus and Factoids by Shafia Shaan.
PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.
Shriyuta Abhishek, Anjela Taneja, Ankit Vyas and Nitin Jadhav
Oxfam India, New Delhi