Rss

  • stumble
  • youtube
  • linkedin

Archives for : Health Ministry

#India -Do you know incentive and target based health services can be coercive ? #Vaw

My elder sister in law was the one who suggested that I should go for female sterilization, if I get lucky I may win a motor cycle in the lottery….. 

The Ration Unit and Fair Price Shops in Bundi District of Rajasthan have been given instructions by the State Health Department to meet the target of at least two sterilizations before 30th March. There is also an incentive attached. The dealer s with the maximum cases will be certified and rewarded.  Targets are distributed further to the fair price dealers because the health department workers could not meet their family planning targets, which focus heavily on sterilization….. (Source: local newspaper, Rajasthan Patrika, 22.03.2013).

In a family planning camp held in a Community Health Centre (CHC) in Raipur Block of Pali district of Rajasthan on 22.03.2013, though the district collector announced various prizes including motorcycles, Colour TVs and home appliances to be distributed to ‘lottery winners’ among couples who opted for permanent sterilization as well as targets of village health providers to motivate women for sterilization; this camp did not see much of a turnover. The service providers shared that this could be because of Holi (a festival of colours in India) and during Holi people in the villages were busy.

Women present in the camp at Raipur were going under the knife without fully understanding the risks, precautions, consequences and their rights as claimants in case of failures, as nothing was explained o them or read out to them from the consent forms on which they gave their thumb impressions.

There are national guidelines of the Ministry of Health and Family Welfare that have a detailed description of the contents of medical history, Personal characteristics and reproductive history, menstrual history, obstetrics history, contraceptive history that is to be recorded in detail before female sterilization is done, however, this has not yet been built into the MIS system of the facilities. The only records that were maintained were the social-demographic profile and the consent form of the acceptors.

Follow up instructions, discharge cards, monitory incentive to sterilization acceptors were not given to the women before they left the facility. The families of women arranged their own transport to get back homes after the camp concluded at 3:00 pm on 22.03.2013.

Family planning should be regarded as a matter of choice and rights by both the service providers and the community. But this is not at all the case of what is being recorded and reported. While the National Population Policy has seen no place for targets, rural women continue to be seen as family planning targets and family planning camps as best models to meet these targets. This approach is problematic as there is no equal precedence given to post operative care and follow-up.

The government must audit and ensure strict compliance to the quality assurance mechanisms that have been established. There is an urgent need to understand both population issues and health service delivery within in the perspective of ‘women’s rights’ and justice, by the service provide

Related posts

Draft manual for docs bans word ‘rape’, two-finger test #Vaw #sexualassault #Goodnews

Rape

In the first detailed manual for medical examination of rape victims, the Health Ministry has advised doctors not to use the word rape as it is “not a medical diagnosis but a legal definition”.

It has also asked them not to identify a victim as “habituated to sexual intercourse” as this amounts to unlawful interference in her privacy and therefore a violation of her human rights. “Rape is not a medical diagnosis, it is legal definition. Hence word “rape” should not be used while forwarding opinion… Even he/she should not depose on the same issue. Do not identify victim as “habituated to sexual intercourse” on the basis of findings of finger test as (it) is unlawful interference with her privacy and unlawful attacks on her honour and reputation and is violation of her human rights,” says the manual.

It will also mentions that in the prosecution proceedings for sexual assaults, prior sexual experience is irrelevant as the issue at hand is consent or lack of it. The manual also forbids the use of the two-finger test on the same ground.

This is the first time the Department of Health Research has attempted to draw up a comprehensive manual for examination of victims of sexual crimes in consultation with experts and framed guidelines on what the conclusions should be for a given set of observations.

It has now invited public comments on the draft.

 

Related posts

PRESS RELEASE- Demand for compulsory licensing for Trastuzumab, a life-saving drug for women with HER2+ breast cancer #womensday

CAMPAIGN FOR AFFORDABLE TRASTUZUMAB

8 March 2013

 

The Campaign for Affordable Trastuzumab has called on the Commerce Minister to mark International Women’s Day 2013 with an announcement of compulsory licensing for Trastuzumab, a life-saving drug for women with HER2+ breast cancer. Trastuzumab, the patent for which is held by Swiss pharma giant Roche, is currently priced at Rs.6-8 lakhs for a full course of 12 injections, and is out of reach for all but the most privileged. An estimated 25,000 new cases of HER2+ breast cancer are recorded in India every year, with younger women in the majority among patients.

Trastuzumab has been recommended for compulsory licensing by an Expert Committee set up by the Health Ministry. The recommendation is currently under the consideration of the Department of Industrial Policy and Promotion in the Ministry of Commerce.

The Campaign has urged the Minister to issue a notification under Sections 92 and 100 of the Indian Patents Act, which will end Roche’s monopoly and open the door for local manufacturers to enter the market with affordable biosimilar versions that can compete with Roche’s product.

The letter cites evidence to show that Roche’s pricing policy is irrational and unethical, reflecting its strategy of pushing the pricing envelope to the maximum extent possible.

The Campaign has also cited compelling evidence to show that measures such as negotiated price reductions and voluntary licensing floated by the Ministry of Chemicals and Fertilisers are weak in comparison to the option of compulsory licensing, which can bring prices down four times more than price negotiations. Moreover, while negotiated prices will apply only in India, Indian generics/biosimilars have the potential of increasing access across the developing world.

The letter expresses concern at the Government of India’s apparent reluctance to use the compulsory licensing option to ensure access, even though this measure is available under the Indian Patents At which was amended in 2005 to make it TRIPS-compliant. The first compulsory licence awarded in India – for production of a generic competitor to the liver cancer drug Sorafenib – has been recently upheld by the Intellectual Property Appellate Board.

The Campaign is endorsed by more than 150 Indian and global groups of cancer survivors, health rights activists, women’s groups, treatment activists and public interest organisations.

The full text of the letter is given below.

 

To the Hon’ble Minister for Commerce, Government of India

 

Compulsory licensing for breast cancer drug Trastuzumab

Respected Minister,

Greetings from the Campaign for Affordable Trastuzumab on International Women’s Day.

We are writing to you to enquire about actions taken by your Ministry on the recommendation from the Expert Committee set up by the Ministry of Health to explore the possibility of issuing compulsory licences (CLs) for encouraging the entry of low-cost generic/biosimilar versions of cancer drugs in cases where patents and predatory pricing policies of multinational pharma companies continue to block access to these medicines for the vast majority of patients in India.

Breast cancer drug Trastuzumab on short list for compulsory licensing

Trastuzumab, a patented drug that can save the lives of women suffering from HER2+ breast cancer, has been recommended for compulsory licensing by the Expert Committee set up by the Health Ministry. The patent for the drug is held by Roche and is valid for another seven years. This patent, weak though it is, is discouraging local manufacturers from investing in the development of biosimilars of Trastuzumab that can provide affordable alternatives to Roche’s product.

The recommendation for compulsory licensing of Trastuzumab was welcomed by us as a huge relief to the thousands of women with HER2+ breast cancer whose lives can be saved by Trastuzumab, but who are unable to access this drug because of predatory pricing by Roche.

We surely do not need to remind you that breast cancer is now the second most common form of cancer in the country, and that young women constitute the majority of those affected by the aggressive HER2+ variant of the disease. An estimated 25,000 new cases of HER2+ breast cancer are reported each year.

Trastuzumab, often called a miracle drug for its efficacy in preventing recurrence and extending life in cases HER2+ breast cancer, is currently priced at between Rs.55,000/- and Rs 75,000/- per 440 mg dose, and is therefore out of reach for all but the wealthiest. An oncologist at the Tata Memorial Cancer Centre has been quoted as saying that less than 10% of the patients he sees are able to afford Trastuzumab at all, and even fewer are able to complete the recommended course of 12 injections. This is borne out by the testimonies of other survivors and their families1.

The recommendations of the Expert Committee were under consideration by the Department of Industrial Policy & Promotion (DIPP) under your Ministry. Since then, we – and thousands of women who are battling HER2+ breast cancer – have been waiting for a notification from DIPP that will open the door for domestic manufacturers to invest in the development, testing and marketing of biosimilars of Trastuzumab.

We are mystified by the delay in the issuance of a notification under Section 92 of the Patents Act to initiate the process of compulsory licensing for Trastuzumab. The case for compulsory licensing presented by us in our letter to the Prime Minister in November 2012 (see attachment) have been endorsed by over 150 organisations and citizens including cancer survivors, women’s groups, human rights organisations, health NGOs and treatment activists from around the world and eminent jurists. Our argument has now been validated by the recommendations of the Expert Committee of the Ministry of Health.

Discount schemes are no match for generic competition

There is plenty of evidence to show that Roche’s pricing and marketing policy is completely arbitrary and unethical. The so-called “voluntary price reductions” announced by Roche – from Rs.1.2 lakhs to Rs.92,000/- and then to Rs.75,000/- – each time the issue of over-pricing is raised, are merely pre-emptive measures to ward off competition and retain their control of the market. Roche is also using market segmentation to protect its monopoly. Trastuzumab is being sold under two different brand names – Herceptin (Roche) at Rs.1.2 lakhs for 440 mg, and Herclon (Emcure) for Rs.75,000/-.

There is also evidence of a nexus between Roche and doctors in private hospitals – patients are being pressurised to buy the drug from the hospital pharmacy at the official price of Rs.75,000/- per dose, rather than from retailers and agents who offer the drug at prices as much as 25% lower than the MRP.

The Indian Railways has been procuring Trastuzumab for the last three year at Rs.86,957/- per dose2. This is also the amount reimbursed under the CGHS3.

These figures leave little doubt that Roche’s pricing policy is determined primarily by their assessment of how much they can push the price envelope rather than by the idea of an ethical profit margin.

Perhaps the Honourable Minister for Chemicals & Fertilisers was not aware of these details when he stated in the Lok Sabha that Roche would be bringing the price of Trastuzumab down to Rs.75,000/- per dose4 under an upcoming deal with Emcure for local manufacture. Considering that the present MRP of the drug is Rs.75,000/-, and it is already being offered by retailers for 55,000/- per dose, we fail to see anything to cheer about in the Roche-Emcure deal. In fact, there are reports that Roche has imposed anti-competitive terms such as a ceiling on volume of sales and a mandatory minimum price.

Negotiated prices do not expand access

Respected Minister, you are no doubt aware that the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers has recently released a report by a committee set up to examine the issue of price negotiations for patented drugs. We are concerned about the fact that this report being released at a time when a compulsory licence for Trastuzumab is under active consideration by both the Health Ministry and your Ministry.

While Roche’s actions in blocking any attempts at competition are understandable even if not justifiable, we are shocked that a government entity should seriously propose to negotiate with pharma majors without any reference to other concerned Ministries, and in complete disregard of global experience, which confirms that measures such as negotiated price reductions do not result in any significant expansion of access, since prices continue to remain beyond the reach of most citizens. Generic competition on the other hand can bring prices down to four times lower than negotiated prices 5.

Apart from yielding only limited benefits, time-consuming price negotiations with pharma companies can delay action on more rational options such as compulsory licensing, thereby putting thousands of lives at risk. The Government of Thailand, which began issuing compulsory licences in 2007, noted that “Prior negotiation with the patent holders is not an effective measure and only delays the improvement in access to patented essential medicines and puts more lives in less healthy or even dangerous situations.”

What is more, negotiated price reductions will be applicable only in India – a biosimilar of Trastuzumab from Indian manufacturers on the other hand have the potential for a global impact and can expand access to this life-saving drug across the developing world. India’s scientific and technical capacity in this sector is well recognised. The announcement of a compulsory licence for Trastuzumab will encourage local pharma firms to step up their investments in ongoing research projects for biosimilar development, and will facilitate the speedy entry of biosimilars into the market.

We have been greatly encouraged by the recent decisions of the Intellectual Property Appellate Board (IPAB) in revoking the patent for the Hepatitis-C drug pegylated interferon Alpha 2A, and now in upholding the compulsory licence for a generic competitor to Sorafenib. These decisions have been applauded and welcomed by health rights groups and public interest groups around the world, for whom they are an assurance of India’s political will to resist arm-twisting by pharma companies.

When India amended its patent laws in 2005 to make them TRIPS-compliant, there was widespread concern about the possible adverse impacts of this move on access to treatment. The then Union Minister of Commerce & Industry, Shri Kamal Nath had said at the time that “the government has built in enough safeguards in the Patents (Third Amendment) Act 2005 passed by Parliament to protect the interests of consumers by ensuring availability of medicines at affordable prices6. We are disappointed that eight years later, despite sharp increases in the number and prices of patented drugs, the Government of India is so reluctant to use the provision of compulsory licensing under Sections 92 and 100 of the Patent Act to expand generic competition, bring down prices and expand access.

We urge you to mark Women’s Day 2013 with the announcement of a compulsory licence for Trastuzumab – a progressive and principled step that will bring relief to thousands of Indian women and their families who are struggling to deal with HER2+ breast cancer and its economic, social and personal costs.

Thousands of lives are at stake – we look forward to your immediate and decisive action.

 

KALYANI MENON-SEN (on behalf of the Campaign for Affordable Trastuzumab)

1See for instance an interview with the husband of a cancer survivor who describes his experiences in accessing Trastuzumab. <http://newsclick.in/india/recounting-personal-experiences-accessing-herceptin>

5See attached press note for details.

6 ‘ENOUGH SAFEGUARDS IN PATENTS ACT TO PREVENT PRICE RISE’, Press Release, Ministry of Commerce,  04 April 2005, http://commerce.nic.in/pressrelease/pressrelease_detail.asp?id=1610

 

Related posts

SIERRA LEONE: Shifting tide on abortion law

 IRIN NEWS Africa English reports

 

http://www.irinnews.org/report.aspx?reportid=96907

 

FREETOWN, 27 November 2012 (IRIN) – The new government is responding positively to health workers and youth groups who have long called for a change in the 1861 law banning abortion except in exceptional circumstances.

A draft law which would make abortion legal under certain conditions, is currently waiting to be passed by parliament following the 17 November elections, according to Sas Kargbo, director of Reproductive Health at the Health Ministry.

“The present laws are outdated and violate the rights of the women of Sierra Leone,” said Al Saccoh, coordinator of a youth network called the National Youth Coalition of Sierra Leone, adding that the current law contradicts international covenants on human rights that Sierra Leone has signed since 1861.

Campaigners say the unavailability of cheap and safe abortions is leading to severe health risks for women and girls and pushing up the maternal mortality rate.

Brima Kamara, advocacy manager at the Planned Parenthood Association of Sierra Leone, told IRIN: “Because there is no legal framework that gives women the right to choice governing abortion, the present law is killing women.”

Sierra Leone has one of the world’s highest maternal mortality rates: 890 women die for every 100,000 live births.

It is not clear how many women seek abortions in Sierra Leone each year as so many of them do so clandestinely, but reproductive rights NGO Marie Stopes International estimates at least 40,000 women and girls in Sierra Leone had abortions in 2011.

According to the UN Population Fund (UNFPA), some 250,000 children across the globe lose their mothers to abortion-related deaths.

Quacks
The problem is most women seeking an abortion will turn to uncertified doctors or quacks who perform cheap abortions, as few can afford the SL 200,000 (US$46) fee that a certified doctor would charge.

Methods used by quacks include giving women detergent to swallow, administering high doses of aspirin or antibiotics, or using native roots and herbs, according to Williamson Taylor, a gynaecologist at the Princess Christian maternity hospital in the capital, Freetown.

Taylor said he often tends to patients who have undergone botched abortions. Most of them arrive in a state of severe pain, or have heavy bleeding, or may have infections linked to perforations of the uterus, intestines or abdominal cavity.

“I have performed many surgical operations due to abortion complications in young girls,” he told IRIN. “Cassava sticks and other objects that they use to abort a pregnancy are a very crude method and usually perforate the womb or the intestines.”

Betty Ranney, a gynaecologist at the Medecins Sans Frontieres-run Emergency Unit Hospital in Bo, in south-central Sierra Leone, told IRIN: “In the most severe cases the womb has to be removed altogether, to save the young girls’ lives.”

Some 4-10 percent of women who have a medical abortion will need to have a surgical procedure following it, to remove the remaining tissue, said Sarah Koroma, delivery manager at the Planned Parenthood Association clinic at West Street in Freetown. Uncertified doctors lack the training or equipment to do this.

But it is hard to find certified doctors who are willing to perform the procedure – many fear legal redress. “The present law does not favour us as qualified doctors. As such, there is constant fear. I perform abortion for humanitarian purposes where the life of the girl or woman is at dire risk. It’s important that the present law is reformed to create accessibility to abortion services as a right, without fear,” Taylor told IRIN.

Most cases require consent from the partner of the woman, or in the case of a minor, her parents, which puts off many would-be patients.

Reproductive health agencies will also perform abortions if the pregnancy is seen to put the life of the patient at risk. A nurse at one practice told IRIN: “It’s not yet legal, so we do it within the parameters of the present law.”

Pressure mounting
But pressure among many sections of society is mounting for a change in the law. Many doctors who have experienced first-hand the implications of unsafe abortions support a new law. “We have to give people choice. Sex is an unavoidable thing so we must make it safe for people who want to have an abortion in a country like Sierra Leone,” said Taylor.

Ex-Minister of Health and Sanitation Zainab Hawa Bangura would not be pinned down, but told IRIN: “Improvements in laws and policies, and a more responsive approach to the reproductive health needs of women is needed in Sierra Leone.”

In a recent county-wide Ministry of Health-led survey of health workers and legal professionals on attitudes to abortion, most respondents favoured a review of the law, calling for the government to liberalize abortion as part of its commitment to reduce maternal mortality rates.

However, many religious leaders are not in favour, and see imminent change as destroying the moral fabric of Sierra Leonean society. A group of Islamic clerics recently came forward to announce they would accept abortion if it took place within the first four months of pregnancy and if the mother’s life was in danger.

Family planning
Legalizing abortion, however, is just one step in a much more complicated puzzle, say campaigners and health workers.

Access to family planning services remains very poor for youths, especially girls and women.

Sierra Leone has high teenage pregnancy rates due to poor education standards for girls; initiation rites into secret societies which make even young girls eligible for marriage; high levels of sexual violence; low access to contraception; and low awareness of family planning methods, according to reproductive rights agencies.

A number of agencies (including UNFPA, Marie Stopes, Planned Parenthood, and the UK Department for International Development) are trying to boost access to quality family planning services for Sierra Leoneans of all ages, across the country. UNFPA launched a family planning campaign in July 2012.

But while attitudes towards family planning are shifting, particularly among urban women, say health workers, they will not change their behaviour unless access to services becomes much more readily available. Too often health clinics remain under-stocked, particularly in rural areas.

“The use of contraceptives must be pushed aggressively in Sierra Leone to help reduce the huge number of young girls seeking abortions in secret,” concluded Taylor.

 

Related posts

Attn Delhi-Protest-The Draconian Mental Health Care Bill- Oct 10th #Mentalhealthday

 

Disability Rights Group (DRG)

&

National Alliance for Access to Justice for People Living with Mental Illness (NAAJMI)

 

Protest

 

The Draconian Mental Health Care Bill

 

Time: Wednesday, 10th October, World Mental Health Day

 

Time:  11 A.M.

 

Venue: In front of Ministry of Health and Family Welfare office,

at Nirman Bhavan, C Wing, New Delhi

 

 

India is home t0 30-40 million people living with psychosocial disabilities or what we refer to as disability caused due to a ‘mental illness’.

 

The archaic Mental Health Act of 1987, an offshoot of the colonial Lunacy Acts, makes people with ‘unsound’ mind non-human! They are not considered to have opinions, wishes or feelings; and cannot act upon their own will, as per laws.

 

The Disability Act of 1995 defines ‘mental illness’ as a disability. India has also ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) that talks about India’s obligation to respect, protect and fulfill the human rights ofALL persons with disabilities.

 

However, the Ministry of Health & Family Welfare seems to be ‘unaware’ of this. Nothing explains why then it has come out with a Mental Health Care (MHC) Bill, while completely failing to include mental health & well being to the Right to Health Act!

 

The draft of the Rights of Persons with Disabilities Bill 2012 recently unveiled by the Ministry of Social Justice & Empowerment (MSJE) guarantees the ‘legal capacity’ and the ‘right to choice’ of all persons with disabilities, including those with psychosocial disabilities. The Ministry of Health has gone drastically against CRPD and the draft Rights of Persons with Disabilities Bill and has advocated for involuntary incarceration and continuing with electric shock treatments and even lobotomies!

 

  • The rights of people with psychosocial disabilities must be governed by the Ministry of Social Justice & Empowerment. Why is the Health Ministry then overstepping its turf? What is the Health Ministry’s motivation?
  • While the draft Rights of Persons with Disabilities Bill of MSJE talks about ‘full legal capacity’, MHC Bill talks about ‘involuntary incarceration’? What is the Government of India’s stand on the issue if two of its Ministries are talking diametrically opposite on this?
  • Involuntary incarceration, over drugging, mental asylums, electric shock treatment and the rampant abuse & exploitation that goes on in the name of psychiatry and mental health goes against the letter of CRPD that India has ratified. What is India’s answer to the international community?

 

WE DEMAND AN IMMEDIATE STOP TO THE PROCESS OF BRINGING A DRACONIAN MENTAL HEALTH CARE BILL

 

Related posts