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'Draconian' Kerala health law follows WHO diktat: Govt readies to take harsh measures

By Dr Maya Valecha* 
The Governor of Kerala has signed the Kerala Public Health Bill, which essentially reverses the people’s campaign in healthcare services in Kerala for decentralisation. The campaign had led to relinquishing of state powers in 1996, resulting in improvement of health parameters in Kerala. Instead, now, enforcement of law through the exercise of power, fines, etc., and the implementation of protocol during the pandemic, are considered of prime importance.
This is being done to implement World Health Organisation (WHO) directives more stringently. The WHO treaty is to come into effect by May 2024, providing legal binding for all countries to amend their laws accordingly.
The Kerala government appears to be ready to be the first in implementing harsh measures. The new law suggests it wants to be prepared with the law to implement the WHO diktat.
Words carry meaning and show the intention. The first thing done under the Act is public health officers are renamed under this Act as Public Health Authorities. And these Public Health Authorities will have all-compassing powers to get work done as directed by Government departments, including police. Any refusal or non-cooperation will be considered breach of conduct and indiscipline.
Even the elected bodies are to provide all support to the Public Health Authorities.  The elected bodies will not be approached while deciding actions, not mention taking feedback from them or  people in general.
The State Health Authority and the District Health Authority will advise the State government/ district magistrate to declare emergency. While giving definitions in the Act, the WHO definition is followed: Sudden and rapid increase in number of diseases is mentioned, and not its severity or hospitalisation burden, as we saw during Covid-19, when even asymptomatic people with a non-diagnostic test were forcefully quarantined.
The district collector in the event of an outbreak, with or without the application of Public Health Authority, can prohibit assembly of persons, offering the numbers to be gathered at a place, public or private -- as we had seen in some western countries where only  specified number of friends or relatives were allowed to come to one's place. These are all irrational, unscientific measures just to establish control over people. Also in India, different number of people were allowed to assemble for different purposes, as if the virus knew how to attack when assembly is for marriage or for last rites.
The law says, “The State Public Health Authority shall publish Standard Medical Treatment Protocols that are to be followed by public and private healthcare providers and healthcare establishments in respect of the National Health Programmes and the diseases notified under this Act.”
Protocols are to be followed not only by patients who are diagnosed but even patients with symptoms of a disease.  “Where the State Public Health Authority has notified an epidemic disease and prescribed the mode of management to be followed exclusively in the management of the disease, including collection of specimens, diagnostic and therapeutic procedures, such mode of management and procedures shall be followed by all the medical practitioners and healthcare establishments, who treat the patients with the symptoms of such disease."
Though after the protests by Ayush doctors, they have been included in some advisory committees, most Ayush doctors fear that their presence will be ornamental. Kerala is the hub of other medical knowledge systems and it is a major reason for better health of people in Kerala. Excluding them during a health emergency is not advisable. Also, what about individual freedom to choose the type of medical treatments that are legal? 
Medical ethics violation by doctors of all systems has no mention in the Act. Where is the judgement of the doctor who is handling these cases if the strict protocol is to be followed? As with all other provisions, the non-compliance will be dealt with fines.
Houses or buildings can be vacated to carry out activities as are necessary for that area to prevent spread of infection. Occupants have to leave the house in 12 hours. Where will they go? What about their health after displacement? Didn't we see the images of China showing such government activities, evacuating residents from their apartments? Is this public health management or active mismanagement?
Any person or medical establishment who notices or knows of any incident/death or outbreak of any notifiable or communicable disease, have to report it to the Public Health Authority, and failure to report is punishable with fine up to Rs 5,000! So, citizens are made vigilantes.
The private and public health establishments will have to provide data in the format prescribed by the Authority. There is no mention of data safety in the Bill.
Rationality is sought to be given for forceful isolation of infected persons, though  our experience during Covid-19 shows the incidences of 3 years old children, who should not have been tested in the first place, were even isolated for full month, just because the child was exposed to the asymptomatic positive father and tested positive herself. Imagine the life time trauma the child would face!
Once open discussions and involvement in decision making is discontinued, authoritarian, irrational, scientifically unproven measures start. Even the asymptomatic adults were quarantined, and some of them committed suicide.
Recent reports about tribal deaths due to malnutrition and lack of medical care facilities point fingers to things to improve in Kerala
In the words of AK Shiburaj, “The provisions of this bill have been prepared without considering the socio-economic and political conditions that render due importance to the social determinants of health The new bill provisions are limited to a regulatory approach without exploring possibilities like service approach and health education. Instead, enforcement of the law through the exercise of powers, fines, etc., and the implementation of protocol during the pandemic are of prime emphasis in various ways throughout the Bill.”
An important worrying aspect is that, no prosecution shall be instituted against the authorities without  previous sanction of the Government in case of malicious abuse of power under the Act. The high-ranking officers are likely to go scot-free under these circumstances. This even after the reports of tribal kids’ deaths in 2020 from malnutrition.
In fact,  recent reports about tribal deaths due to malnutrition and lack of medical care facilities point fingers to the things to be improved in Kerala’s health system. There is no mention of nutrition monitoring and management in any section of the Bill -- it's not there in maternal, nor in neonatal, nor  in the adolescent health section, nor in preventive or promotive guidelines.
This is particularly objectionable for Kerala, where in 1996, recognizing the eroding trust in the public system, Kerala underwent a major overhaul when the State government implemented the People's Campaign for Decentralized Planning movement. Through this reform, the State government decentralized and relinquished a significant amount of power.
Communities were brought together to determine which health topics were important and needed attention, with selected topics ranging from strengthening Primary Healthcare Centre (PHC) facilities to improving water and sanitation safety.
The results were for all to see.  Even with comparatively low per capita income, Kerala improved its health parameters better than the national average. Now, under the effects of market forces, budget cuts because of decreased funding from the Centre, and blind faith in “science” that comes from the west or the WHO, all the gains of public health will be reversed, and a medical tyranny is to set in.
Not only the people of Kerala but the people all over India should protest against the Bill with its potential for human rights violation in the name of public health, violating the basic principles of public health. The Central government is consenting for WHO Pandemic Preparedness Treaty without informing the public to enforce WHO directives.  To introduce such Bills in the States, one after the other, appears to be a Central strategy.
---
*Senior physician based in Gujarat 

Comments

Ruben said…
An eye openeing report to the people who forget the fundamental rights.
Looks like the law will effectively prevent people from taking recourse to other systems of medicine such as Ayurvedam and Homeopathy that are promoted by the government of India. A very retrograde step considering that other counties like China are promoting their traditional systems.

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