PREAMBLE
We, the participants of National Conference on Rural Health meeting in Loni, India on 5-7 December 2002 propose a "National Rural Health Policy" with an Initiative of "Healthy Villages" for the advancement of the health of the country's rural people. We wish to work in partnership with government, voluntary, non-government, bilateral and multilateral organizations, to overcome the inequalities being faced by the people living in rural areas, especially women, children, indigenous people, farmers, farm workers, migratory workers, elderly, physically and mentally challenged.
We recognize the significant contributions and progress in some pockets of the country, and organizations but express in general our profound concern and dismay at the continued neglect of the people of the country who live in rural, tribal and remote areas. We are deeply saddened that in many parts of the country the majority of rural people live in absolute poverty without the benefits of education, empowerment, health care, and local developmental programmes with dire consequences on the health of these people and/or resultant migration to the cities especially the youth.
The poor, the women, the children and other vulnerable sections of the community living in rural areas are further being marginalised as they are displaced from home and alienated from their sources of livelihood as a result of the forces unleashed by this system.
Rural people in the country have a low life expectancy, and suffer twice the morbidity and mortality rates compared to their urban counterparts. Half of all children are underweight, and most go to bed with hungry stomachs. Infectious diseases, malaria, tuberculosis, and now HIV infection, accidents, injuries devastate the lives of these poor people. The future looks bleak. Income disparity continues to widen between rural and urban people.
Agriculture is the most hazardous occupation, hence we recognize the urgent need for declaring this as an "Industry" and to announce a National level Comprehensive Occupational Health Policy for the farming community (farmers and agricultural workers).
The Medical Education needs reorientation to positively respond to the felt needs of the rural communities. More appropriate medical education methodologies such as Problem Based Learning, Community Oriented Education need to be accepted in medical colleges. Appropriate Medical Manpower planning is the need of the hour.
We recognize that 10 % of research funding is targeted to the diseases, which account for 90% of the disease burden.
The failure of the program, 'Health for All by the Year 2000', underlines the failure of our government, non-governmental organizations and international institutions to give sufficiently high priority to overcoming rural poverty and poor health.
We now present our positive vision of the way forward.
VISION
To improve "quality of life" by enabling people in rural communities to access a full range of services means ensuring the recruitment and retention of key health care providers for local communities through 'local democratic bodies'. It also means carefully taking into account the specific needs of rural people when dividing up health funding.
PRINCIPLES
We reaffirm our faith in basic human rights, including right for health, in the dignity and worth of the human person, and in the rights and obligations of individuals and the community in attaining the highest possible level of health.
We reaffirm our justifiable fundamental constitutional right to comprehensive public health care that includes clean drinking water; food security; education; sustainable lively options; access to adequate housing; efficient sewage disposal, a safe environment and appropriate & affordable medical care for all and demand these services from the state on priority.
We reaffirm that every citizen of the country has the right to a standard of living adequate for the health and well being of himself/herself and of his/her family and the right to security in the event unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his/her control.
We reaffirm our support for a global campaign to achieve "Health for All"
We are convinced that health is central to sustainable development and well being. We are also convinced that "Rural Health" helps increasing productivity, which can translate into prosperity leading to peace in the community at large.
We recognize that alleviation of poverty and equity and equality of human rights; access to all natural resources is fundamental to any endeavour to improve the lot of rural people as matter of highest priority.
We recognize that water is fundamental for life and health. The human right to water is indispensable for leading a healthy life in human dignity. It is a pre-requisite to the realization of all other human rights.
We recognize that motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same special protection.
We recognize the rapid spread of HIV/AIDs throughout the world is a cause for grave concern and it poses the greatest threat to the humanity, especially women and children who are discriminated against by individuals and the society and call for urgent attention of all government, voluntary, non-governmental organizations.
We recognize the scientific and technological advances in medicine are used to exploit and harm the rights of the woman and child and call for an urgent attention of all.
We recognize that the inequalities present in the system are unacceptable and demand the following on urgent basis to reduce such inequalities
- Political commitment is essential to reduce unfair gaps in health and health care, regardless of peoples' ability to pay, geographical location, sex, age, ethnicity and other variables.
- Concerted efforts must be made from political and policy levels to redress the disparities in health and its determinants.
- Concerted efforts should also be made to set up/update and follow the standards of good health practices, and accordingly, institute accreditation of health institutions, both public and private.
- Private health institutions should provide not only curative, but also preventive, promotive and rehabilitative health services.
- The process for a "total health sector reform" should be initiated. In order to plan for such reform, dis-aggregated data should be collected, analyzed and utilized in assessing gaps in health and health care.
- Provision of essential health care services of good quality to all, particularly the poor and vulnerable groups of populations, should form an essential component of health sector reform.
- Access to a use of essential health care services must be governed by needs rather than by individuals' purchasing power.
- There is a need to further refine the conceptual framework, methodologies, indicators and related data, as required, to measure inequality in health and health care.
- Health information systems be strengthened at the state and central level so that dis-aggregated data could be obtained to better reflect the inequality in health and health care.
- Partnership with other sectors should be further strengthened and operationalized to improve equity in health and its determinants.
We firmly believe that people have the right to health information and education in order to protect and promote their own health, and take control over the factors that determine their health.
We demand a health care system which is responsive to the needs of the people and whose control is vested in the hands of the people.
We are convinced that medical research priorities should be based on morbidity and morality profile of the country and all research programmes made entirely transparent.
We are convinced that the "Priority Research Frame Work" developed by Global Forum for Health Research should be propagated by all academic and non academic bodies of government and non-governmental organizations in the country, with appropriate modifications and call for greater importance to the research in rural health initiatives in traditional and Indian System of Medicine and to monitor progress in rural health care, gender bias and other inequalities leading to ill-health.
Need to focus on health and wellbeing of people in rural and remote areas so as to break out of the poverty-ill health-low productivity-inertia downward spiral.
We are committed to the ethical concepts of equity and social justice, and in particular to ensuring gender equity, as fundamental to the sustainable pursuit of health for all.
We the participants hereby commit ourselves and voice our concerns for the cause of equity, equality and empowerment of rural, poor and vulnerable sections of the community.
We demand for a "National Rural Health Policy" addressing the core issues of equity, equality and empowerment.
WE, THE PARTICIPANTS, hereby commit ourselves to launch a National Initiative on "Healthy Villages" Movement.