The article 21 of the Constitution of India guarantees protection of life and personal liberty by providing that no person shall be deprived of his/her life or personal liberty except according to the procedure established by law. The liberal interpretation of this provision at different occasions by the judiciary logically concludes that health is also a human right. Even the World Health Organization’s Constitution states “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without discretion of race, religion, political belief, economic or social condition”. Though ‘Health as Human Right’ is not directly mentioned it is an extension of right to life. It would be impossible to exercise the other fundamental rights without guarantee of health and well being.
Health and medicines are inseparable. The modern healthcare is not possible without the use of modern medicines. The medicines are not only essential components for curative care but are equally essential for preventive care and health promotion as well. Accordingly the access to medicines is also viewed as human right, an extension of health as human right. The handling of modern medicines requires specialized care as they are double edged weapons. The appropriate use of medicines benefits the humanity but the inappropriate use of medicines not only causes harm to the patients but often leads to serious economic loss and dangerous drug resistance. The inappropriate handling of such medicines may be disastrous as this may result in medicines expiring well before the expiry date, wrong medicines reaching the patients or the system, harming the patients. Handling of medicines at different levels after manufacturing is managed by the pharmacists and this service is termed as pharmaceutical service. The pharmaceutical services in India are regulated by two main Acts: Pharmacy Act, and Drugs and Cosmetics Act.
The present article narrates the two incidents of Human Rights Commission’s intervention on pharmaceutical services. The National Human Rights Commission (NHRC) and the State Human Rights Commissions (SHRC) are constituted under Human Right Protection Act 1993 at National and State levels. They are autonomous institutions and commissions have the unique provisions of monitoring the execution of their recommendations.
Recently the Kerala State Human Rights Commission has questioned the State government and State Pharmacy Council for not implementing its earlier order (2013) on the implementation of Pharmacy Act. The Section 42 of the Pharmacy Act is dealt with dispensing by unregistered person. This specifies that no person other than the registered pharmacist is permitted to compound, prepare, mix or dispense any medicine on the prescription of registered medical practitioner. Contravention of this provision is punishable with imprisonment for a term which may extend to six months, or with a fine not exceeding one thousand rupees, or both. However, the medical practitioners are permitted to dispense to their own patients or with permission of State government to the patients of other practitioners. Modern drugs require trained persons to handle them. Any lapse on this could adversely affect the patient safety. There are reports of dispensing by unqualified persons both in government hospitals and private pharmacies. The State government is empowered to ensure the presence of pharmacist in the private pharmacies through inspection under Drugs and Cosmetics Act. This is the part of licensing requirement. On the other hand, government hospitals do not require licence to dispense medicines but the dispensing must be done by registered pharmacists. The state pharmacy council is also empowered to have pharmacy inspectors (with approval of the State government) to ensure dispensing by the registered pharmacists only. Hence, the direction of State Human Rights Commission to both the State government and state pharmacy council! showing displeasure on the serious lapse on the part of both the government and state pharmacy council, the State Human Right Commission now issued the second order that strong actions be taken to implement the Section 42. This means creation of ample job opportunities for the qualified and registered pharmacists in Kerala. It is understood that State government has already initiated steps in this regard. Earlier the Pharmacy Council of India too written to Central government seeking its support and urging the Ministry to impress the State governments implementing Section 42 of the Pharmacy Act in the interest of public health.
The second incident is little old and relate to the National Human Rights Commission’s recommendation for setting up of modern hospital pharmacy in government hospitals under an officer having a minimum qualification of post graduate in Pharmacy and creation of a post of joint Drugs Controller of India (Pharmaceutical Services). Following the complaints of Indus Hospital of Shimla on fungus contamination of Large Volume Parenterals, manufactured by Ahmedabad based pharmaceutical company; the Himachal Pradesh State Human Rights Commission brought the issue to the notice of National Human Rights Commission (NHRC). The issue of fungus contamination was also reported in capital’s leading government hospital. After hearing all stakeholders and realising the necessity of in depth examination of the whole issue, NHRC appointed an expert committee consisting of two renowned pharmaceutical experts: Dr. Nityanand and Prafull D Sheth. The committee’s report submitted in 1999 was accepted by the NHRC without any modification and is known as ‘Large Volume Parenterals: Towards Zero Defect’. In addition to other recommendations, the expert committee opined for setting up of modern hospital pharmacy, in large hospitals, to be headed by at least a post graduate and at a seniority level of assistant professor (perhaps now associate professor) reporting directly to the medical superintendent. It had also recommended for developing policies and procedures for appropriately managing medicines from procurement to dispensing; and setting up of computerized Drug Information Services. Again this all means improved pharmaceutical services benefiting people and creating job opportunities for pharmacists. Though NHRC observed that the delay in implementation of these recommendations is likely to put health and life of innocent citizens of India to grave risk, unfortunately not any progress made!
The Human Rights Commissions’ recommendations are often taken back seat in Governments’ agenda due to several factors including economic constraints. The persuasion of these recommendations at various levels would help improving pharmaceutical services benefiting both the pharmacy profession and the patients.
(The authors are with Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu – 608 002)