The Gauhati High Court has just issued sweeping orders to the State of Assam to improve health services on tea estates. Recognizing the serious human rights violations on estates, the High Court held, “The reliefs sought are absolutely necessary to meet the health needs of the workers of the tea gardens…The State authorities are directed to comply the scheme as prayed in the writ petition within six months.”
Tezpur District Hospital
At 390 deaths for every 100,000 live births, Assam’s maternal mortality ratio is the highest in India. Maternal mortality represents a grave violation of women’s rights to life, health, dignity, and equality. As a part of a wider litigation strategy on maternal mortality, HRLN teamed with PAJHRA (Promotion and Advancement of Justice, Harmony and Rights for Adivasi rights) to hold the State accountable for violations and to demand changes in Assam’s tea estates.
An initial HRLN-PAJHRA fact-finding mission surveyed 6 Tea-Estate Hospitals, 1 village and 2 Primary Health Centers and uncovered the following fundamental rights violations:
- For every facility visited a single doctor treated between 25-300 patients per day.
- Of the 9 facilities visited, 3 hospitals did not have a doctor.
- Of the 9 facilities visited, 3 hospitals had no electricity. One facility conducted deliveries by candlelight.
- The only blood bank in the district is housed at Tezpur District Hospital, located 32 kms from Rangapara PHC.
- The team also observed that ambulances available at Tea Gardens Hospitals are rarely used and the management is reluctant to allow the use of the vehicle for all patients.
- From January to June 2011 three women died for pregnancy-related causes in Kalabeel and four cases of maternal and infant death occurred in Amlonga in 2010.
Based on these rampant failures to implement the National Health Mission guarantees, to ensure women’s Constitutionally guaranteed rights, and to uphold international legal protections, PAJHRA filed a Public Interest Litigation in the Gauhati High Court in 2012 (PIL 21/2012).
Throughout the legal process HRLN and PAJHRA continued to visit the tea estates to document maternal deaths and inadequate health services. After a trip to the Supreme Court in 2012, the case returned to the Gauhati High Court in 2015. In May 2015, the Hon’ble Chief Justice (Acting) Mr. K. Sreedhar Rao and Hon’ble Mr Justice P.K. Saikia directed state authorities to make broad changes in tea estates to improve staffing, guarantee emergency obstetric care, ensure safe abortions, and install blood storage facilities. A copy of the order is below:
- “For an order directing respondents to immediately implement the NRHM in the TEs bound by the MoU according to NRHM norms. Specifically , to ensure adequate facilities are set up in order to deliver NRHM service guarantees, including but not limited to emergency obstetrical care, access to safe abortion services, timely and adequate referral system and access to a functioning blood bank.
- For and order mandating development and implementation of a time-bound Plan of Action for implementation of NRHM services as established under the MoUs.
- For an order directing Respondent to immediately ensure the appointment of sufficient number of doctors, health professionals and support staff that are available 24 hours and 7 days at Tea Gardens’ Hospitals as well as at each level- PHC, CHC, SHC, and DH- of health institutions in Sonitpur district.
- For an order directing the establishment of a better transport system linking Tea Gardens with Government Hospitals and PHCs with sub-centers. Transportation must be free and not dependent on employment status. Ambulances must be available outside the hospitals and ambulance must not be subjected to the decision of the doctor but promptly guaranteed without delay.
- For an order directing an audit and quality control review of all health facilities be done in Sonitpur district by third party Commission including representative from civil society appointed by the Court. Further to make publicly available the findings of the Audit and the action taken on these findings.
- For an order directing the establishment of an efficient and transparent mechanism to review and monitor the implementation and delivery of NRHM services, in particular the expenditure of Government funds received by TEs management under the MoU. Monitor mechanisms must avail of, inter alia, conditions of health infrastructure, quality of care provided, organisation of awareness raising camps, use of ambulance service.
- For an order directing the Respondents to collect disaggregated health and nutritional data on TE workers and their families.
- For an order directing respondents to introduce NRHM in all Tea Estates of Assam through mandatory MoUs between Tea Estates and the State Government.”
For additional information on this case, please contact Debasmita Ghosh- firstname.lastname@example.org, Alin Mahanta email@example.com Pritisha Borah firstname.lastname@example.org; Sanjai Sharma Sanjai.Sharma@hrln.org
For additional information on Maternal Schemes visit http://nrhm.gov.in/nhm.html