User fee removal in the health sector in low-income countries: lessons from recent national initiatives

Edited by Bruno Meessen, Lucy Gilson and Abdelmajid Tibouti

Health Policy and Planning – Volume 26, Supplement 2 – November 2011

This supplement, sponsored by Unicef, focuses on the challenges related to the design and implementation of user fee removal policies in low-income countries.

“User fees have triggered impassioned discussions in international health over the last two decades. Promoted by a number of international organizations since the late 1980s as a strategy to finance struggling public health facilities in many low-income countries, recent years have seen growing criticism of the impact of fees on access to health services, particularly for the poorest groups…..

In mid-2008, UNICEF approached a group of researchers with the request to document recent experience with user fee removal. While aid actors in the North were still arguing fiercely about the pros and cons of user fees, a growing number of countries had already decided to remove user fees, at least for some priority services…. A consensus was easily reached between UNICEF and the research team led by the Institute of Tropical Medicine, Antwerp: the multi-country review would not (again) focus on evidence against or in favour of user fees, but would instead try to document how countries formulated and implemented user fee removal.

This focus was seen as valuable because it could generate practical lessons for other countries interested in such a step…. the research team judged that the main question of the multi-country review—the challenges related to design and implementation of user fee removal policies—deserved more visibility than just another report….

Our objectives for this supplement were multiple. From the start we decided we would welcome contributions from different regions and fields of expertise, as the supplement had to be useful for researchers, but also for programme officers and policy makers directly involved in health care financing policies in low-income countries. We acknowledged that contributors would adopt different types of methodological approaches to address different questions. We were also keen to get contributions from the different ‘corners’ of the user fee debate. Experts familiar with the controversy can see for themselves that this objective has been achieved; a glance at the list of contributors to this supplement suffices….”

Available on Online

Maharashtra Govt issues important GR related to mis-use of Ration card

The Govt of Mah. has issued a GR on 16th Jan 2012 stating ration cards can no longer be used during this election as identity card nor ration card will be used as resident proof any longer(in ration card this has already being mentioned).Ration card to be used only to get ration from ration shop(FPS).

Justice Wadhwa which has already recommended in its report to Mah.State on functions of Public distribution system(PDS) that ‘ration card’ should not be used for any other purpose except for drawing ration commodities. It should be de-linked from all other schemes connected with BPL identification done for this purpose. It should not be used be used as proof of residence or as an identity proof for any other purpose. This should be strictly implemented.

The Wadhwa Committee was informed about the large number of Bogus cards. In Jalna some drive for weeding out bogus card was done. In Aurangabad 70% of BPL cards were stated to be bogus and in Parbhani Activists informed that they found1638 bogus cards. Bogus/ ghost card is a big menace in the PDS which needs to be tackled effectively to ensure food security for the needy and to stop large scale diversion in PDS. The Committee during the visit to the State observed that number of bogus / ghost cards in the State are in abundance. The Committee is of the view that an Amnesty Scheme may be adopted for giving sufficient time to the public for surrendering the unauthorized ration cards on their own clarifying that any disclosure / surrender during the Amnesty Scheme period will not entail any punishment / penalty. However, if any bogus / unauthorized ration card is found in the possession of anybody after the Amnesty period, strict action as per Essential Commodities Act will be taken not only against the unauthorized ration card holders but also against the concerned officers of the Department found involved. Steps should also be taken to scrutinize ration cards issued to all the government officials and ensure that none possess Saffron APL. Strict penalty must be imposed on such officials who do not surrender their Saffron APL.

The Jus.Wadhwa Committee has found that one of the reasons affecting the viability of FPS is the unequal distribution of the ration cards. The exercise of rationalization of ration cards attached to each FPS should be undertaken at the earliest to bring about uniformity in the distribution of ration cards to respective Fair price shops (FPSs).

Distribution of foodgrain to the beneficiaries was found to be in a dismal condition, particularly in the Marathwada region. Most beneficiaries did not possess rations cards. At one village about 150 ration cards were found at the FPS. There were several villages where none of the beneficiaries possessed rations cards. In the Vidarbh region, though the situation was better in terms of distribution to beneficiaries, but there were glaring discrepancies in the manner in which foodgrain was being allocated and lifted from the godowns.

In many districts the ration cards had been issued more than 10 years ago and are in extremely poor and unusable conditions. This gives the FPS dealer an excuse to avoid making entries in the card. At many places the Committee found that the ration cards of the beneficiaries had been deposited at the Tehsil office for renewal but had not been issued to the beneficiaries for months. The beneficiaries are left without cards for months together and cannot claim their PDS entitlement. The drive to issue fresh ration cards should be accelerated. Issuance of ration cards should be strictly within the prescribed period. In case of delay the applicant be informed delay along with the reason for the delay.

The Ration Card GR

SC pulls up Centre for prolonged detention of Pak prisoners

Tuesday, January 24, 2012
Press Trust Of India    The Supreme Court on Tuesday pulled up the Union government for prolonged incarceration of several Pakistani prisoners in Indian jails despite their having completed their sentences. “There is total inaction and laxity on the part of the government. “We are more concerned about the liberty of the persons who continue to be in jails despite serving their sentences,” said a bench of justices RM Lodha and HL Gokhale while ruing that some prisoners had been kept in detention even without having any case registered against them.

“Please show us the procedure under which you have detained and kept them for prolonged incarceration. We are more concerned with the question of substantial justice which should prevail over the procedures,” the bench observed.

The bench pointed out that the prolonged detention of foreign nationals was violative of the constitutional right of the life and liberty granted under Article 21 to every person in the country, including the foreign nationals, infraction of which cannot be condoned by the courts.

The apex court directed Additional Solicitor General Vivek Tankha to furnish to the court the government’s policy, if any, for dealing with such foreign nationals.

The apex court pointed out that the case relating to the alleged illegal detention of foreign nationals was pending with the courts since 2005 but the government was not taking any steps to deport them, even after they having completed their respective prison terms.

The apex court pointed out that the Union government has been lax in dealing with the issue inspite of several directives from it. It said while some of them were held for illegal entry into the country, others were arrested for alleged subversive activities.

“We don’t want your bureaucrats to sleep over the files and go into slumber. We don’t want clarifications from section officers, please give us comprehensive details as to whether there is any bilateral policy.

“Don’t compel us to summon the presence of a senior officer for clarification,” the bench said.

The court also termed as “infraction of human rights of the worst order” the cases relating to certain prisoners who were held under the preventive detention law under section 109 of the Criminal Procedure Code (CrPC) in jail for over a year.

Citing the instance of one particular prisoner detained since October 6, 2009 under the preventive detention law, though no offence was registered against him, the bench observed that these are things that no court will countenance.

The apex court made the observation while dealing with two separate public interest litigations (PILs) relating to alleged prolonged incarceration of Pakistani and Bangladeshi nationals in Indian jails.

Sri Lanka: No Progress on Justice | Human Rights Watch

A member of the Free Media Association shouts slogans in front of an image of missing cartoonist and columnist Prageeth Eknaligoda during a protest in Colombo June 8, 2011. The protest was held to mark 500 days since the disappearance of Eknaligoda, a pro-opposition journalist who worked for Lanka-e-News, a private-owned independent website that was critical of the government. The placard reads “500 days since Prageeth’s disappearance.” © 2011 Reuters

In 2011, accountability remained a dead issue, the media faced increasing censorship, and the long-standing grievances which led to the conflict were not seriously addressed. Sri Lankans face a lack of justice, weak rule of law, land grabbing, and a censored media from a government that is increasingly authoritarian.
Brad Adams, Asia director

(New York) – The Sri Lankan government in the past year failed to advance justice and accountability for the victims of the country’s 26-year-long civil conflict, Human Rights Watch said today in its World Report 2012. While Sri Lanka’s war-ravaged north and east became more open, the government deepened repression of basic freedoms throughout the country.

The government of President Mahinda Rajapaksa continued to stall on accountability for abuses by the security forces, threatened media and civil society groups, and largely ignored complaints of insecurity and land grabbing in the north and east, Human Rights Watch said. The long-awaited report of the Lessons Learnt and Reconciliation Commission (LLRC), published in December, largely absolved the military for its conduct in the bloody final months of the war with the Liberation Tigers of Tamil Eelam (LTTE), which ended in May 2009.

“In 2011, accountability remained a dead issue, the media faced increasing censorship, and the long-standing grievances which led to the conflict were not seriously addressed,” said Brad Adams, Asia director at Human Rights Watch. “Sri Lankans face a lack of justice, weak rule of law, land grabbing, and a censored media from a government that is increasingly authoritarian.”

In its 676-page report, Human Rights Watch assessed progress on human rights during the past year in more than 90 countries, including popular uprisings in the Arab world that few would have imagined. Given the violent forces resisting the “Arab Spring,” the international community has an important role to play in assisting the birth of rights-respecting democracies in the region, Human Rights Watch said in the report.

The government’s failure to hold perpetrators of abuses accountable remained a key issue throughout the year. No one was prosecuted for atrocities committed during the conflict with the LTTE. The government ignored the findings of a Panel of Experts report, commissioned by United Nations Secretary-General Ban Ki-moon, which found rampant abuses by both government forces and the LTTE, and called for an independent international mechanism to investigate laws-of-war violations. The government insisted instead that its LLRC would be the mechanism to address wartime abuses, though the mandate, composition and procedures of the commission were deeply flawed. The LLRC effectively exonerated government forces for laws-of-war violations, rehashed long-standing recommendations, and took no concrete steps to advance accountability.

The commission’s findings stand in stark contrast to those of the UN Panel of Experts, the UN special envoy on extrajudicial executions, and nongovernmental organizations, including Human Rights Watch. Although the LLRC found that government shelling resulted in civilian casualties, an allegation that the government had strenuously denied, it did not even consider the repeated attacks on civilian areas and hospitals as possible indiscriminate attacks prohibited by the laws of war, Human Rights Watch said.

“The abuses by government forces detailed in the UN Panel of Experts report are strangely missing in the LLRC’s findings,” Adams said. “Even the LLRC’s useful recommendations seem destined to join those of other Sri Lankan commissions that got filed away and ignored.”

Free expression in Sri Lanka was under assault in 2011. The editor of a Jaffna-based newspaper was beaten with iron bars by a group of unidentified youths in late July. Also in July, a team of Radio Netherlands journalists were harassed by police and later robbed and attacked at gunpoint by men in a white van, a notorious symbol of terror in Sri Lanka. The chairman of the Sunday Leader, whose brother Lasantha Wickrematunge had been gunned down in 2009, received a phone call from President Rajapaksa who threatened to attack him personally in response to articles in the Sunday Leader about high-level corruption. In December, two human rights activists, Lalith Kumar Weeraraj and Kugan Muruganathan, disappeared, apparently abducted while en route to a planned protest rally in Jaffna. Weeraraj’s father stated that his son had received anonymous phone calls prior to the protest telling him that he would be eliminated if he continued his political involvement.

In November, the government-owned Daily News announced that the government would issue guidelines and a code of conduct for the country’s media. The Media Ministry called on all news websites to register. At least five websites critical of the government were subsequently blocked inside the country.

“A free media is an essential building block of a democratic state,” Adams said. “The Rajapaksa administration is putting this in jeopardy by reacting to criticism with heavy-handed measures.”

The government says that there has been meaningful progress on reconciliation, but there is little evidence to support that contention, Human Rights Watch said. Talks between the government and the Tamil National Alliance (TNA) on distribution of powers remained stalled through most of 2011. While campaigning ahead of elections in Jaffna in June, members and supporters of the TNA were attacked by army personnel wielding rods, batons and sticks.

There were some improvements for the Tamil population in the north and east in 2011. Freedom of movement to the north has allowed for greater access by humanitarian, local human rights and media groups, as well as by families. However, the government took inadequate steps in 2011 to normalize living conditions. Security in the region remained poor, with alarming incidents reported of gender-based violence and enforced prostitution. The unsettling attacks mid-year by “grease devils” – unidentified male assailants – exposed the vacuum in the security forces’ ability to respond adequately to civilians’ needs for protection. The heavy military presence in the north and east was a continuing source of distrust among the largely Tamil population.

The issue of land, one of the central problems undergirding the decades-long conflict, remains unresolved. Although the cabinet in April passed a circular intended to address the issue of land ownership and competing claims, particularly for those who fled during the war, little was done to implement its provisions.

Further, the government failed to appoint a National Land Commission, as required under the 13th amendment to the constitution. Reports of land-grabbing by the military in the north and elsewhere in the country increased through 2011. In some cases, the military provided some compensation, but sporadically and only when initiated by the owners, not the occupiers.

“The government has barely made an effort to address the grievances of the Tamil population,” Adams said. “Instead of the government facilitating greater dialogue, Tamil political representatives are subject to threats and harassment.”

Most of the nearly 300,000 displaced persons illegally confined in military-controlled detention centers after the war were able to leave by early 2010, but many have still not been able to return to their previous homes or communities. About 57,000 people live with host families, and another roughly 53,000 remain in the camps, in part because de-mining activities have not yet been completed in their original home areas.

By December, the government had released all but about 1,000 of the nearly 12,000 LTTE “surrenderees,” alleged combatants and supporters that it was detaining without charge or trial, and claimed that those remaining would be released by mid-2012. The government says these former combatants have been rehabilitated and trained to enter civilian life. The government said another 1,000 “hardcore” LTTE members are being held at Camp Boosa. The conditions for all of these detainees are not known.

Allegations of mistreatment and torture in custody have not been investigated.
The Emergency Regulations were allowed to expire on August 31, but the 1979 Prevention of Terrorism Act (PTA) and other laws and regulations permitting detention without charge for up to 18 months leave an abusive detention regime in place.

Local government elections held between March and October further consolidated the hold of Rajapaksa’s United Freedom People’s Alliance party. It won control over 270 of the 322 local authorites contested. As in previous years, the president relied on close family members to strengthen his hold on government. Various Rajapaksa brothers remain as cabinet ministers with important portfolios. Opposition parties were effectively sidelined.

Sarath Fonseka, the former army commander who challenged Rajapaksa during the 2010 presidential election, was sentenced to an additional three years in prison after his current sentence expires in January 2012.

“As the Rajapaksa government has strengthened its grip politically, basic rights protections in the country have deteriorated,” Adams said.

Download-World Report- Srilanka 2012

Intent can be reason for denying information to applicant

English: Adivasi woman and child, Chhattisgarh...

Intent can be reason for denying information to applicant

Chhattisgarh Legislative Assembly hikes application fee to Rs 500, could also reject request for information

Prakhar Jain
New Delhi

In a move that is clearly against the letter and spirit of Right to Information (RTI) Act, 2005, the Chhattisgarh Legislative Assembly will now consider an applicant’s intent before providing information. The Assembly could even reject the application if it is convinced that it has been made with mala fide intent. This clearly goes against the Act, which says that an applicant requesting for information shall not be required to give any reason.

The Assembly, which had issued a notification to this effect last month, also hiked the fee for an RTI application from Rs 10 to Rs 500. Besides, the applicant will have to pay Rs 15 per copy of any document instead of the standard fee of Rs 2 charged across the country.

Devendra Verma, Secretary, Legislative Assembly, explains, “Earlier, there were no (specific) rules for the Legislative Assembly. While framing rules, we adopted from Uttar Pradesh”. The intent clause has been derived, he says, from the Preamble of the RTI Act.

Dharam Lal Kaushik, Speaker of the house, defends the notification saying that information regarding questions raised by Assembly members is still provided at Rs 1 per copy. Higher fee would apply only to information sought about the Assembly, he says.

Activists who have fought a long battle for introduction of the RTI Act are appalled. “Imagine a person who buys a kilo of ration for Rs 5 per kg. He/she will have to sacrifice the budget for 100 kg of ration to just file an RTI application. It goes against the spirit of the Act,” says Shekhar Singh, whose NGO National Campaign for People’s Right to Information (NCPRI) has been instrumental in introducing the RTI Act. The NGO, which has termed the fee hike arbitrary and harsh, will issue a press note on the matter.

Shailesh Gandhi, Central Information Commissioner, couldn’t agree more. “Bad practices set precedents easily. This is disappointing. The intent clause is disrespectful of the law. The RTI Act mentions a reasonable fee and Rs 500 is not reasonable. These (legislative) bodies just don’t want to provide information,” he told TEHELKA. Gandhi has even shot off letters to the Chief Minister, the Leader of the Opposition and the Speaker asking them to maintain the earlier fee amounts.

This is not the first time that such a step has been initiated in the state. In 2009, the government limited the word count to 150 and number of subjects to one for every RTI application. The ‘one subject per application’ rule in turn was adopted by the Madhya Pradesh Assembly in 2010.

Nikhil Dey of NCPRI says that “restricting the subject to just one is illegal as the RTI Act clearly provides for even partial transfer of application to other public authorities if all the information is not available with one department”.

Prateek Pandey, RTI activist from Chhattisgarh Citizen Initiative, recalls his experience. “Once, I asked the ex-State Information Commissioner (SIC) to define ‘subject’ and he just smiled. If the SIC can’t answer that, how will a Public Information Officer? Everyone interprets it in his own way,” he says.

The Chhattisgarh Assembly has been feeling the heat of several RTI applications of late. An Information Commissioner of the state recently had ruled against the “Speaker’s privilege” to deny information in the case of an applicant seeking audit reports of accounts of the house and RTI applications received by it. Many legislators have also been in line of fire due to information obtained under RTI applications last year which revealed them receiving gifts like microwave ovens, washing machines, etc. bought in violation of rules by various state departments.

The way ahead is either to accept the Assembly’s decision or resort to legal means. According to Singh, confrontation can be avoided. He gives the example of Manipur, which had taken a similar decision on RTI applications. However, when activists wrote to the government expressing concerns, the application fee was reduced.

Prakhar Jain is a Correspondent with Tehelka.

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