W.P. (PIL) No. 39/2012. Case: Rinzing Chewang Kazi Vs The State of Sikkim and Ors.. Sikkim High Court

Case NumberW.P. (PIL) No. 39/2012
CounselFor Appellant: Doma T. Bhutia and Mina Bhusal, Advocates and For Respondents: J.B. Pradhan, Addl. Advocate General and Santosh Kr. Chettri, Asstt. Govt. Advocate
JudgesSunil Kumar Sinha, C.J. and Meenakshi Madan Rai, J.
IssueConstitution of India - Articles 14, 15, 21
Judgement DateApril 05, 2016
CourtSikkim High Court

Judgment:

Sunil Kumar Sinha, C.J.

  1. By way of introduction, it may be stated here that this is a Public Interest Litigation seeking effective implementation of the National Rural Health Mission (for short NRHM) in the State of Sikkim by issuing appropriate orders to provide for required facilities and personnel in remote rural villages of the State, focussing in particular on the health of Women, Children and Senior Citizens being Marginalised Groups of society. It is also concerned with the violation of Articles 14, 15 and 21 of the Constitution alleging failure on the part of the Respondents to provide adequate facilities to women in terms of reproductive and child health services.

  2. Before proceeding further, it may be elucidated here that the National Health Mission (NHM), whose vision is the "Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people's needs, with effective inter-sectoral convergent action to address the wider social determinants of health." (See Framework for Implementation, National Health Mission, 2012-17), encompasses two Sub-Missions being the National Rural Health Mission (NRHM) which was launched on 12.4.2005 and the National Urban Health Mission (NUHM). The NHM aims at guiding states towards achieving health care through strengthening of health systems, institutions and capabilities. The objective of the NRHM, inter alia, is to reduce maternal mortality rate, infant mortality rate and total fertility rate. Within the ambit of the NRHM is the Janani Suraksha Yojana (JSY), a scheme, which is a 100% Centrally Sponsored and ".....integrates the cash assistance with antenatal care during the pregnancy period, institutional care during delivery and immediate post partum period in a health centre by establishing a system of coordinated care by field level health workers." (See Janani Suraksha Yojana Guidelines for Implementation, Ministry of Health and Family Welfare, Government of India)." The vision of the scheme besides being to reduce maternal mortality and the infant mortality rate, seeks to increase institutional deliveries in women belonging to the Below Poverty Line (BPL) households of the age of 19 years or above, up to two live births. Along with the Scheme of Janani Suraksha Yojana, is the Janani-Shishu Suraksha Karyakram (JSSK) which assures that pregnant women and new borns do not have to incur pocket expenses in all Government institutions and lays down the entitlements for pregnant women and sick new born till 30 days of the birth.

  3. Under the NRHM, Accredited Social Health Activists (ASHA) are to be appointed in each village and trained to act as an interface between the community and the public health systems. They are to assist the pregnant women belonging to households Below Poverty Line (BPL) in obtaining the use of health services by inter alia undertaking certain responsibilities, which include identifying pregnant women, providing them with checkups, counseling them for institutional deliveries, etc.

  4. This Writ Petition, as already stated has been filed seeking proper implementation of the NRHM.

  5. In view of the facts put forth in the Writ Petition, this Court vide an Order on 24.8.2012, observed as follows:-

    "...From the perusal of the averments made in the Writ Petition, we find that various Govt. Sponsored Schemes, namely, National Rural Health Mission (NRHM), Janani Suraksha Yojana (JSY) and other schemes have not been implemented in right spirit. There are also averments regarding non-availability of life saving drugs in most of the Government Hospitals/Health Centres both at District and Sub-Divisional level. State Respondents will furnish details of the facilities available at District and Sub-Divisional level Hospitals and Primary Health Centres including Dispensaries with details of the number of such Centres. The availability of life saving drugs with its names/brand and quantity with the expiry dates will also be disclosed in the Affidavit so filed.

    In the meantime we further direct that the State will ensure availability of life saving drugs in all the Hospitals/Health Centres within a period of 2(two) weeks, if not already available..."

  6. On 21.11.2012, Counter Affidavit was filed by the Respondents No. 1 and 2, which was taken up on 23.11.2012 vide which "Details of Essential and Life Saving Drugs..." issued to the various hospitals and health centres were enumerated as follows:-

  7. The details supra reveal only a total of 4 (four) numbers of District Hospitals, 5 (five) numbers of Primary Health Centres (PHCs) and 18 (eighteen) numbers of Primary Health Sub Centres (PHSCs), while as per the Counter Affidavit, there is one Referral Hospital at STNM, four District Hospitals (Namchi, Gyalshing, Singtam and Mangan), a total of 26 Primary Health Centres and 146 Primary Health Sub Centres in the State, thus indicating that the required details have not been furnished for all the PHC's and PHSC's in the State.

  8. It was also stated in the Affidavit of the Respondents that to facilitate better management and to ensure community participation in the daily working of the Primary Health Centres, "Rogi Kalyan Samitis" have been registered for the existing 24 (twenty-four) Primary Health Centres, while for the 2 (two) newly notified Primary Health Centres (being Hee Gyathang in North District and Tokal Bermoik in South District) the matter is under process.

  9. It has further informed that there is a proposal for reconstruction of the Lachen and Lachung Sub Centres with provision of a Doctor's Clinic and accommodation.

  10. It was admitted that in terms of the population of Sikkim which stands at 6,07,000 as per the 2012 Census Report, the total requirement of beds in the hospitals and health centres is 1840, while at present there are 1440 beds only. That, this shortfall will be met up by construction of a 575 bedded Multi Specialty Hospital at Gangtok, which was to be completed by 10.9.2013. It was brought on record that, subsequently, the bed strength of the Multi Speciality Hospital was revised from 575 to 1000 and the date of completion was extended from 08.09.2013 to June, 2016. Status of the work as on 30.05.2015 was shown to be 86.50% completed.

  11. On 23.11.2012, it was observed by this Court while referring to the Order dated 24.8.2012 that

    "....One of the directions contained in the order was regarding availability of life saving drugs.

    Though list of the life saving drugs has been appended with the affidavit as Annexure 1-3, however, in the affidavit no details are given about the availability of such life saving drugs in the hospitals and any health centres in the State of Sikkim.

    Mr. J.B. Pradhan, learned Addl. Advocate General seeks one week's time to file additional...

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