UN human rights review: India must end its doublespeak and practise what it preaches

As its record comes up for review at the Human Rights Council in Geneva today, there is little progress to show.

As India’s human rights record comes up for review under the Universal Periodic Review Process at the United Nations Human Rights Council in Geneva on Thursday, one hopes that Indian authorities will drop their defensive posturing and practise what they preach.

The peer-review system was set up in 2006 to take stock of every UN member’s human rights record in a four-year cycle. Each country gets to present what it has done to meet its human rights obligations and other member states have a chance to give feedback and recommendations on what needs to be resolved or improved.

India’s government, the National Human Rights Commission and civil society coalitions have all made their submissions to the United Nations Human Rights Office, which reported these to the council. On May 4, the government will present its record and receive recommendations from other member states.

A major concern leading up to the review has been the contradictory messages from the government regarding its commitment to human rights. For instance, the government’s official submission talks about the Supreme Court’s 2016 order against blanket immunity for security forces and the Justice JS Verma Committee’s recommendation to do away with prior sanction for prosecuting security personnel for sexual offences. However, not only have we seen no movement towards accepting the Verma Committee’s recommendation, just last week the Attorney General Mukul Rohatgi unsuccessfully asked the apex court to recall the 2016 order, arguing that the Army’s actions during military operations could not “be put to judicial scrutiny”.

The government’s submission reiterates its commitment to promoting and protecting human rights defenders. But at the March 2017 session of the council, India voted on an amendment proposed by Russia, China and Pakistan to remove the term “human rights defender” from a resolution on the issue.

The submission notes that “a vibrant civil society keeps the government accountable for its commitments”, but at home, it has used the Foreign Contribution Regulation Act, 2010 to stifle dissenting non-governmental organisations, and human rights activists have faced threats and violence from vigilante groups, and arbitrary arrests and detention.

This doublespeak on human rights is unhelpful and raises questions about how seriously the Indian authorities take the review process.

Since India’s last review in 2012, despite legislative reform on some human rights issues such as violence against women, there has been limited progress on many recommendations accepted by the government, particularly on civil and political rights.

At the last review, India accepted recommendations to prevent discrimination and violence against women and girls, members of religious minorities, and Scheduled Castes and Scheduled Tribes. However, the authorities have failed to ensure that cases of violence against women and girls are properly registered and investigated, and rape within marriage is yet to be recognised as a crime. Laws to prosecute crimes against members of Scheduled Castes and Scheduled Tribes, and laws to end the practice of manual scavenging are still poorly enforced.

The government also accepted recommendations to promote equal access to justice for all, including by providing more legal aid to the poor and marginalised. But inadequate provision of legal aid continues to contribute to excessive pre-trial detention. Two-thirds of India’s prison population is of pre-trial detainees, with Dalits, Adivasis and Muslims disproportionately represented.

The government’s submission for the upcoming review reaffirms its commitment to key human rights issues such as an anti-torture legislation, non-discrimination against lesbian, gay, bisexual and transgender people, and a law against enforced disappearance. However, given the lack of serious groundwork by the executive on these issues in the last four years, this promise sounds more like an attempt to evade criticism. The Prevention of Torture Bill, 2010 lapsed with the end of the 15th Lok Sabha in 2014. Apart from announcing last year that a new Bill was ready, there is little to suggest the government is serious about introducing an anti-torture law.

On the issue of lesbian, gay, bisexual and transgender rights, the government has done little to reverse the setback of December 2013, when the Supreme Court disappointingly re-criminalised consensual same-sex relations. BJP parliamentarians have not even allowed private members’ Bills seeking amendments to Section 377 of the Indian Penal Code to be introduced. The only substantive response has come from civil society actors who filed a curative petition against the ruling, which of course finds mention in the government submission.

The government also claims that it is committed to ratifying the International Convention for the Protection of All Persons from Enforced Disappearances, but we have not seen any movement towards creating an enabling domestic legislation or ratifying the convention.

Merely promising to ratify and implement human rights treaties without any apparent intent to do so does nothing to improve the human rights situation in the country. India must drop its defensive approach to human rights issues and use the review to start an earnest process of addressing key human rights challenges.

Raghu Menon works with Amnesty International India.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.