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Chapter-2 Rights, Duties of Service Recipients and Responsibilities of Health Institutions

  1. Access to and certainty of health service: (1) Every citizen shall have the right to obtain quality health service in an easy and convenient manner.

(2) For the purposes of getting the service referred to in sub-section (1), it shall be the duty of every citizen to be involved in the programs relating to health as prescribed by the Government of Nepal, from time to time, under the prevailing law.

(3) No citizen shall be deprived of health service.

(4) Every citizen shall have the right to obtain free basic health services under the following headings, as prescribed:

(a)        Vaccination service,

(b)       Motherhood, infant and pediatric health service such as integrated infant and pediatric disease management, nutrition service, pregnancy, labor and child birth service, family planning, abortion and reproductive health,

(c)        Service relating to communicable disease,

(d)       Service relating to non-communicable disease and physical disability

 (e)        Service relating to mental disease,

   (f)        Service relating to elderly citizen’s health,

  (g)        Service of general emergency condition,

  (h)        Health promotion service,

(i)         Ayurveda and other accredited alternative health service,

(j)         Other services prescribed by the Government of Nepal by a notification in the Nepal Gazette.

(5) The Provincial and Local Governments may make necessary addition to the basic health services determined by the Government of Nepal pursuant to sub-section (4).

(6) The concerned government shall bear the burden of financial expenses of the services added under sub-section (5).

(7) Other provisions and processes relating to detailed descriptions, service flow and management of the services referred to in sub-section (4) shall be as prescribed by the Ministry.

(8) The Local Level may provide the basic health service in partnership with any health institutions operated under the Province and the Federation.

  1. Emergency treatment: (1) Every health institution shall provide emergency health service as prescribed.

(2) It shall be the duty of each health institution and health worker to provide health service referred to in sub-section (1).

(3) Notwithstanding anything contained in sub-section (2), if emergency health service is not available in any health institution, such health institution, after providing treatment available at such an institution, shall refer to another health institution for additional treatment.

(4) The expenses of treatment under this Section shall be borne by health insurance if it has been made, and by the person concerned, his or her guardian, family member, patron or the person who has accepted patronage if health insurance has not been in effect or the amount of health insurance is not sufficient to cover the expenses.

Provided that the health institution shall provide the health service under the basic health service without charge.

(5) While providing emergency health service under this Section, the concerned service recipient shall be required to adopt the process to be fulfilled for obtaining such service only after starting the treatment.

(6) Other provisions relating to emergency treatment service shall be as prescribed.

  1. Specialist service: (1) The Government of Nepal shall provide specialized services prescribed as necessary on the basis of nature of service, geographical condition and the rate of epidemic of the disease.

(2) The Provincial Government shall provide specialist’s service as per the standards prescribed by the Federal law.

(3) Other matters relating to the provision of the specialist’s services shall be as prescribed.

  1. Referral service: (1) Every health institution shall, after providing service available in its institution, if there is no possibility to provide further treatment to the patient who comes for treatment due to the structure, equipment of its health institution, lack of specialist’s service or any other appropriate cause, refer immediately to the health institution that can provide additional treatment to such a patient.

(2) While referring pursuant to Sub-section (1), the health institution shall fulfill the methods and procedures as prescribed.

(3) After establishing necessary referral system among health institutions that provide specialist’s service and basic health service, the Government of Nepal, Provincial Government and Local Level shall make necessary arrangement to make the service effective.

(4) Notwithstanding anything contained elsewhere in this Section, while referring the patient undergoing emergency treatment, referral shall be made by the referrer health institution, along with minimum equipment and available health facility available with it.

  1. To provide quality health service: (1) The Government of Nepal shall make arrangement for providing every citizen with quality health service from a health institution.

(2) The Government of Nepal shall, in order to provide the citizen with health service based on available resources and means, perform the following functions:

(a)        To determine policy for the protection and promotion of the health of citizens,

(b)       To provide service in an egalitarian manner by determining priority of health service.

(3) The Federation, Province and Local Level shall, in order to implement this Act, make arrangement for human resources, technology and equipment in such institution on the basis of necessity after establishing health institution that have fulfilled the prescribed standards.

  1. Duties of service recipient: The duties of the service recipient receiving service from a health institution or health worker shall be as follows:

(a)        To be aware regarding his or her own health, adopt healthy life style, profess yoga and physical exercise and use the service provided by the health institution,

(b)       To comply with the rules of the health institution by the person receiving health service,

(c)        To provide the health institution with actual information related to own health condition, and to help the health worker in the course of obtaining health service,

(d)       To respect and honor the health worker and health institution,

(e)        Not to commit any act that constitutes physical, mental and gender violence against a health worker,

(f)        To sign on treatment or discharge card by mentioning in case of refusal made to receive partial or full treatment recommended,

(g)        To obtain service upon visiting the health institution referred by the health institution subject to Section 6.

  1. Responsibility for getting treated: If any family member, patron or any person, whose patronage has been accepted falls ill, the guardian, family member, patron and the person who has accepted patronage shall have the responsibility to take such a person to a health institution, get treated, bear treatment expenses and help and facilitate in the treatment.
  2. To provide service recipient with information: (1) Every health institution and health worker providing treatment shall provide the service recipient with information on the following matters:

(a)        Regarding his or her condition of health and treatment of every service recipient,

Provided that if there is a sufficient ground that it may be against the interest of him or her or the community while providing information of the health of the service recipient, it shall not bar the health institution from keeping such information as confidential.

(b)        Regarding diagnosis of the illness, natural effect of the diagnosed illness and standards, and alternative of, the service related to treatment,

(c)        Regarding estimated expenses and potential result related to alternative health treatment,

(d)       Regarding the refusal of health service likely to be made by the service recipient, and potential result, risk and liability likely to arise while refusing the service.

(2) While providing the service recipient with information referred to in sub-section (1), the health institution shall provide such information in a language he or she can understand, as far as possible.

(3) Notwithstanding anything contained in sub-sections (1) and (2), if there is no condition to provide the information of the service recipient’s health condition to the concerned service recipient, such information shall be provided to the adult member of his or her family.

  1. To obtain informed consent of service recipient: (1) Every health institution shall obtain informed consent of the service recipient, while providing him or her with health service.

Explanation: For the purposes of this Section, the term “informed consent” means written or oral consent given by a person who is legally competent to obtain health service.

(2) For the purposes of sub-section (1), written consent shall be obtained to provide the prescribed treatment.

(3) Notwithstanding anything contained in sub-section (1) and (2), health service may be provided without informed consent of the service recipient in any of the following circumstances:

(a)        If the service recipient is not in a condition to give consent or has not given anyone else permission or authority to give such consent, his or her wife or husband, father or mother, grandfather or grandmother, adult son or daughter, brother or sister so far as available respectively or available closest person of the service recipient who has given such consent.

(b)       If the health service has been provided without consent under the prevailing law or by an order of the court,

(c)        If there is a serious threat likely to occur upon public health if any person is not treated,

(d)       If there is a possibility of death of the concerned patient or likely to occur irreparable damage to his or her health if it is delayed to provide health service,

(e)        If the concerned person has not refused to obtain health service in an expressed or unexpressed manner or by conduct,

(f)        In other cases as prescribed.

  1. To behave equally: (1) While carrying out treatment pursuant to this Act, it shall be the duty of the concerned health worker to behave equally and respectfully towards all the service recipients.

(2) Notwithstanding anything contained in sub-section (1), a health institution may prioritize on the basis of the seriousness of the health of the patient while carrying out treatment.

(3) No health institution shall discriminate, or cause to be discriminated, anyone in the treatment on the basis of his or her origin, religion, race, caste, ethnicity, gender, occupation, sexual and gender identity, physical or health condition, disability, marital status, pregnancy, ideology or similar other basis as such.

  1. Professional conduct: Health institutions and health workers shall comply with the professional conduct as determined by the concerned councils.
  2. To maintain confidentiality: (1) While providing health service, information including health condition of the service recipient, diagnosis or treatment obtained by him or her shall be kept confidential.

(2) Notwithstanding anything contained in sub-section (1), nothing herein contained shall be deemed to prevent the information from being published, in any of the following circumstances:

(a)        If the service recipient gives written consent to publish the information,

(b)        If any information is to be published in accordance with the order of the court or prevailing law,

(c)        If it appears to have serious impact in public health if information is not published.

(3)        For the purposes of clause (c) of sub-section (2), it shall be in accordance with the decision made by the prescribed official regarding whether serious impact is going to occur in the public health.

  1. To provide discharge summary: Each health institution shall provide the patient, who has undergone treatment upon getting admission to such an institution, with a discharge summary, along with the information as prescribed, while discharging such a patient.
  2. Liability of health institution: (1) Each health institution shall provide health service from a qualified service provider only.

(2) Each health institution shall adopt necessary safety measures towards not spreading infection and preventing any disease.

(3) Each health institution shall make arrangement for the transmission of following information relating to health service provided by it:

(a)        Available health service, its nature, estimated time and cost  needed,

(b)       Work operation table and time schedule of physicians or health workers,

(c)        Procedures to establish access to health service,

(d)       Procedures relating to complaint management.

  1. To provide information to local administration: (1) In case anybody takes a person to any health institution for the treatment due to accident or any other reason, such a health institution shall provide such a person with treatment service as immediately available with it, and if such person is not identified, it shall provide such information to the concerned local administration.

(2) While providing information pursuant to sub-section (1), the health institution shall provide information of the person treated and other information related to him or her as far as available.

(3) After receiving information pursuant to sub-sections (1) and (2), the local administration shall give information by searching for the family or guardian of the concerned person.

  1. To make a complaint: If additional complication appears in the health of any service recipient in the course of treatment or if he or she has some doubt in the process of treatment, he or she may make a complaint as prescribed to the prescribed authority against the health worker and health institution involved in the treatment.
  2. To impose condition and restriction: The chief of the health institution may impose certain conditions and restrictions in the service to be provided by the health institution on the basis of health condition of the service provider under the prevailing law.
  3. To adopt necessary measures: Each health institution shall, subject to the prevailing law, adopt necessary measures towards the safety of the employees and preventing infection and disease.