S.C Das, J.:— By presenting the petition addressed to Hon'ble the Chief Justice and other Hon'ble Judges of the High Court of Tripura in the form of a Public Interest Litigation, the petitioners, Keshab Debbarma and Kartik D. Jamatia (Advocate), sought before this Court to issue appropriate writ/order/direction to the appropriate authorities in view of the breakout of malaria epidemic and death of many people in the year 2014 in the interior areas of Dhalai District, Unakoti District, North Tripura District and South Tripura District. It was alleged in the petition that malaria epidemic would not affect the people in such a large scale had effective steps were taken by the responsible authorities of the State. It was also alleged that proper health care was not provided which is a fundamental right of the common man of the country as guaranteed under Article 21 of the constitution and as a result many people died due to the malaria epidemic.
2. This Court by order dated 28.07.2014 treated the petition as a Public Interest Litigation and issued notice to the State of Tripura through the Chief Secretary to the Government of Tripura and the Principal Secretary to the Government of Tripura, Health Department.
3. In response to the notice respondent Nos. 1 and 2 submitted their affidavit on 27.10.2014 The petitioners submitted a rejoinder affidavit on 17.03.2015 and thereafter respondent Nos. 1 and 2 submitted another affidavit in response to the rejoinder affidavit on 27.05.2015 Considering those affidavits-in-opposition filed by respondent Nos. 1 and 2 and considering the rejoinder affidavit filed by the petitioners, this Court passed a details order on 15.06.2015, which reads as follows:
“We have perused the supplementary affidavit filed in response to the rejoinder affidavit. This affidavit has been field by Sri. M. Nagaraju, Secretary, Health and Family Welfare Department to the Government of Tripura, the respondent No. 2.
We are not at all satisfied with the averments made in the affidavit. In para 43 of the rejoinder affidavit, the petitioner has quoted the report of the National Vector Borne Disease Control Program, in short NVBDCP.
In the said report, the team of the NVBDCP has pointed out the reasons for the large scale outbreak of the Malaria Epidemic and the large number of deaths caused due to the malaria epidemic in the year 2014.
The report clearly indicates that this epidemic occurred because early warning signals were missed in the second weak of May 2014 in District-Dhalai and despite the NVBDCP team visiting two districts in 1st week of June, 2014 and informing the health authorities about the infirmities. It is reported that DDT spray was delayed and because of inadequate manpower the NVBDCP program could not function properly. Poor monitoring and supervision is another reason given. The report also mentions that the surveillance is very poor and surveillance mechanisms are also poor.
We are not going into the details of the report as mentioned in para 43 but we find that in the affidavit of the Secretary, Health and Family Welfare Department to the Government of Tripura, there is no answer to the observations made by the team of the NVBDCP which are quoted in Para 43.
The NVBDCP is a central sponsored program and its recommendations must be given due weightage by the State Government. In the reply filed, not a word has been sated as to what the state has to say in respect of the report. We, therefore, direct the Secretary, Health and Family Welfare Department to the Government of Tripura to file a supplementary affidavit within 10 days from today detailing therein the response of the State to the report of the NVBDCP, especially that portion of the report which has been highlighted in Para 43 of the rejoinder affidavit.
Coming to para 44 of the rejoinder affidavit, it refers to mid-term and long-term measures recommended by the NVBDCP for taking necessary action. With regard to this also, the reply, in our opinion, is not wholly satisfactory. Though an attempt has been made to reply to this paragraph, in para 23 of the supplementary affidavit, the same is extremely vague.
It has been stated that as per NVBDCP guidelines, funds have been released to eight districts so that they can function properly. In the supplementary affidavit to be filed the Secretary, Health and Family Welfare Department to the Government of Tripura shall give details of the funds released, the date on which these funds were released, whether those funds have actually been released and how those funds have been utilized till 15th June, 2015.
In the next portion of the affidavit, it is stated that action was taken against the health workers who were found to be negligent in discharge of their duties. Again there are no details. The Secretary, Health and Family Welfare Department to the Government of Tripura shall in his affidavit clearly set out what disciplinary action or otherwise was initiated against those health workers whether ASHAs, MPWs, Supervisory Staffs etc., who were found negligent in the discharge of their duties. The Secretary, Health shall make specific reference with regard to the villages where deaths have taken place and what inquiry has been conducted with regard to those deaths, village wise and what steps were taken against the earring officials, if any, who have failed to discharge their duties.
One of the principal observations of the NVBDCP was that most of the health staff who is deployed and is supposed to stay in the villages, is not actually staying in the villages but they visit the villages occasionally. What steps has the Health Department taken to ensure that these health workers actually reside in the villages where they are posted? If these health workers are being paid salary with a condition to reside in the villages, they should not be paid their salary if they don't reside in the villages. The poor tribal villagers living in the far-flung areas of Tripura are as much entitled to the protection of Article 21 of the Constitution of India as any other citizens of Tripura. Nothing has been stated in this affidavit as to what steps the State has taken to ensure that these para-health workers actually reside in the villages.
In the next portion, it is stated that for seven posts of Vector Born Disease Consultants, interviews were held on 16.12.2014 The affidavit was filed on 30 April, 2015 and it is absolutely silent as to whether these appointments were actually made or not. If interviews were held on 16.12.2014 then we see no reason why the appointments should not have been made well before the onset of the monsoon in the year 2015. In the latest affidavit, the Secretary Health shall inform us whether actually these posts have been filled up till now or not and whether these consultants have joined their duties or not. It has also been stated that due to the roster relating to reservation, six posts belonged to the scheduled caste category could not be filled up because none from the scheduled caste category appeared for the interview. We are dealing here with the lives of citizens. We are dealing here with the health of the poorest of the poor. We are dealing here with people afflicted by Malaria and other vector born diseases which even this year have led to the death of two or three infants. When the lives of the citizens of the State, reservation will have to give way to Article 21 of the Constitution of India and we therefore direct the state to fill up all the six remaining posts even if they have to be filled up from unreserved category candidates but with the stipulation that these reservation will be carried forward. These posts which are necessary to maintain the health of the citizens cannot be allowed to remain vacant only because Scheduled Caste and Scheduled Tribe candidates are not available.
With regard to the training of the ASHAs, MPWs, NPS and Nursing staffs, again all that has been stated is that in all eight districts training was imparted in the month of December 2014. We direct the Secretary, Health to file a detailed affidavit giving details of the days of training, the programme conducted during the training, the number of persons who attended the training, the places where the training were conducted and the persons who were the resource persons to conduct the training.
The Secretary, Health shall also in his affidavit set out the latest position about the steps taken by the State Government to ensure the prevention of the outbreak of any vector born diseases and also how the State has empowered the health workers to deal with the situation, where there is some outbreak of these diseases.
This affidavit shall be filed within 10 days.
List on 29 June, 2015.
Copy of this order be supplied to both the learned counsel appearing for the parties.”
4. In view of the above order, respondent Nos. 1 and 2 filed a details affidavit on 27.06.2015 specifically responding to the averments made in different sub-paragraph of para 43 of the rejoinder affidavit filed by the petitioners. The response of the respondents have been made in paragraphs 4 to 15 of the affidavit dated 27.06.2015 It is also stated in the said affidavit that action has been taken against 10 MPW workers for their negligence in duty and that a good number of MPWs and MPS and other surveillance staff have been deputed to Gandacherra and Longtaraivelly sub-Division where epidemic was severe. It has been stated by the respondents that a total 96 deaths due to Malaria were reported from different villages out of which 74 were confirmed for malaria by laboratory examination and the remaining 22 deaths were assumed to be due to malaria as deaths due to fever have occurred in the malaria affected areas before the patients could be tested for malaria. The list of names of the persons died due to malaria in the year 2014 also annexed with the affidavit.
5. In para 21 of the affidavit the respondents further stated about the steps taken in the year 2015 as a measure of prevention. Para 21 reads as follows:
“21. That regarding the Malaria situation of this year and steps taken by the State Government to ensure the prevention of outbreak of vector borne diseases I beg to submit the status of Malaria situation from 1 January, 2015 to 31 May, 2015 as follows:
• No. of patients whose blood were examined for malaria: 133753
• No. of Malaria positive cases: 6619 (Pf:6121, Pv: 498)
• No. of death due to malaria: 08
Steps taken by the Health Department to ensure the prevention of outbreak of vector brone diseases:
I. Weekly surveillance was continued throughout the year.
II. Daily surveillance on vector borne diseases started from 1 April, 2015 and will be continued. The surveillance report is shared with all the CMOs, SPO, NVBDCP, MD (NHM), DHS, DFWPM and is monitored by Secretary (Health). Action is being taken based on the report.
III. 2357 nos. of health camps have been conducted in the state up to 24 June, 2015.
IV. First round of DDT spray was commenced on 2nd March, 2015 and completed on 16 May, 2015. The 2 round has started on 16.06.2015 and will continue up to 29.08.2016 Each round is for 75 days as per Gol norms.
V. Impregnation of household bed nets is being carried out.
VI. Sufficient quantity of anti malarial drugs have been procured. The details of procurement of anti malarial medicine and the stock position as on 3rd June, 2015 in the Central Medical Store are enclosed and marked as Annexure R/60 series in the affidavit.
VII. Adequate quantity of RD kits for rapid diagnosis of Malaria have been distributed up to ASHA level.
VIII. Gol has assured supply of sufficient quantity of Long Lasting Impregnated Nets (LLIN) but we are yet to receive. The letter of Dr. Avdesh Kumar, Addl. Director, NVBDCP, Gol in this connection is already placed in annexure R/40.
IX. Awareness campaign is being continued through print and electronic media, interpersonal communication. One mobile IEC van with display message on malaria, Japanese Encephalitis and Dengue moved all over the state with particular attention to remote areas.
X. The health workers have been empowered with training on malariology, treatment protocol, guidelines, RD kits for rapid diagnosis & medicines for initiating immediate treatment.”
6. By order dated 21.03.2016 learned Advocate General was orally asked to furnish some further information by affidavit and the respondent No. 2 filed an affidavit again on 27.05.2016, wherein the amount spent on different heads has been stated in paras 4, 5 and 6 of the affidavit, which reads as follows:
“4. The details as above, extracted from the Statutory Audit Report for the Financial Year 2013-14 are shown below:
Lab. Technicians (F.1.1.a.ii)Rs. 1,41,119.00ASHA Honorarium (F.1.1.b)Rs. 27,410.00Spray Wages (F.1.1.c.i)Rs. 88,17,571.00Operation cost for IRS (F.1.1.c.ii)Rs. 14,68,675.00Impregnation of bed nets (F.1.1.c.iii)Rs. 30,02,130.00Monitoring & Supervision (F.1.1.d)Rs. 24,403.00IEC/BCC (F.1.1.e)Rs. 14,22,103.00Training & Capacity Building (F.1.1.g)Rs. 6,625.00Human Resource (F.3.a)Rs. 54,00,550.00Training cost (F.3.b)Rs. 65,228.00Planning & Administration (F.3.c)Rs. 3,19,805.00IEC/BCC (f.3.d)Rs. 14,15,547.00Chloroquine Phosphate tablets (F.6.a)Rs. 1,95,788.00Primaquine tablets 2.5 mg. (F.6.b)Rs. 60,768.00Pyrethurm extract 2%(F.6.j)Rs. 6,27,872.00Other expenses (F.6.M)Rs. 18,145.00
Copies of the Head wise expenditure details are enclosed herein and they are marked as Annexure-R/2 series of this affidavit.
I further submit the details of utilization certificates from Districts, frame in tabular sheet for convenience, copy of which is enclosed herein and is marked as Annexure R/3 of this affidavit.
5. That, I beg to submit that for the financial year 2014-15, Govt. of India sanctioned Rs. 11,15,00,000.00. Total fund was available to the NVBDCP, Tripura for Rs. 17,43,00,485.50. Out of which, Rs. 6,28,00,485.00 was carried forward as opening balance from the last financial year 2013-14. Total audited expenditure was Rs. 5,00,69,735.50. The unspent closing balance was Rs. 12,42,30,750.00 (Rs. 6,28,00,485.00 + Rs. 11,15,00,000.00) - Rs. 5,00,69,735.50). Fund in transit Rs. 2,64,36,000 [(Rs. 1,26,96,000.00 (from 2013-14) + Rs. 1,37,40,000.00 (from 2014-15)]. Copy of sanction of fund are enclosed herein and is marked as Annexure R/4 of this affidavit.
6. I submit the Head wise expenditure for the financial year 2014-15 in the following ways:
ASHA Honorarium (F.1.1.b)Rs. 22,65,506.00Operation cost (F.1.1.c)Rs. 72,64,517.00Spray Wages (F.1.1.c.i)Rs. 65,03,550.00Operation cost for IRS (F.1.1.c.ii)Rs. 7,60,967.00Monitoring & Supervision (F.1.1.d)Rs. 21,99,921.00IEC/BCC (F.1.1.e)Rs. 6,50,113.00Training & Capacity Building (F.1.1.g)Rs. 3,340.00IEC/BCC/Social Mobilisation (f.1.2.g)Rs. 40,000.00Training specific for J.E prevention & management (F.1.3.c)Rs. 59,691.00Human Resource (F.2.b)Rs. 14,55,029.00Training/Capacity Building (f.2.c)Rs. 7,52,000.00Human Resource (F.3.a)Rs. 62,23,626.00Training cost (F.3.b)Rs. 11,52,386.00Planning & Administration (F.3.c)Rs. 12,40,375.00Monitoring & Supervision (F.3.d)Rs. 20,52,546.00IEC/BCC (F.3.e)Rs. 27,33,386.00Operational expenses for treatment of bed nets (F.3.f)Rs. 16,98,678.00Other items (F.4)Rs. 8,006.00ACT (F.6.k)Rs. 1,89,61,074.00Other (F.6.M)Rs. 13,09,541.00
I submit that above information was extracted from the Statutory Audit Report for the financial year 2014-15. Copy of the extract of the audit report is enclosed herein and is marked as Annexure R/5 of this affidavit.
I further submit the details of utilisation certificate from Districts in 2014-15, framed in a tabular sheet for convenience, copy of which is enclosed herein and is marked as Annexure R/6 of this affidavit.”
7. We have now finally heard learned counsel, Mr. M. Debbarma for the petitioners and learned Advocate General, Mr. B.C Das, assisted by learned Government Advocate, Mr. T.D Majumder for the respondents and also heard learned CGC, Mr. A. Roy Barman.
8. It is no more res integra that right to life, enshrined in Article 21 means something more than survival or animal existence. It would include the right to live with human dignity. It would include all those aspects of life which go to make a man's life meaningful, complete and worth living.
9. The Apex Court in catena of judgments has held that Article 21 imposes an obligation on the State to provide medical assistance to every person. It has been held by the Apex Court that preservation of life is of paramount importance and failure on the part of the State to provide proper treatment in case of need to a citizen is the violation of his right to life guaranteed under Article 21 of the Constitution.
10. Mr. Mangal Debbarma, learned counsel of the petitioners submitted that the alert signal of malaria epidemic was not publicized in time and the preventive measures were not taken by the State authorities. He has submitted that the team of National Vector Borne Disease Control Programme(‘NVBDCP’ for short) has, therefore, indicted the State authorities. He has further submitted that the death was much more than what has been stated by respondent Nos. 1 and 2 in their affidavit. According to Mr. Debbarma, the malaria epidemic could have been avoided had the authorities were sincere and committed to their duties.
11. Mr. Roy Barman, learned CGC has submitted that the funds allocated to prevent and control vector borne diseases cannot be said to have utilized in a proper manner and he has referred to affidavit dated 27.05.2016 submitted by the Principal Secretary to the Government of Tripura, Health and Family Welfare Department.
12. Learned Advocate General has submitted that the outbreak of malaria in spite of all measures taken by the State Government was there in 2014 and it is a fact that number of people died due to malaria. According to learned Advocate General, there was no lapse on the part of the State Government and the affidavit submitted in response to the rejoinder affidavit makes it clear that all possible steps were taken for prevention, control and treatment of vector borne diseases.
13. NVBDCP is a centrally sponsored programme and the guidelines were issued time to time by the Central Government. We are informed that there is a programme taken “National Framework for Malaria Elimination in India(2016-2030)” and we hope that all the concerned authorities shall remain sincere and committed to the national programme to eliminate malaria. It is a fact that malaria was broken out in the interior areas of the State where poor people tribal/non-tribal resides. The State shall ensure-
(i) Early warning signal in respect of vector borne diseases like malaria.
(ii) There should be DDT spray in time.
(iii) Rural people should be sensitized to use mosquito net at night and in case of necessity the State shall provide mosquito net to the poor people who cannot provide for it.
(iv) MPW and MPS workers must be deputed in the particular village/area and there should be strict surveillance about their performance.
(v) The preventive measures as indicated in the NVBDCP should be monitored and supervised.
(vi) If in any area malaria larva borne mosquitoes are found increased, preventive measure should be taken immediately.
(vii) There shall be early diagnosis and prompt treatment and the people should be encouraged to attend public sector health facilities.
(viii) Before onset of monsoon health workers should be on duty to sensitize and aware the people in the malaria prone areas.
(ix) The medical and para-medical workers in the malaria prone areas should be given proper training to deal with the situation effectively.
14. We are informed that NVBDCP issued guidelines time to time to prevent and control vector borne diseases including malaria. If those are strictly followed, we are confident that in future such type of situation of epidemic may be avoided. In the areas prone to vector borne disease, all required facilities of detection of disease should be ensured in the nearest health center. There shall be adequate storage of required drugs by the State health department to combat the situation in case of epidemic.
15. We find no reason to further continue this writ petition and hence, with the above observations/directions it stands closed.
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