Table 1.

Did health services protect Ibu Rahmi's right to health?

Criteria for protection of the right to health (22)	Description (adapted, 22)	Comment related to the case of Ibu Rahmi	Protected?
Availability	Functioning facilities, goods and services, as well as programmes, have to be available in sufficient quantity.	Despite the abundance of tertiary level healthcare, it was not functioning, e.g. Ibu Rahmi was left unattended in a poor state of health in hospital C.	No
Accessibility
Non-discrimination	Facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population.	Ibu Rahmi's economic and geographical situations, her gender and social status clearly constrained her access to healthcare.	No
Physical accessibility	Facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups.	Due to the unavailability of effective community based services, Ibu Rahmi and her family had to undertake long journeys to reach care.	No
Economic accessibility (affordability)	Facilities, goods and services must be affordable for all. Payment for healthcare services has to be based on equity, ensuring that services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups.	Healthcare was clearly unaffordable for the family, e.g. Ibu Rahmi discharged herself from hospital on two separate occasions due to concerns over the costs of care. There was also an expressed suspicion that quality of care was lacking on account of the family's poor status.	No
Information accessibility	The right to seek receive and impart information and ideas concerning health issues.	Ibu Rahmi and her family may have made different decisions about healthcare had they been informed about their (apparent) eligibility for health insurance.	No
Acceptability	Facilities, goods and services must be respectful of medical ethics and culturally appropriate, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.	The final journey in the complicated referral chain demonstrates a grave lack of dignity expressed by hospital D towards Ibu Rahmi, to refer a woman in a critical condition unattended in an unstaffed ambulance.	No
Quality	Health facilities, goods and services must be scientifically and medically appropriate and of good quality	Several, serious instances of poor quality care were apparent, primarily an unmet need for effective community-based services and effective referral. The referral hospital(s) should have been adequately staffed and equipped, with procedures for admitting patients who were in the process of arranging health insurance that did not delay their care in an emergency. Possibly the most serious health system failures were Ibu Rahmi's rejection from hospital C and the unequipped, unstaffed and unsafe ambulance that she died in.	No