Office of the commissioner for fundamental rights of hungary

Several petitions had been submitted earlier to the Office of the Commissioner for Fundamental Rights in relation to the imposition of cervical screening as an obligatory task to be performed by health visitors. With a view to the comprehensive and complex examination of the problems related to care provided by health visitors, the Commissioner for Fundamental Rights conducted an inquiry, which concluded that the delegation of the task of public health cervical screening in itself does not give reason for concern from the perspective of fundamental rights. Nevertheless, he formulated certain recommendations to ensure that the service complies with fundamental rights in all respects.

The Commissioner for Fundamental Rights examined whether the delegation of the undoubtedly cardinal task of cervical screening to health visitors endangers the adequate performance of their duties in prenatal care and child protection, as well as in family and neonatal care. Moreover, he also investigated whether the personal fundamental rights of either the health visitors concerned or of the potential patients affected by this service are injured in the context of this new role, and whether the legal implementation of the extension of health visitors’ competence was carried out in conformity with fundamental rights.

The inquiry found that the legislator provided sufficient time to prepare before introducing the new task. Necessary instruction was provided in the educational programme in a phasing-in system, while those working in the care system already could acquire the required qualification by attending free training courses. Despite the above, a significant number of health visitors have not yet completed the training. At the same time, due to the lack of completion of the training, municipalities responsible for providing basic care find themselves in an impossible situation: either they are forced to dismiss those health visitors who cannot prove that they have completed the training – thus losing significant professional experience and local knowledge –, or they take responsibility for the fact that the health visitor basic care provided by them does not conform with the legal regulations, which, in turn, causes concern in the context of the inhabitants’ right to health.

The current legislative regularization of public health cervical screening does not guarantee that the programme will achieve its original objective, namely, that the screening would reach as many members of the target group as possible. In fact, essential temporary rules are missing: the ones that would make it possible to potentially regroup certain health visitor duties between the individual health visitor districts, so that cervical screening, for instance, could be carried out by a duly qualified and motivated health visitor working in the proximity of the patient’s domicile.

As the Commissioner for Fundamental Rights had already emphasized in several earlier Ombudsman’s reports issued prior to the delegation of the task of public health cervical screening to health visitors, access to care provided by health visitors is unevenly distributed in Hungary. The functional inaccessibility or limited accessibility thereof leads to an impropriety related to the right to health of the persons living in the given area, especially in disadvantaged regions.

The Commissioner for Fundamental Rights concludes that upon establishing health visitor districts, the current method to define the number of persons to be looked after by one health visitor may hinder the provision of personalized care that is the token of the enforcement of fundamental rights. All of the above raises the imminent danger of the occurrence of a constitutional impropriety relative to the right to health.

In order to prevent the occurrence of such improprieties as the ones exposed by the report, the Commissioner has asked the Minister of Human Capacities to consider reviewing – with the involvement of the professional body of health visitors and the representatives of the municipalities in charge of organizing basic care – the regulatory environment in force scrutinized in the report, and in light of that, formulate temporary rules in order to ensure that certain tasks imposed on health visitors could be potentially transferred between the individual health visitor districts.

Furthermore, the Commissioner has also requested that upon establishing the individual health visitor districts, the regulation pay attention to considerations pointing beyond the number of persons to be looked after. Thus a weighted evaluation should be performed, taking into account the structure of the settlement, the composition, health condition and social situation of the population, and that a differentiated upper limit should be established when determining the number of persons to be looked after.