Shifting Nepal’s Health Priorities

Nepal’s health sector is witnessing a significant shift in the federal context. Over the decades, we have seen ups and downs in its political history. Undoubtedly, health sector is vastly different in terms of global economy, globalisation, rapid advancement in information and technology, health infrastructure, pharmaceuticals and human resources. In addition, the emergence of climate-sensitive disease outbreaks, pandemics such as COVID-19, natural disasters, and shrinking the size of health financing are adversely impacting on effectiveness of resilient health. 

Therefore, there needs a deepening inquiry into how diverse actors such as states, communities, health experts, institutions, technologists, medical professionals and media shape Nepal’s health trajectories amid shifting geopolitical, social, cultural, economic, environmental and digital forces. There are competing pathways to ensure health sector reform in the country. In this context, it is relevant to explore how people and organisations navigate, contest and remake the history of health sector in the changed socio-political context. Understanding the importance of a transdisciplinary approach, the historical and socio-political perspectives of health care systems must be debated to identify new health priorities. 

Concepts

Harnessing the concepts of anthropology, sociology, political economy and history, among others, is crucial for an engaging yet inclusive framework to explore wider determinants of health. This greatly helps us understand how health care extends far beyond medical practice. In the light of health-related Sustainable Development Goals (SDGs), Nepal must craft pragmatic reform strategies to ensure good governance, transparency and social accountability. Moreover, there is an emerging need of sharpening health diplomacy for efficient coordination with development partners, civil society, academia, media, and private sector to address critical gaps in health policies and their effective implementation at local level. 

More significantly, health governance operates across different sectors and institutions. This is largely about the institutional capacity to deal with overlapping and often conflicting priorities. There is still lack of concrete health strategies on how to use data, research and analysis to address trade-offs in policy and practice. In the changed socio-political context, policy makers must deliver bold ideas, strategic thinking, long-term planning, and sharp analytical skills to win trust and credibility of health bureaucracy in delivering concrete results. Towards this end, the new government has taken some positive initiatives to improve governance in health sector. But people want to see more tangible changes in health economy, governance and social accountability. 

On the other hand, there is a growing curiosity on how the new government works differently and handle persistent institutional bottlenecks which were not effectively addressed in the past. Reviewing the lessons learned, bold measures along with strong political commitment to counter corruption, mismanagement, unnecessary delays and irregularities must begin soon.  Again, maternal and child health, non-communicable diseases, mental health, infectious diseases such as HIV and TB, and climate-induced health vulnerabilities are some of the major concerns. Still, barriers faced by rural health facilities include fragmented local development priorities, workforce shortages, insufficient infrastructure, and lack of culturally competent care. Moreover, the effective management of hospitals across the provinces and districts still remains a recurring challenge. 

Thinking health systems across cases and contexts, it is necessary to explore how Nepal is grappling with health infrastructures, human resources, health security, financing for universal coverage, politics of social inclusion and equity. Shedding new light on resilient and sustainable health systems allows unique vantage points for rethinking innovative interventions for incremental improvement in federal health systems for sustainability. 

Zooming in on how the government’s new priorities in health aims at achieving tangible outcomes, the uneasy question that remains is whether there appears a real breakthrough in health administration and governance.  Therefore, progressive and sustained emphasis on new initiatives should complement and strengthen primary health care system. Furthermore, it is necessary to focus on inclusive social protection services for people who are poor, landless, disabled, displaced, and socio-politically marginalised in the communities. 

Take, for instance, implementation of health insurance is suffering from a range of financing and other management issues. There is no concrete solution yet. Other incentives such as free health care and child grant need efficient implementation to benefit the poorest of the poor and most marginalised communities. I still carry vivid memories of people walking long and their countless struggles to access health care in remote areas. Therefore, more emphasis is needed to further strengthen the capacity of local governments and rural health institutions in effectively delivering basic health care services. 

Sustainable health systems

It is yet to explore how ideas of resilient and sustainable health systems extend beyond the traditional boundaries and how these concepts emerge, evolve, and travel within and across communities. Of course, we need interdisciplinary perspectives in strengthening federal health systems at large. Because the concepts of One Health and planetary health are largely global priorities to tackle with human and environmental health issues. Rising global warming, climate change and air pollution are growing threats to human health. However, existing efforts are not enough, and so yielding slow progress. 

In the context of an ageing world, caregiving needs are growing in health facilities and families. The critical role of family caregivers is often overlooked in health systems. Therefore, embedding family health care into mainstream health policy and practice must be a high priority for actions. The new government must look at the urgency and criticality of shifting health priorities to improve health outcomes and ensure health for all.   

 Bhandari is a health policy analyst interested in anthropology.