Mukti Rijal

Dr. Govinda KC has halted his hunger strike citing that the nation's interest of defending and articulating voices in favour of territorial integrity deserves an enhanced priority at this time even though shuffling out the malaises hitting the medical sector is also important. Dr. KC had started seventeenth hunger strike at Dadeldhura almost ten days ago accusing that the government has reneged on and dishonoured the terms of the agreement entered many times in the past.Though the attempts were made to whisk him off to Kathmandu involuntarily for medical attention and care as his health condition had worsened due to the hunger strike, he refused insistently to come on board the army helicopter to get back to Kathmandu thereby adding headache to the authority .
Whenever Dr. KC goes for hunger strike, it does grab the attention of all civic stakeholders and becomes a matter of nervousness for the government and ministers. It also compels one to raise question as to why Dr. KC is forced to resort to strike time and again to get it across loudly that his demands to reform medical education have not been met despite commitments and agreements signed time and again in the past.
It also indicates expressly about the government apathy to implement the terms of the past accords agreed with him. This time his hunger strike was staged and did happen to coincide with the time when the medical students have gone on strike placing demands for securing the refund of the amount unduly charged and extracted from them without regard to the fee structure set and prescribed by the government. According to the media report, a hefty sum of money has been collected unduly and illegitimately by the private medic college operators to the detriment of the interests of students who have been venting grievances against the cost prohibitive medical education in the country. Though the education minister has ordered the medical colleges to refund the amount unduly collected from the students within fifteen days, it is yet to see to what extent the minister's order will be effective to meet the demands raised by the agitating students. Whether there is Dr. KC's complaints or not, the state of public health service delivery is very poor in the country.
The discrimination and skewed pattern in the provision of health service delivery is evident in the fact that the leaders are sent overseas for minor check up at the expense of the state coffer, but poor people are suffering due to lack of provisions of the basic and rudimentary services in the sub-national hospitals and health institutions spread across the country. The poor people who land in the hospitals for medical services have not only to face hassles but are made to pay fees even for basic services that are declared to be free on behalf of the state.
And doctors, medical personnel and nursing staff assigned and posted for the district hospitals are often found not attending to their duties on a regular basis. The basic diagnostic equipment and appliances like X-ray and ultrasonogram are allowed to go dysfunctional rendering the hospital assets to become non-performing and general services go bust. The medicines supposed to be distributed free in line with welfare based health services have been allegedly sold out through private medical outlets in the market. Not only the district hospitals but the performance of hospitals run by state (Pradesh) government at the headquarters is tardy and poor.
The responsibility for management of primary healthcare centres and health posts have been devolved upon the local government in line with the functional allocation set forth in the constitution. The devolved service provision in line with principle of subsidiarity allows room for local monitoring and management of public health services in the country. Not only at the districts but the national level public hospitals like Bir Hospital, Teaching Hospital and the Chitwan Cancer Hospital have not been doing well. The services especially at Bir Hospital and Chitwan Cancer hospital have come under sharper public scrutiny. The political meddling in the appointment of the doctors and executives in the Bir Hospital together with the discriminations and partiality in the provisioning and allocation of services have been central to poor management of the nation’s oldest and premier hospital.
There has been the long unresolved dispute on the modality, character and management of medical education. The entire medical personnel and doctors are split on several issues including the mode of medical education in the country. The controversies often grip on the national parliament marked by much heated debate too. Those lawmakers who have personal stakes on the lures and lucre of the medical education have emphasised on the need to permit and grant affiliation to the medical colleges for the education opportunity expansion.
Dr. KC's hunger strike time and again has shaken not only the conscience of the medical fraternity but also the entire nation underlining the need for proper regulation appropriate reform and management of the medical education in the country. However, on the pretence of regulation and management of the medical education, there should not be unwarranted curbs and control to discourage the genuine public initiative in the expansion and development of medical education to cater to the needs of the country.

(Rijal, PhD, contributes regularly to TRN and writes on contemporary political, economic and governance issues. He can be reached at rijalmukti@gmail.com)