Monday, 6 December, 2021

Reforms In The Health Sector

Uttam Maharjan


Healthcare is one of the fundamental rights of Nepalis as enshrined in the constitution. Still, not all people are in a position to exercise this right. For this to happen, the health sector should be robust, with health services available to all people. But the health sector is in the doldrums. Concentration of health facilities in city centres has deprived rural folks of enjoying health facilities. On the other hand, ministers, leaders and well-to-do people tend to fly overseas for treatment, which has left the health sector in a sorry state. That VIP cabins at Bir Hospital have remained unused for years speaks volumes for the neglect in the health sector.

Shortage of facilities
Lack of hospitals in remote or rural areas has taken a toll in terms of both costs and life. Transporting sick or injured people to Kathmandu or other cities all the way from remote or rural areas is a compulsion for lack of healthcare facilities there. Sometimes, even women in labour pain or new mothers have to be transported to Kathmandu or other cities. Healthcare is a sensitive matter; even a minute counts. This tendency, for sure, results in procrastination in treatment, which can even claim life.
The healthcare system in Nepal leaves much to be desired. The poor have limited access to healthcare services due to high costs and unavailability of healthcare facilities. They also lack awareness of health. They are generally undernourished and prone to disease. They end up consulting witch doctors or shamans whenever they fall ill. Traditional beliefs and superstition have influenced their thinking.
Nepal is, however, trying to meet the universal health coverage and SDG goals in health. SDG No. 3 stipulates that countries around the world should ensure healthy lives and promote wellbeing for all at all ages. Nepal has notched up success in some aspects of healthcare. Maternal, under-five and infant mortality rates have come down; there is satisfactory progress in the treatment of HIV/AIDS, tuberculosis and malaria; and poliomyelitis, maternal and neonatal tetanus and leprosy have been eliminated.
The National Health Policy of Nepal (2014) aims at improving quality and equitable healthcare services and providing basic healthcare services free of cost and non-basic healthcare services through social healthcare insurance. The Nepal Health Sector Strategy (2015-20) conceives of improving the health sector through health system reforms, equitable access to healthcare services, improved quality of healthcare services and multi-sectoral approaches. These goals are in conformity with the aim of the National Health Policy.
With the adoption of federalism, all the three tiers of government - federal, state and local - are responsible for providing healthcare facilities for people. The structure of healthcare services has also changed. For example, the services being provided by district health offices in the past are to be provided at the subnational level as per the new federal structure. In fact, the responsibility for providing for healthcare services primarily falls on the shoulders of local units. There are, however, some challenges to overcome, including manpower and financial resources.
Healthcare workers deputed to local units are trained in providing healthcare services but they lack management and procurement skills. Managing the procurement of medicines and medical equipment as per the needs as well as properly storing them is important in providing healthcare services without any interruption. So it would not be an exaggeration to say that the government should pay heed to capacity building at local units. Skilled human resources need to be provided for local units so that planning, monitoring, evaluation, management and even quality assurance for essential drugs and medical equipment can be carried on effectively.
There is lack of clarity as to what the jurisdictions of the three tiers of government are. The constitution states that local units are responsible for managing basic health services, including the procurement of medicines and medical supplies. They can procure necessary medicines and medical goods and equipment as per the local needs. However, healthcare being a national priority, the economies of scale can be attained if the procurement of all medicines and medical supplies is made at the national level. As a matter of fact, federal legislation is required to manage the healthcare sector at the national level.
It is deplorable to note that out of the 753 local units, as many as 649 do not have hospitals. It is, however, heartening to note that the foundation stones for as many as 309 basic health service hospitals were laid at as many local units across the country the other day. The government is planning, as per the policy and pogrammes of this fiscal year, to establish such hospitals at all local levels. The hospitals will have well-equipped infrastructure, medical equipment and an adequate number of doctors and health workers. The concerned local governments have been assigned the responsibility for looking after the completion of the hospitals by heeding the cost, quality and timeliness.

New era
A new era has dawned in the healthcare sector with the government's initiative in establishing basic healthcare service hospitals at all local units. This will give some relief to people, not least to those living in remote or rural areas. The government should also establish well-equipped hospitals in the districts that have none so that the need for referring patients to Kathmandu and other cities can be obviated. Moreover, the provision of free basic healthcare services and social healthcare insurance for non-basic healthcare services as stipulated in the National Health Policy should be implemented without delay. This will assure people that the government has taken the initiative in making reforms in the health sector, besides helping Nepal to meet international healthcare standards.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000.