Saturday, 4 December, 2021

The Urgency Of Reviewing Health Policy

Mukti Rijal


I have tried to set up an appointment with doctors for check-ups and review on my own chronic case of diabetes and hypertension for last two weeks. I have been dialing the hospitals almost daily to know and confirm whether the doctors concerned could be tapped and consulted but, to my utter dismay, I have found the phone connections for enquiries mostly unattended, if not switched off. This shows that the private hospitals and doctors that have done thriving business during normal times and earning super profits tend to shy away and shirk to deliver services when the situation turns out to be risky or unfavorable due to one or the other reasons.
Needless to say, the country has been locked down due to the fear of coronavirus infection for the last two months. Of course, this has engulfed the world and presented an unprecedented crisis to humanity. In such a precarious situation, human health is under serious threat which does need in-time readiness, care and effective response from health service providers - be it private or public.
It is true that the global attention is riveted to find the ways and means to combat corona virus. But it does not mean that threat to human health generated by other communicable and non-communicable diseases apart from corona does not exist. Some reports during the last fortnight indicated that the private hospitals and health service providers in Nepal refused to take in obstetrics patients to redress pregnancy complications. This nay saying of the private hospitals has meted out hassles and unnecessary detours resulting into further aggravation and health deterioration .There have been instances of deaths of patients after hospitals reportedly refused to take in or allegedly mishandled the cases.
When the country is in dire need of medical facilities and logistics to meet growing challenge of growing corona infections, the plum private hospitals and health institutions seem to be back tracking on their responsibilities oblivious of their core mandates and tasks. The private hospitals and health service providers seem not expectedly forthcoming to extend their helping hands to provide services to the people when they knock at their doors. The lukewarm and reluctant response of the private hospitals that have occupied prominent place and enjoyed dominance in health service delivery landscape has sparked a debate questioning the rationale of the private sector in service delivery in an effective and affordable manner. They are believed to be more equipped, competitively managed and resourceful relative to the government aided public hospitals. In fact, the cooperation and participation of private hospitals with their pool of experts and capacity of medical facilities and logistics in handling corona crisis could definitely mitigate the load borne by the government sector.
It is relevant to note the fact that the government-aided health institutes and facilities are also not in proper shape and many of them are operating in a shabby manner. Moreover, according to a report, the government hospitals has a limited number of intensive care units (ICU), ventilators and other vital equipments which are necessary to treat the critically ill corona affected patients. As the number of the infected people has gone up exponentially in the recent days, more isolation wards and intensive care facilities will be needed to handle the patients.
The much feared probable scenario will be difficult to handle if the private hospitals do not join hands with the government to tackle the challenge. In fact, according to a report, in terms of national capacity, four types of hospitals operate in Nepal namely public hospitals (known as government hospitals), private hospitals, nursing homes, and medical colleges. Around 700 big and small private medical establishments are said to be in operation, along with 19 medical colleges during the normal times. In the public health domain there are three federal level hospitals, seven regional hospitals, and 77 district hospitals, in addition to smaller health and sub-health posts in local units.
At this time of crisis, government hospitals alone seem to be fighting the corona battle with private sector acting as a hesitant bystander. The constitution of Nepal guarantees right to basic health services to citizens saying no one shall be deprived of emergency health services. The constitutional provision creates an obligation upon the government to enhance its greater involvement in quality health services delivery as people are entitled to take the government to task if their basic health rights are not taken care of. In the quest for delivering health rights as core public service, private hospitals should also be made responsible to contribute. The government should regulate the private hospitals to this end setting some standards and conditions for health service delivery.
Be that as it may, private sector has expanded its role in health sector mainly as health service provider and medicine producer following the adoption of enabling national health policy in 1990. Private hospitals have been required to set aside 10 per cent of their total beds for free treatment of the poor and marginalised communities.
According to the Auditor General’s reports issued time and again, most private hospitals are not implementing this provision. This indicates that private hospital are not observing the terms of regulations, the government should revisit and review health policy and expand its role in delivering universal health service to the people.

(Rijal, PhD, contributes regularly to TRN and writes on contemporary political, economic and governance issues.