Nepal’s health sector has miles to go
If numbers are made the basis to see how the land lies in our health sector, one can’t say fairer than that. However, in reality, the situation suggests otherwise. The government boasts of 4,750 public health institutions, including 11 central level hospitals, 31 regional hospitals, and 130 district level hospitals, but the availability and accessibility to health services still raise a few eyebrows.
After the 2006 April uprising, the Interim Constitution ensured the rights of all Nepali citizens to enjoy free basic health services. Essential health care services related to
maternal health, child health and control of communicable diseases are provided free in health posts and Primary Health Care Centres. At district hospitals, outpatient, inpatient and emergency services, including 40 essential medicines, are free of charge to poor, vulnerable, and marginalized groups.
There are altogether 676 health posts and 3,134 sub-health posts (one at each VDC) in the country, all providing basic health care services. However, the demand of time has shifted to specialised health services with the change in the pattern of diseases from communicable to non-communicable.
“Despite the increasing number of public health institutions, we lack health specialists and staff nurses,” said Dr Baburam Marassani, senior official at the Ministry of Health and Population (MoHP). “However, with the ministry implementing a two-year compulsory service scheme for physicians who study under the scholarship of the Government of Nepal (GoN), medical doctors have been working in most parts of the country.”
Surya Acharya, joint secretary at Human and Financial Resource Management Division of MoHP, is on the same wavelength. He said the main problem of human resources in the health sector is the deployment and retention of physicians and nurses. However, there is a problem of deployment and retention of all categories of health personnel in the high mountain districts, Acharya said. “Also, coverage of health institutions and access to health services is not that good in mid-western and far-western regions.”
Majority of the government-funded hospitals are sick with dysfunctional equipments, and unhygienic environment, among many other drawbacks. Equally worrisome is the rampant tendency of skipping work in government health centres and attending to patients in private hospitals among many doctors.
Right after the launch of free medicine services people started pointing fingers at the quality of medicines. Also, complaints about stockouts of drugs and date expiry, too,
are rife in mofussil. The present iron pills controversy can be taken as a case in point.
In one of its report, MoHP says stockouts of medicine rose significantly in 2008 and 2009, and the problem of procurement of over-priced drugs in local level has surfaced. Seventy-five percent of health and sub-health posts had stockouts between March 2008 and March 2009, the report reads. Free medicines and services have mainly focused on communicable diseases. However, the pattern of diseases, too, have changed with the passage of time.
“Earlier, infectious diseases such as diarrhoea, pneumonia and others were the main problems. However, non-communicable diseases (NCDs) are more prevalent now and we
are still in the policy making stage on it,” said Dr Bal Krishna Subedi, MoHP spokesperson, adding that the expectation of people have also accentuated. “We have made much progress in the infrastructure side, but we are not much satisfied with the available services.”
NCDs are now responsible for more than 44 percent of deaths and 80 percent of outpatient contacts in Nepal. The present five-year health programme—Nepal Health Sector Programme-II—aims to address many of the pertinent issues, including NDCs, said Subedi.
The contribution of the private sector has been laudable in the health sector. However, there is a common perception that general public cannot afford private medical institutions. It is noteworthy that Nepal has made a commendable progress in achieving some of the Millennium Development Goals.
What kind of quality services can be expected when a health assistant hands over his tasks to a peon and doctors leave their tasks to unskilled ones? The mushrooming of health institutions doesn’t guarantee the quality of services. Majority of the health institutions are centered in urban areas and people in rural areas are clamouring for health services. More complicated issues have risen lately like cases of doctors’ sheer negligence. The authorities concerned have so many tasks to carry out. Ensuring favourable working conditions for doctors has never been a priority of the state. As long as these burning issues are not addressed, the overall quality of health services will remain mediocre.
Posted on: 2011-11-14 08:59
Post Your Comment
Today's Paper
The Kantipur in Print
FROM THE PAST 7 DAYS
ENTER KEYWORD OR DATE
FROM THE PAST 7 DAYS
ENTER KEYWORD OR DATE
Abin
All of them discussed the issue. The result was the same...and we have committed to continue discussions on the issue till midnight.
ADVERTISEMENTS
OUR PUBLICATION :
