HEALTH SECTOR IN NEPAL AND ITS CHALLENGES

 As in many developing nations, health care in Nepal is provided jointly by the government and the private sector. The private sector is mostly profit oriented and is barely providing health care to the privileged group. The public health institutions are however the only hope for the remaining larger population. The services at these institutions are either not within reach of the majority of the population or simply lack the adequate man power, technology and infrastructure to provide the care for the needy.

According to the World Health Organization report on 2000 of the assessment of the world’s health systems, Nepal ranked 150^th out of the 191 member states. The report also highlighted the important fact that Nepal was one the countries which was having the least fair financing of the health system. This had been attributed to the inequitable distribution of the health care to the general population with failure in the implementation of the running health programmes.

The Alma-Ata declaration of 1978 to which Nepal abided to, affirmed health as a fundamental human right and that the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. Nepal has been adopting the primary health care (PHC) with essential PHC services for the last two decades. Various goals and targets were set for ‘Achieving Health For All by the Year 2000’; some of the goals include at least 5% of gross national product should be spent on health; at least 90% of children should have a weight for age that corresponds to the reference values; safe water should be available in the home or within 15 minutes’ walking distance, and adequate sanitary facilities should be available in the home or immediate vicinity; people should have access to trained personnel for attending pregnancy and childbirth; and child care should be available up to at least one year of age.

Nepal had developed and adopted a national health policy in 1991. A 20 year (1997- 2017) Second Long Term Health Plan (SLTHP) is also being implemented which mainly aims at improving the health status of the underprivileged, the most vulnerable groups, women and children, the rural population, and the marginalized. This was promulgated to deliver essential health care in equitable distribution to the community with their full participation by means of technically competent and socially responsible health personnel. Different national health programmes were devised to curtail the existing health problems; however these programmes achieved relatively few successes when considering benefit to the aimed population.  The reason for failure of these national health programmes can be attributed to be multifactorial. The most noteworthy factors that can be attributed to this are the lackadaisical approach by government officials and bureaucrats, non-scientific allocation of resources and uncoordinated implementation. The health ministry bewildered by its internal as well as external chaos also fails to enforce regulations that they themselves have created or are supposed to implement in the public interest. The availability of the resources at time s has not been justifiably utilized with waste of the medicines or facilities as expired or unusable state. By proper channels and coordination of the various levels of this chain of health system, this could be avoided and thus those facilities be utilized by the needy people. The Jajarkot incidence which took a heavy toll of life by a mere diarrhea or an outbreak of measles can exemplify how efficient and expedite management is of the government and health system to tackle any disasters. As a further setback, the existing allocations for the health sector have been curtailed off in the name for the various general development programmes which would barely exist.

A note must also be made to the volatile political scenario of the country which poses a great impact to the health sector. The monopoly and biased appointments have created havoc as seen in the recent shutdown of major hospitals with the brunt of the impact going to the marginalized society who cannot afford the expense of aristocratic private hospitals. Lack of security at working place, no proper incentive to the workers has led to massive brain drain in the medical field thus adding to the ongoing health related crisis. It should however be commented that the disarray in health sector doesn’t lie on the government alone but a major role also does play from the community as well as the medical fraternity itself. The various bandhs and inhumanly attitude of a part of the community has further dragged the health sector to dismay. The implementation of various essential health services and provision of emergency services to the needy have been affected immensely resulting in increase of the already high morbidities and mortalities.

The integrity of the medical fraternity itself is also in a mess and can also be questioned. In recent times, an inharmonious difference among the fraternity has also been an inculcating process to the disgrace of the medical community in general. Politicization and segmentalization of the institution has been a root for the dividend of the medical professionals. Be it the medical council’s election or any appointment of the members of the medical association, we have witnessed how much the system have been supervened by these processes. This has led to the deterioration of the already crippled health system thus warranting a drastic change to revert it. Over impulsive propagation of the hierarchy has also led to mistrust and bitter relations among the medical workers. Besides, the various incidences depict the widespread corruption, bribery, moonlighting and other illegal practices being practiced and encouraged by the health professionals themselves. The evil of commission, nepotisms has rooted so deeply that it deems very much imperative to wipe it from the bottom lest it corrodes the entire society.

 Recently it has been advocated that health insurance system be implemented to the large population. In a country where approximately 30 % of the population is living under the poverty line, although virtually it may appear beneficial to the poorest people, it however doesn’t seem quite practicable and realistic at the present context of the economic instability of the country. A more rational approach would be the proper training of the health workers, proper implementation and distribution of the available resources and education of the community from the grass-root level, to achieve the expected goals.

A sound vision from the policy makers with proper implementation of the programmes, an attitude of humanity above self from the medical professionals and a thorough commitment from the community will definitely be a boon to the health care system thus making a healthier Nepal.

August 25, 2010 | Categories: CURRENT AFFAIRS, EDUCATIONAL, VIEWS | Tags: Health | Leave a comment