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 150th 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.
WEEK IN REVIEW
Something extraordinary did happen this week which makes me imperative to jot it down and post it here. From sports to the medical field something one of a sort had taken the headline.
- Muttiah Muralitharan bid farewell to the World of Cricket with an extraordinary career of a 800 hundred wicket as a bowler.
- Rudy Koertzen retires from umpiring in International Cricket with the last test being that between Australia and Pakistan.
- Pakistan registered their first test win against Australia in more than a decade
- Ben and Angela Ihegboro, a Nigerian couple gave birth to a white baby thus reminding us that we all were inherited from the same ancestor.
MOUNT EVEREST-THE ECHOES TO BE HEARD
Mount Everest which is also called Sagarmatha (Nepali) and Zhumulangma (Chinese) is the highest peak of the world measuring a height of 8848 metres above the sea level. The mountain belongs to the Himalayan range and is located at the border of Sagarmatha Zone, Nepal and Tibet, China. Although there were multiple attempts to climb the mountain since early 1920’s, it was in the year 1953 that the duo pair of a Nepalese Tenzing Norgay and New Zealander Edmund Hillary first accomplished the mission. Since then almost 3000 climbers have attempted with more than 700 climbers having successfully scaled the summit. However, with the number of successful summit, the morbidity and mortality has also increased proportionately. Although the charm of the Mount Everest does lie in all, the various aspects that concern have to be dealt with lest some menace do occur.
Morbidities and Mortalities
A retrospective study done by Dr Paul G Firth and published in the British Medical Journal examined the pattern of death among the climbers on Mount Everest from the year 1921 to 2006. The noteworthy finding of the study which supplemented previous studies was that the death rate on Mount Everest is greater than that of lower mountains attempted by similar populations of climbers; the death rate among climbers is higher than that among Sherpa; majority of the death occurring at height above 8000m (the death zone) during descent of the summit. The cause of death in Mount Everest was classified as involving trauma (objective hazards or falls), as non-traumatic (high altitude illness, hypothermia, or sudden death) or as a disappearance. The blood oxygen saturation level even at the base camp falls to 85% (98% to 99% at sea level). The level of oxygen in the blood progressively declines at higher altitude. Although the use of bottled oxygen have been a boon, however other factors as exhaustion, extreme temperatures and the physical hazard are a posing factors for the increasing calamities.
More than two hundred deaths have been reported to have occurred at level above base camp. The death of the population of Sherpas and other climbers appears a little different in etiology. The deaths of Sherpas have in majority occurred at lower sections of the climbing routes which are prone to avalanches. This has been linked to external factors as longer stay attributed to time taken for transport of equipment for the climbers at the extreme situations. The deaths of climbers have been seen more during the descent from the summit related to the neurological and respiratory conditions. This may be as failure of acclimatization to the environment at such high altitude. Besides, increasing crimes at the high altitude and morbidity related to the adverse environment as altitude sickness and extreme cold also poses a major problem.
Environmental and Ecological impact
Following the successful summit of the Mount Everest, the number of climbers has increased drastically in the Himalayan Region. There are also additional Everest tourists and those exploring the region for various purposes. This has been a source of influx of revenue to the region and also source of improvement in the daily living of those associated to the mountaineering. However, with this the ecological system of the region has also become more fragile with evidence of so called adverse environmental effects of tourism. Garbage on the mountain that includes climbing equipment, foods, plastics, tins, aluminum cans, glass, clothes, papers, tents, and dead bodies have caused the region to be labeled the Highest Junkyard of the World. It has been estimated that there are about 50 tonnes of waste at the Everest region. Realizing the reciprocal impact of the tourism to the environment of the region an initiative by the government had been taken with inclusion of the Everest and surrounding area to the designation of Sagarmatha National Park and the area was made a Natural World Heritage Site. Although, the effort has been started for the conservation, the area still has to bear the brunt of the impact of deforestation, pollution and increasing population of the region. Various Non government organizations as the Sagarmatha Environment Expedition (SEE) were established with the initiative of cleaning the Everest. SEE led by Brent Bishop has hauled more than 18,000 pounds of trash from the Everest. In the wake of environmental activism, Ministry of Tourism cut back the number of expeditions allowed yearly and also raised the climbing fee in 1992. Another initiative that was implemented was imposing a must deposit of four thousand dollars from each expedition with returning it on assumption that they bring down as much trash as they carried. Other measures taken include prohibition of deforestation on the mountain and the sale of bottled drinks in the surrounding park. A portion of the climbing fee has been utilized for the collection of trash and cleaning of the region. Although efforts have been made for the conservation of the region to its natural conditions, the area still bears the brunt. Recently a group of Sherpas climbers have taken an initiative to clean the Everest which is noteworthy and to be appreciated.
Allure and hype of records
Climbing Mount Everest is obviously an allure to the trained climber. Thousands of climbing enthusiasts have attempted to reach the summit since the first successful attempt. It should however be noted that various factors do affect in the success of the expedition. Personal experiences, weather factors are the most important issues that have major prognostication values on the success of the trip. Improper training and preparation, non acclimatization of the conditions are the major factors that contribute to the major morbidity and mortality of climbing these high mountains. Even for the most experienced climbers, calamities do occur at instances owing to various environmental and other issues. Recently, individuals are so perplexed to combat the expedition without previous any experience or for sake of records or prestige risking the lives of many on the way with disasters. Recently, hype surrounding the climbing of the Mount Everest has posed a source of controversy from everywhere. A noteworthy event is the recent climbing by a 13 year old teenager for the sake of record holding and propagandas attempting to surpass the record hold by a Nepalese Temba Sheri Sherpa. A sparking controversy arose in the world community and among child rights activist regarding this ascent. They have challenged with criticism that climbing of Mount Everest is itself a challenge to the most experienced as evident by death of climber who have had multiple successful attempt, the teenager Jordan Romero is physically and mentally immature to scale. As there was no any casualty, this issue has been dissolved however it would have sparked to wider extent had the event turned around. Another noteworthy remark regarding this event lies on the fact that the summit of Mount Everest lies on Nepal and Tibet. On this circumstance Romero had breached the law of Nepal as Nepal government has posed a lower age limit of 16 years to climb the Mount Everest. Recently, China has too barred an age limit for the climbers. Moreover many various individuals with different walks of life having no prior experiences and training are too attempting and poised to even endanger lives for the mere achievement of the feat. Cumulative efforts and initiative should be taken from both the Nepalese government and Chinese Government to curtail such activities and for preservation of the heritage site.
Mount Everest and the Himalayan region are a natural heritage and the preservation of this rests on not only on the Government but also should be on individual basis. A sense of responsibility and sentiments from the climbing fraternity, locals and everyone associated directly and indirectly would go a long way in improvement of the environment in and around Mount Everest.
A LAYMAN’S PERSPECTIVE AND EXPECTATION FROM THE NEPALESE POLITICS
http://www.telegraphnepal.com/news_det.php?news_id=7708
A layman’s perspective and expectation from the Nepalese politics
Dr. Prasanna Ghimire
Currently in China
Nepal has always been a country witnessing the changes within itself in its timeline of existence. Bounded by two evolving super power, Nepal has always been a subject of concern to most foreign countries. This fact has often been taken as an instance to divert we the laymen from the reality of the state by the so called politicians and leaders of our country.
Political turmoil envisioned by the country had not just been the ordeal of the past but rather ordeal for decades to come. A question just lingers in every layman as to whether we were destined or were compelled to bear this way? We, Nepalese nationals have witnessed the various political transition of the country and most of us have been dragged by those events. We were always innocent to be driven by those words of the politicians that we forget their past resolution and we are defying from repeating the same mistake to be buried again.
Democracy as we all know is the rule by the people for the people, but does it make any attribute to our nation? What did we gain in these two decades of democracy besides the cultivation of religious, cultural, social discrimination and unrest? Was it what our long desired democracy offer to us? Almost two-third of the current population was fortunate enough to have witnessed the democratic revolution of 2046, the so called Jana Andolan I. We still can recall how much euphoric all of us were to the democratic transition. We all hoped for a brighter future for the country and to us.
Frequent reshuffle of government was the observance in the time to follow for we the laymen, and we just hoped that new government will be a worthwhile which can live to the expectations of the general mass. Seasons come and seasons change, so had been the political scenario of the country which was so volatile to be. The country had been vaguely crippled by nepotism. Also began the tradition of bandh by various parties and organizations to cripple the nation and to affect the general public making them struggle for daily living. We just hoped that one day a change will come paving a road for the country’s well being but we were just doomed to be right.
This instability in the political process with counter accusation of leaders to each other had already dragged the country to a darker side which was to be further amalgamated by the newly boomed Maoist. The decade long insurgency that followed led the country to another dark era where we now faced the sense of insecurity in our own country. The country faced an almost complete halt in every aspect of development with destruction of the countries’ existing so called infra-structures (not to be mentioned how concrete they were thanks to the politicians) and no any new project underway.
The loss of more than ten thousand brothers and sisters in this decade long war can hardly been forgotten as it is we the laymen who are perished and whose tears filled the eyes and suffering was in the store for the years to come. It is our brothers and sisters be it from the state side or the other who were there enduring the sufferings while leaders remained in safer places of Kathmandu.
Although some consider it as battle against so called aristocratic high class to justify the reason for the insurgency, it definitely acted as dividend of the integrity and harmony of the society with again came as a suffering to the laymen. The so called Jana Andolan II was considered as a major turning point for the country whereby the Maoist came to the main political stream, abolishment of the century long monarchy and establishment of a democratic republic. Much was anticipated from the Maoist by the general public envisaging that a radical change in the country would be made possible. The constitutional assembly election paved the way for the Maoist to perform now as the state authority after they emerged victorious as the lay man entrusted them for a change. As what Lord Acton said “The danger is not that a particular class is unfit to govern: every class is unfit to govern”, the oppositions did not realize what disarray they did all through yesteryears that they now self claimed as the righteous ones to govern even at this losing stage.
With toppling of the Maoist led coalition government following resignation of the then Prime Minister Pushpa Kamal Dahal, May 4, 2009, formed a coalition government led by UML under Madhav Kumar Nepal. This government was considered illegitimate since its very inception and the general public had very little confidence that it can bring all the political parties under one roof and attain the task of constitution drafting. Formation of a high level commission among the major parties to sort out the existing differences and promote a logical direction of the political vacuum was disarrayed by the death of Girija Prasad Koirala. The demise of the NC president then resulted in the self proclaimed seniority for the vacant post in the Nepalese Congress. Recently, a wave of protest demanding resignation of the prime minister of the present government was proclaimed as the Jana Andolan III. The atrocities and burden to the country and general public could not be understood by the leaders who were staging the protest as well as those who were driving the nation.
The protesting leaders considered it as a major success but they do not have the legitimate right to consider this unless they view from the general public’s perspective. Be it the foreign intervention (as we have been hearing it since old days to our politics by our dear politicians), or some domestic or internal matters resulted in the discontinuation of the protest is of less concern to the general public (also called MAHAN NEPALI JANTA) who now breathe a brief sigh of relief that they are able to continue their ordinary life till another wave erupts.
2010-05-19 07:16:00
Prasun's Words 