Unhealthy Health Care System

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In the last 25 years, the health care system of Nepal has been revised about a dozen times; however, the policies have proven to be restrictive, repetitive, and unimaginative with no clear roadmap. There are fundamental flaws in how the health policies are devised and executed by the government. Be it “Nepal's National Health Policy, 1991” or “Nepal's Health Sector Programme - Implementation Plan, 2004-2009”  or “Second Long-term Health Plan, 1997 -2017”, the focus of the promulgated health plans and policies have always been stagnant on ensuring the accessibility of essential health care to the general populace of Nepal without any pre-defined set of progressive actions.

Owing to this ineffectual policy formulation and implementation, the dedication and hard-work of tens of thousands of medical/non-medical professionals have been unable to substantially improve the health standard of the nation. Based on 2013 United Nations (UN) statistics, human development index of Nepal is 0.54 in the scale of 0-1 and infant mortality rate is 39%, placing us at 145th and 132nd position out of 193 member states of UN, respectively.

There is an evident ethnical, environmental, and infrastructural diversity across Nepal which directly or indirectly impacts the health-related problems and subsequent provisioning of health services. Hence, it is unrealistic to devise a common health policy and bring the entire nation under the umbrella of a single health care system. The rural areas of Nepal inhabit largely illiterate people who have limited reach to medical information and health care facilities. There are numerous instances when basic hygiene-related carelessness, common communicable diseases and minor maternity issues have proven to be fatal amidst this populace, like the episode of diarrheal outbreak in Jajarkot, 2009 which killed more than 200 people. Hence, it is prudent to embrace policies/actions of disseminating primary health care service and basic health education to the rural population. This policy, however, might not suit the urban community that have multiple means of acquiring health information, easy access to drugs, and better reach to hospitals/health centers. Hence, to start with, health policies need to be localized and should address the major issues pertaining to that region. Moreover, the policies need to be more detailed and should be tailed by a phased road-map of set of actions.

Further, there is no provision/policy from the government to provide universal coverage for medical care of Nepalese citizenry. The patient’s health treatment is mainly based on out-of-pocket expenses; therefore, the type of care received by patients in hospitals is dependent on fee they can afford. Many hospitals in Nepal including Tribhuvan University Teaching Hospital label the hospital sections on the basis of the economic affordability of the patients so that the staff understand the patients’ financial situation before providing them with economically appropriate medical care. In lack of national health coverage plans, there are numerous instances when patients have gone bankrupt while paying their medical expenses or have lost their lives unable to afford the proper health care.

To aggravate the situation, the environmental settings of villages and cities in Nepal are very health-unfriendly. One of the major objectives of “Three Year Interim Plan, 2007/08 – 2009/10” was to provide technical assistance to coordinate with the concerned ministry and non-government organizations for the provision of healthy environmental standards and hygiene related services in municipal areas. This initiative has utterly failed in regulating the air/water pollution and food adulteration standards in the country.

 The particulate matter with a diameter of 10 micrometers or less, aka PM10, is a deadliest form of air pollution due to its ability to penetrate deep into the lungs/blood streams unfiltered and therefore, is designated as Group 1 carcinogen by World Health Organization (WHO). The current average level of PM10 in Kathmandu Valley is 254.75µg /m3, which is more than twice the safe threshold of 120µg/m3. The situation is no better in rural areas where, owing to sanitary issues, water and food borne diseases like, typhoid and cholera are commonplace. The inhalation of this doubly-polluted air, drinking of insanitary water and consumption of vegetables with unsafe level of pesticides have upscaled the propensity of sinusitis, bronchitis, heart disease and multiple forms of cancers amidst the denizens.

The flaw in the health care system of Nepal stretches far beyond futile policies and substandard environmental conditions. Insufficient financing from government and people’s flippant attitude towards health check-ups are equally responsible for it.

Only 5.4% of the national budget for the fiscal year 2014/15 (i.e., NPR 33.5 billion) is dedicated for improving the health service delivery. It is not only surprising but also ridiculous that twice this amount (i.e., NPR 65.94 billion) is provisioned for the national defense and security of a comparatively peaceful country. In Nepal, the health spending per capita is around USD 25, which is way below than the threshold of USD 44 per capita estimated by WHO’s Taskforce as necessary to provide key health services to everyone with a minimal income. For a country with meager health standards, this insufficient allocation of government resources in the health sector is unwise and equally alarming.

Nepal's interim constitution, 2006 has established free basic health care service as a fundamental right of every citizen. To ensure this, there have been few initiatives from the government in the past. One of them is a national free delivery policy, Aama. With the financial assistance from the UK Department for International Development (DFID), this project was launched in January 2009 to give priority to safe motherhood in Nepal. To foster such targeted projects and to encourage affordable health service in general, the budgetary allocation from the government should align with the constitutional declarations. The revenue collected in the form of tax should be cautiously utilized in providing either a subsidized health service or in promoting a national health coverage plan so that the service utilization is not limited by the patient’s economic potential. Further, government should target a preventive method of health care system rather than curative by defining and properly regulating the standards of human essentials like, food, air and water.

Moreover, we, the citizens of Nepal, have a very different perspective towards health and wellbeing in general. Our unhealthy attitude of enduring ill health until they reach severe conditions not only puts us in economic disadvantage but might also endanger our lives. The practice of undergoing regular and timely check-ups needs to be cultivated among people, which will help both the patients and hospitals benefit from a stronger primary health care system focusing on awareness, self-management and preemptive care. This will help people manage their health within the community and reduce the pressure placed in secondary care within a hospital setting where patients are admitted severely ill or at the terminal spectrum of their disease. It will also lessen hospital costs for patients and save the health cost for the country.

Change in people’s perspective towards health, prudent investment of national resources and effective health/regulatory policies from the government are mandatory if we want to uplift the health standard of the country.

This article was published on Republica on 2014-08-06.





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