Kathmandu The Constitution of Nepal guarantees every Nepali citizen the fundamental right to free basic health services along with emergency facilities and equal access to healthcare. However, even with the number of hospitals and health service institutions in the country increasing steadily, the government has been unable to safeguard the basic right of its citizens as many people, especially those belonging to marginalised communities, rural and remote areas or underprivileged societies, still do not have access to quality health services. CURRENT SITUATION To ensure quality health facilities to Nepali citizens, the Ministry of Health and Population (MoHP) tabled the Public Health Service Bill under The Public Health Service Act in 2018. Sushil Nath Pyakurel, Director General at Department of Health Services (DoHS), shares that now that the Act has been introduced, everyone including the government is becoming aware of the deadly effects of the increasing air pollution, water pollution, use of pesticides and insecticides in fruits and vegetables on people’s health. He says, “We will be preparing codes under the Act shortly which will make its efficient implementation possible in the coming days.” According to him, the Act will also set specific type and standard of services that various types of health institutions are supposed to provide to citizens. Pyakurel informs that in order to ensure the availability of free basic healthcare and maintain minimum service standards, adequate budget is required, which, as per him, is not sufficient at the moment. In the current fiscal, the government has allocated Rs 56.41 billion for the country’s health sector. He says, “Only about four per cent of the total budget amount has been allocated for health sector in Nepal, more than half of which is usually spent on healthcare professionals’ salaries and incentives.” He estimates that only one per cent of the budget allocated for health sector can be spent to uplift the public health sector. “It is the government’s responsibility to ensure the availability of free basic healthcare to civilians and to do that effectively, it must increase the budget allocated for the health sector.” “People’s awareness regarding their health is steadily increasing but unfortunately both private and government health sectors have not been able to meet the demand of public seeking quality health services,” says Anjani Kumar Jha, Immediate Past President of Nepal Medical Association. He adds, “As the government continues to transition to a federal system, issues regarding health infrastructure and professionals are still prevalent.” Jha points out that with the change in medical science practices, people who seek care from medical specialists are steadily increasing. He further says that the government has not been able to provide adequate number of specialist health care professionals to the public across Nepal. PROFIT OVER SERVICE  As per the data provided by DoHS, the number of institutions involved in the delivery of basic health services in the fiscal 2010/11 included 117 government, non-government and few private teaching hospitals, 208 primary healthcare centres and 676 health posts. However, as per the data pertaining to the fiscal 2017/18, the number of public hospitals reached 125, along with 1,822 non-public health facilities, 198 primary healthcare centres and 3,808 health posts. The statistics are evidence of the fact that health sector of the country is gradually gaining momentum with ample participation of both public and private sectors. Jha informs that even though the numbers of private healthcare institutions are increasing steadily, they are mostly centred in urban areas where people can afford such services. On the other hand, he feels that public health institutions face problems like lack of equipment and quality of healthcare. “There are many private hospitals in Kathmandu and bringing patients from all over the country to these private institutions is not an option. Private sector invests a lot of money in the health sector for profit generation, which may be the reason why it has not been able to extend services all over Nepal,” shares Jha. He adds, “Not all but some private health institutions charge a lot of money from patients and that is why I feel that many people refrain from going to such places for treatment. That being said, a systematic approach of healthcare and adequate health equipment and healthcare professionals are absent in many central government hospitals due to which these institutions are unable to handle the huge number of patients all at once.” Jha informs that patients often need to wait for long to acquire public health facilities, which eventually compels them to seek services of private hospitals. Bishnu Prasad Timilsina, Deputy General Secretary at Forum for Protection of Consumers’ Right-Nepal feels that health institutions need to be service oriented rather than profit-oriented. As per him, at present, existing public health institutions do not provide good service while the private sector is entirely business and money-oriented. He questions, “How can something as important as healthcare become a mode of profit generation?” Timilsina opines, “Health and education should be taken over and controlled entirely by the government so that everyone can afford and access health services. Along with that, the government must fix reasonable price for both health services and medications and provide free healthcare facilities.” He also shares that the authorities responsible for monitoring health institutions are negligent which has made health sector monitoring ineffective. On the other hand, Pyakurel shares that lack of monitoring is to be blamed on the lack of human resources in MoHP, which is only enough to monitor public health institutions. He assures, “Once the minimum service standard is set, each health institution will have to provide quality health service with essential machinery and must employ sufficient heath manpower.” NEED OF THE HOUR Just last year, the spread of viral fever claimed the lives of more than 14 people in Jajarkot while more than 2,000 cases of dengue were reported in Dharan this year — all of which paints a dismal picture of the existing health sector of Nepal. From lack of primary healthcare services, healthcare professionals, nutritious food and safe drinking water to poor living conditions, increasing climate change and natural calamities, the livelihood of Nepali people is affected by various factors leading to diseases like diarrhoea, influenza, cholera, dengue, malaria among others. And at a time, when problems like lack of health professionals, hospitals and medical specialists in rural areas is rampant, the government must make health service accessible to all, especially to those individuals who cannot afford to pay expensive medical fees in private hospitals. Pyakurel informs, “The current focus of MoHP and DoHS is to upgrade the quality of hospitals in each province and develop potential of existing health training centre and laboratories. Apart from that, the government should prioritise the health sector and increase the budget for the welfare of public health.” Jha shares, “The government must create a channel through which patients from primary health care centres or district hospitals spread across the country can be referred to central hospitals. In addition to that government postings of medical specialists must be increased, healthcare professionals must be questioned if they fail to appear at their designated posting districts.”