Health sector : Despite increase in health budget, results are dismal

Kathmandu, January 23:

Nepal’s health expense, which is already twice as much as the nation’s economic growth, is increasing each year. However, the evidence of little progress in the field has raised question on the efficiency of the health care system.

Nepal’s total health expenditure as a percentage of the Gross Domestic Product (GDP) was 5.7 per cent in 2003 while the GDP growth rate was three per cent. The GDP growth in 2006/07 stood at 2.8 per cent while the government allocated 7.14

per cent of the total budget

to the health sector. Even when the GDP growth rate dropped to -0.5 per cent in 2002, health expenses remained at six per cent.

Although Nepal’s economic growth rate remained constantly low, health budget has seen a steady rise. Despite this the Ministry for Health and Population has been demanding at least 10 per cent of the total budget to bring about a perceptible improvement in the public health sector.

Giriraj Subedi, in-charge of the Health, Economics and Financing Section at the Ministry of Health and Population (MoHP) says there are reasons why the government should increase the health budget.

“We are at the stage of developing a health system for reliable health service delivery for which we have to make an investment,” he said.

Besides, he says the government expenses on health largely depend on the funds provided by external development

partners. “The government budget alone is insufficient for public health,” he said adding, “For instance, WHO has set $34 per capita spending on healthcare per year while Nepal’s per capita expenditure is only $12.”

Subedi says there are a number of factors, which help in determining the health situation.

“It is true that Nepal has allocated more budget compared to other SAARC countries but we have to calculate the cost of health infrastructure, per head expenses, cost of prescription drugs and hospital care that determine the government expenses,” he said.

However, renowned economist Biswambhar Pyakurel says budgeting alone cannot make a

difference unless there is a proper policy and the mechanism to implement it.

“The health and education budget has been increased but we still haven’t made any achievements. The main problem is the accessibility to the programmes. It seldom reaches the target group. Also, other expenditures such as administrative expenses are increasing which further adds to the burgeoning budget in this sector,” he said.

There are 89 hospitals, 186 health centres, 698 health posts and 3,129 sub-health posts across the country. Of these, three are regional hospitals (in the western and mid-western regions), eight zonal hospitals and 69 district hospitals. The remaining nine hospitals are located in the Kathmandu Valley.

Hospitals and health posts still have to be set up at the remaining six districts. According to the government’s health provision each constituency must have one health centre and each VDC must have a health post or sub-a health post. Moreover, these hospitals and health centres are always understaffed. Health assistants run most hospitals in rural areas.

A MoH report shows that out of the 100 posts for doctor allotted for eastern region hospitals, only 44 doctors are working. In the central development region only 104 doctors report for duty out of the 212 doctors allotted for the hospitals here. The western region has the highest number of doctors — 129 doctors for the 173 allocated here. The mid-western region has been allotted 66 doctors but only 24 doctors work here. The allotted doctor quota for the far-western region is 73 but there are currently only 28 doctors in these hospitals.

Subedi admits that the health system needs to be improved but says it will take time.

“There will come a time when an expected result is seen if you keep on investing,” he said adding, “For that we have to have a reliable health system for service delivery.”

Nepal has the highest expenditure in the health sector even though it has the lowest GDP growth rate among the SAARC countries. The overall health level of the nation’s population is relatively low with inequalities (or disparities) in health services. People living in urban areas get better health services as they can themselves afford to pay for these services. We have yet to see if this year’s Rs 310-million ambitious health plan to provide basic health services free of cost will further tax the burgeoning health budget or give the public some relief.