A few months ago, we all heard the news that the Federal Government of Nepal was kicking off a major initiative to overhaul the public health sector with a pledge to build hundreds of new hospitals and health care centres across the country. The plan is to build 396 health centres, a huge commitment that, once delivered, will truly make a difference in people's lives. Yet the pledge took many by surprise because the government has always been struggling to make good on its promises on public health.
This new "Public Health National Mission" should generate interest among the public rather than just disbelief and scepticism, and this would be an opportunity to also involve the private sector because all hospitals being run for a profit must be included in a new national health system, and the roll out of the National Health Insurance should facilitate such a process
Dr Govinda KC, the public health grassroots campaigner and activist, with very mixed results at best, has been trying for years to have the state commit on major reforms, bringing transparency and accountability on a sector that is so important for a prosperous nation. Just in November,16 emergency doctors at the Bir Hospital resigned en masse for lack of basic personal protective equipment.
Infrastructure is a major component of a national public health service, and without modern and functional buildings, it would be hard to attract the technical human resources needed to run them, forcing citizens to come to the capital. Obviously the issue is much more complex, and it also relates to human resource management, including pay and benefits, but having proper buildings in place can make the difference. Thankfully to foreign governments, major health infrastructure and services have been ramped up in the recent years, and some major undertakings in the Kathmandu Valley are being constructed.
Very promising is also the National Health Insurance, a programme that was initially backed by Germany.
Just a few days ago, there was news that soon it would reach all the 77 districts, with the initiative soon being launched in Taplejung, Dolakha, Bara, Sarlahi, Manang and Mustang, Kathmandu and Lalitpur.
The recently launched USAID Country Development Cooperation Strategy for Nepal 2020- 2025 renews the commitment of the American government in the field of public health, with investments focussed on equitable access to health.
Yet the country's public health is in a shambles, and we know that it could be even worse despite all these commitments from international partners. The vicissitudes at the Bir Hospital are a case study of how most of the public hospitals are being run, and this is far from being standard bearers: lack of technical staff, medicines, proper equipment or when equipment is available, a lack of know-how.
A big announcement like building hundreds of health units is definitely a matter of scepticism but also a matter of hope, and I want to focus on the latter.
We have an incredible opportunity to really create a national health service, and let's make sure that the plan for these hospitals and health care centres will be delivered. As economist Mariana Mazzucato says, this should be a national "mission".
For Mazzucato, a professor of Economics of Innovation and Public Value at UCL in London, a national mission is a huge effort to have the state take the lead in catalysing efforts to solve a huge national challenge.
It is a task that governments cannot undertake alone, but governments can provide funding and partner with the private sector and civil society to deliver public interest initiatives.
Together with education, health is one of the major determinants of persistent and profound inequalities in the country that have been only exacerbated by the pandemic.
I want to give the benefit of the doubt to the Federal government and believe that there are sound and detailed plans in place with funding already allocated to build these 396 essential health infrastructures, but we need to be part of the project.
This new "Public Health National Mission" should generate interest among the public rather than just disbelief and scepticism, and this would be an opportunity to involve the private sector as well because all hospitals being run for a profit must be properly included in a new national health system, and the roll out of the National Health Insurance should facilitate such a process. Civic engagement after all starts with people taking a keen interest in the health of public affairs, and why not start with this massive enterprise? NGOs working on health together with external development partners, all of them, should focus on this plan with debates and discussions, locally and nationally.
The federal and provincial governments should themselves facilitate these debates, involving and engaging the public, sharing and discussing the detailed plan for each of these 396 hospitals and health centres.
Public interest and engagement also bring accountability, and we have already several interesting technological tools that can help keep an eye on the development works going on in the country.
For example, Accountability Lab and Young Innovations have been piloting effective monitoring tools that help track key data about essential development work, bringing higher levels of efficiency. The same can be done in a true spirit of collaboration and partnership for this Public Health National Mission.
On April 6, the Nepal Health Conclave (NHC) is being organised, and hopefully, this will be an opportunity to discuss tangible changes that will improve the lives of all citizens, regardless of their economic and social status. Events of such a nature can help lay the foundation for a truly public health renewal in the country.
After all, it is the job of every citizen to take a deep interest in an issue that affects them directly, and that's why we need a Public Health National Mission together with a "396 Campaign" to keep the government accountable to its promises.
Galimberti is the co-founder of ENGAGE, an NGO partnering with youths living with disabilities
A version of this article appears in the print on April 5, 2021, of The Himalayan Times.