The government has introduced a scheme under which poor and destitute people will get, with immediate effect, free indoor and emergency services in the district hospitals having 25 or fewer beds. It has allocated Rs.50 million, to begin with, for the purpose, providing Rs.150, 000 to each 25-bed district hospital, Rs.100, 000 to each 15-bed hospital, and Rs.50, 000 to each primary health centre. This will put district hospitals in a financially better position than in the past to provide free services to the needy. The findings of a survey in four district hospitals show that, on an average, out of the patients seeking medical services, 40 per cent belong to the “poor and destitute” category, 40 per cent can partly pay the charges, and 20 per cent can take the tab fully.

This move, the first of its kind in Nepal, can be expected to go some way towards meeting the urgent medical needs of destitute people. This provision is slated for extension to hospitals with more than 25 beds in a month. The concept is based on equity as it charges those who can pay, and waive the charges depending on the status of patients. Such an approach should have been adopted long ago in essential sectors like health and education. The taxpayers’ money must be optimally utilised in a country where a large part of the population lives below the poverty line. This step assumes further significance at a time when the finalised interim constitution recognises services like education and health as fundamental rights. No citizen should be allowed to die or suffer for lack of timely medical treatment. In light of experience, however, particular care needs to be taken so that financially better-off patients may not misuse the facility and hospital officials may not pad the names of patients.

As the initial allocations are bound to fall well short of the needs, there is a provision for increasing the grants depending on demand, and also the policy of extending the scheme all the way to the central hospitals. In Nepal where the shortage of funds is common, there is no better alternative to adopting an approach that lays emphasis on providing concessionary or free services to the absolute poor, progressively increasing the charges to realistic levels with the economic level of the service seekers. While the cost of services is a vital part of medical treatment, the quality of services in government hospitals and health centres is no less so. But the latter has deteriorated over the past few years, especially when the private hospitals and nursing homes sprouted, making conflict of interest among medical staff all the more noticeable. Most district hospitals are far short of even the officially alloted number of doctors, and far-flung health centres are reported from time to time to provide medical services through non-medical staff in the absence of doctors or even paramedical staff. Improvement in these and other related areas is necessary to ensure that ordinary citizens get the full range of services available in government hospitals and health centres, combined with the reasonably good quality of medical and non-medical services.