For any social health security programme to succeed, first health delivery at the government health institutions will have to improve drastically

The federal government’s decision to hand over the responsibility of managing and regulating health institutions to the provinces is in line with strengthening the spirit of federalism. On Thursday, the Ministry of Health and Population handed over the regional hospitals, sub-regional hospitals, zonal hospitals, district hospitals, regional ayurveda hospitals and district ayurveda health centres to the provinces. However, the Koshi Zonal Hospital, Narayani Sub-regional Hospital, Bharatpur Hospital, Bheri Zonal Hospital and Dadeldhura Sub-regional Hospital are to be developed as tertiary level hospitals with specialised services, as per a decision of the Cabinet. The provinces have also inherited all regional health directorates, regional health training centres, regional medical stores, sub-regional health training centres and district public health offices. The Ministry of Social Development of the provinces will manage these hospitals until the provincial laws are enacted. With the handover, a heavy responsibility has fallen on the provincial governments in providing quality health services that are affordable to the people.

Although the onus of providing healthcare to the people now lies with the provincial governments, it would be naïve to think that they will have the skill and the resources to manage and regulate the health institutions on their own. Hence, the federal government is duty bound to help the provinces with both financial and human resources so that the health institutions are in a position to serve the people better. While the provincial governments must be upbeat about their new responsibility, the people must also have a lot of expectations from the provincial governments in terms of access, quality and affordability. The constitution has enshrined healthcare as a fundamental right of the people, but it is a very expensive service in the country. This is because of the total health expenditure, the private sector accounts for 70 per cent, and of this, more than 80 per cent comes from out-of-pocket payment.

Thus, making the government healthcare institutions more attractive for all – not just the poor -will be a major challenge for the provinces in the days ahead. The challenges facing the health sector are daunting, ranging from poor infrastructure of the health institutions and lack of drugs to inadequate budget and absence of human resources. One way

to overcome the paucity of funds is to have the people pay partially for the services they get. And this could be done through the promotion of the

National Health Insurance Policy. Under the policy, a minimal premium paid by each member of a family entitles one to health services worth Rs. 50,000, although this does not cover expensive medical equipment. The insurance programme provides access to preventive, curative and rehabilitative services. However, membership of the insurance policy has not been very encouraging largely due to lack of information and push by the government. The universal health programme could reduce the huge expenditure on the health sector. But for any social health security programme to succeed, first health delivery at the government health institutions will have to improve drastically.

Housing for poor 

The government has decentralised the housing policy to the provincial governments, which can implement it as per the priorities of the target groups. Till date, the central government was handling the People’s Housing Programme, which started some 12 years ago, for the Dalits, disadvantaged Muslims, Badis, Rajis and highly marginalised and endangered groups. But, a recent report from Kailali has revealed that the scheme has gone kaput because of its failure to connect it with the income and livelihood of the marginalised communities.

Learning lessons from the past, the provincial governments should implement the policy only after conducting their basic needs and priorities. As most disadvantaged communities are deprived of employment opportunities in their locality, they tend to migrate elsewhere in search of work. In Kailali’s Satti Municipality, the government had helped build around 30 houses for the Badis and the Rajis. But they migrated elsewhere in search of work, leaving their homes unattended. A need-based assessment is a must before launching such schemes meant for the target groups.