Nepal | May 20, 2019

EDITORIAL: Review priorities

The Himalayan Times

The government needs to refashion its approach to healthcare including the need of improving administration of health services in public hospitals

A committee formed by the Ministry of Health has reported that the government has given more priority to donor-driven health programmes than to those areas of healthcare that can benefit a larger number of people. The report says that the ordinary people’s right to basic health services has thus been ignored and that most of the health budget is spent on donor-driven programmes. It is generally felt and often reported that in almost all sectors of development, most of the projects and programmes have the heavy influence of donors – countries or multilateral agencies. However, not all the programmes endorsed by the donors may be unnecessary or less important.

But the government is supposed to set its health priorities for the benefit of the general public – for basic health as well as health care which needs advanced technology and super-specialization and more money per person. The report gives the example of almost all hospitals across the country having anti-retroviral treatment and CD-4 count service, which are helpful to HIV patients, whereas several hospitals do not have caesarean sections for saving the lives of women at childbirth and newborn babies. The lack of priority to basic services is also reflected, as per the report, in the fact that even some zonal and regional hospitals do not have basic diagnostic devices, like an electrocardiogram (ECG). The report sees the need to increase the purchasing power of the general people in order to improve the overall health indicators of the country. It also criticizes the government’s policy of reimbursing the part or whole cost of various services provided by private hospitals, such as treatment for kidney failure, cancer treatment and uterus prolapse treatment.

The 19-page report submitted to the Ministry of Health points out areas where misuse of funds provided by the government is likely but poorly regulated and identifies several other anomalies or shortcomings. The committee report’s emphasis on giving top priority to basic healthcare is faultless, because first things should come first. Common health problems such as diarrhea cause many avoidable deaths. The suggestion for not going unthinkingly for almost any programme that donors may push without first deciding the country’s most important healthcare needs and the pros and cons of the donors’ proposals and their impact vis-à-vis other competing programmes. It is a good sign that a number of private hospitals and nursing homes have emerged over the past years. But it is also worth pondering whether the public health system of the country has been improved at the same time, which is of much more importance for the masses. Therefore, the health policy and priorities of the government need to be reviewed in the light of the need to provide affordable treatment to the largest number of people and for the largest number of health problems. However, stressing basic health services does not have to stop giving due attention to other diseases which may not be so common or which may involve more expense. The government needs to refashion its approach to healthcare, including the imperative, but often neglected, need of making much more efficient and effective administration of health services in public hospitals across the country.

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Very unfair

Many mentally ill people are seen wandering in the streets in markets throughout the country. In Dipayal alone there is estimated to be around seven people who are severely mentally disturbed in the streets. However, that one such person who suffers from mental illness has been rehabilitated from the Pipalla market in Dipayal is to be welcomed. The mentally ill can in most cases be treated and managed provided they are provided with proper treatment. It is unfair to regard the mentally disturbed as a nuisance when they damage goods in shops, manhandle others and block the busy streets. The tragedy is that some unfortunate mentally ill people are in many cases abandoned even by their families.

As most of these abandoned mentally ill people do not know their identity it makes reconciliation difficult.  Mental illness is prevalent throughout the world and many patients do not seek treatment as they fear being stigmatized.  Nepal lacks the required logistics and psychiatrists to treat mental patients. There is only one mental hospital in the country in the capital city.

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A version of this article appears in print on January 26, 2017 of The Himalayan Times.


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