If hospitals were to be integrated electronically, they could provide health care easily
Over the decades, the burden of non-communicable diseases (NCDs) has been increasing and now account for 71 per cent of all deaths in Nepal. Of the NCDs, cardiovascular diseases (CVDs) have become the leading cause of deaths and disability in Nepal, with them contributing almost 27 per cent or total deaths in 2017. Ischemic heart disease was the predominant CVD, accounting for more than 16 per cent of the total number of deaths. With the ever increasing cases of CVDs in Nepal, the country should consider itself lucky that patients do not have to travel outside the country for heart surgery or not even come to the capital for treatment. But this was not the case until the Shahid Gangalal National Heart Centre (SGNHC) came into being in 2001, which has now been established as the national referral centre for cardiology and cardiac surgery. Despite the SGNHC being the busiest cardiac centre in the country, there are, however, many shortcomings to address so as to upgrade the quality of health services it provides.
According to a team of South Korean doctors on a visit to the SGNHC, Nepal needs to upgrade its data recording system for the betterment of the health system.
They have found the hospital lacking the facility to record the data of patients, food delivery system and clothing. True, the patients carry with them all the papers and prescriptions with them every time they visit the hospital, as is the case with most other hospitals across the country. By not collecting patient's data at the hospital level, it prevents the doctors from fully understanding the patient's progress after treatment and what treatment would be required in the future. In low and middle-income like ours, fi-nancial and technological constraints largely dictate whether a health facility can make use of an electronic health record software. However, for a national hospital like the SGNHC, finding such resources should not be a big problem.
Maintaining electronic health records, as suggested by the Korean doctors' team, has become a necessity not only for the SGNHC but also for all other hospitals, at least in the government and community hospitals. It is not feasible for patients to be visiting the capital or the large urban centres every time complications arise. If the hospitals and health facilities were to be integrated with the help of a software, the local health care providers could assist in the treatment themselves or seek advice by referring to the big hospitals in the cities. As suggested by the Korean team, the SGNHC should also engage in educational programmes for the health workforce to build up their capacity in surgical capability and patient care.
The extreme shortage of trained health care professionals for CVD care was also pointed out. And the shortage of health care workers is not limited to CVD alone. But this should come as no surprise with young professionals after some experience taking the first flight out of the country for greener pastures abroad. Retaining them or luring those working abroad back to the country will require major policy changes in the health sector, from remuneration for the work they do to opportunities for promotion and professional growth.
Unspent budget
The long-held trend of spending the capital expenditure towards the end of the fiscal year must be put to an end if the quality of work is to be maintained as envisaged by the government agencies while awarding a contract. This kind of tendency is prevalent not only in the development works to be carried out by the federal government, but also by the provincial governments and local levels. As per media reports, the federal government could spend only around 61 per cent of the total budget allocated for capital expenditure by the end of the fiscal year 2022- 23. There is not much difference when it comes to spending the development budget in the provinces and local levels, both of which have yet to develop their institutional capacity.
When development-related budgets remain unspent at all levels, the money is piled up in the national treasury. It means the people will become jobless while the government budgets are frozen in Nepal Rastra Bank. Regular expenditure apart, the government must be able to spend the capital budget in a time-bound manner so that the national economy gets going by providing job opportunities - from highly-skilled people to unskilled labourers. The unemployment rate will continue to grow when the government fails to spend its capital budget.
A version of this article appears in the print on July 20, 2023, of The Himalayan Times.
