The National Health Insurance is a very promising tool to enable people to access such a system, but there are lots of problems with its implementation
KATHMANDU, MARCH 19
The health care system of the nation is founded on a number of best practices and also on a sea of mediocrity and lot of negligence.
Unfortunately, it often depends on individuals to step in and make the difference and save lives.
For example, Basudev and Sushil Adhikari, the founders of Bright Star Society, share a passion and a commitment to help and step in when, otherwise, no one else would do that.Both Basudev and Sushil have been working very hard to uplift many of them, providing them not only guidance but also technical support, leveraging a more entrepreneurial, capabilities-based approach that enables people.
Yet there are cases where the brothers have had to do whatever it takes to save people's lives. A recent case was when Basudev and Sushil came to know about a 10-year-old boy who had been living with a serious heart condition since childhood. On top of this ailment, the boy, I would call him Bikram, has been completely visually impaired since birth.
Bikram and his family live in the Tarai, and their house had got swept away in one of the floods that occurred during the last monsoon season. Basudev and Sushil had come to know about their situation through their network of "informal" social workers, citizens who care about those in need and want to do something for them.
They brought Bikram and his father to Kathmandu and hosted him in their ancestral house on the outskirts of the capital. They provided everything they could for Bikram, including visiting many doctors to treat his heart ailment. Finally, they found relief when they met Dr. Anil Bhattarai, who is also the founder of Save the Heart, a local NGO working to provide heart-related care to persons like Bikram.
When he met Dr. Bhattarai, the boy could barely walk, struggling to breathe, and there was a general pessimism and fear even in Basudev and Sushil. Yet Dr Bhattarai was able to prescribe a different medicine, and Bikram's health condition almost immediately improved.
It took two amazing community workers and activists, one senior doctor and a consultation to radically improve the life of the boy.
I often read in the newspapers about cases of health mismanagement or dearth of primary care facilities that have almost become a death sentence for rights-holders who unnecessarily die. Recently there was the news of a young pregnant woman with twins who died from bleeding because she and her family were living in a remote area without access to proper care.
It does not matter to name the place because it can happen almost everywhere and not necessarily in ultra-remote districts of the country. Even in urban areas, if you think about it, your life could be at risk in case of an accident if the ambulance delays in coming.
Yet while you read a lot of sober news about the health conditions of many persons, there are also positive initiatives being undertaken by some municipalities that are starting new health services in areas that have always been deprived of them. So, all in all, it is a complex picture, and we cannot just generalise or overly criticise the governments at all levels for not doing anything.
Yet in a recent training on good governance, we reviewed some indicators about health policies - those that assess the efficiency of a country's health system. And in the following exercise, participants were asked to assess the country's health system.
Some participants ranked Nepal's health care with one and two marks while another gave a three - on a score of one to five, with the latter, the highest score, describing an excellent health care system.
Among them, there was also Jyoti Budhathoki, a young citizen about whom I have already written in this column, who is suffering from a severe health condition, a rare form of sclerosis. The family had to take loans in order to pay for her treatment, and Jyoti had to really experience some tough times. Now she has to pay for the expensive daily physiotherapy because her condition forced doctors at the Dhulikhel Hospital to amputate one of her legs.
I was hoping the government would at least take notice of her unique situation.
It is true that Dhulikhel Hospital did a lot for her,all for free, but the expenses for her ongoing and future treatments are simply huge. Even some big INGOS, once approached to help bring Jyoti's case to the authorities at the Ministry of Health and Population, did not or could not help.
Luckily the country is not short of humble but at the same time exceptional local heroes and medical professionals of high regard who are ready to give back to the society. This is good, very good, but we cannot just rely on people's willingness to step in to save lives.
While there are new health care initiatives being rolled out locally, Nepal needs a strong national health system that must include, in the equation, the private sector that should be regulated and subsidised for its services to the general public.
The National Health Insurance is a very promising tool to enable people to access such a system, but there are lots of problems with its implementation.
Moreover, the amount being given out should be at least doubled or tripled.
When Prime Minister Dahal talks about good governance, a good deed would be to institutionally strengthen the Health Insurance Board that should be regarded as one of the most important public institutions of the country.
Meanwhile, a simple cataract surgery enhanced the sight of Bikram, and this happened because Basudev and Sushil made this operation possible.
His family never ever thought that anything could be done to improve his blindness, and no one really helped them till recently when the Adhikari brothers stepped in.
At the same time, Jyoti is moving along with her life, always fighting and ready to reclaim a good and meaningful life for herself and, of course, good health.
A version of this article appears in the print on March 18, 2023, of The Himalayan Times.
