Health and education are the responsibility of the government. It is when government doesn\'t take this responsibility seriously that the private sector and charities step in to provide vital services.
But this has brought with it a whole set of problems. The over-commercialisation of medical care is now a national epidemic. And it is to address this crisis in the health sector that the government has announced, and the parliament has ratified, a free health care plan. It's a laudable and ambitious goal, but as with everything else in this country, implementation will be key. Unless properly monitored, free health care will not just be a burden on the government but may also foster corruption.
On a recent visit to hospitals in the far and mid-western region there was a discussion on the government's plan to give women money when they deliver babies in district hospitals. Sounded like a good idea, since only 15 percent of women give birth in hospitals in Nepal and that number is even lower out west.
"Yes, we have the program but we had not been able to give the money because Kathmandu never sent it," was the comment from hospitals in Accham, Salyan and Doti. Many young mothers we spoke to in these districts said they had heard of the government initiative but hadn't gone to collect the money after delivery because it was too time-consuming and they weren't sure whether they would be handed the cash.
A few women who got money said that they had to wait for two extra days after the delivery because the accountant had gone home. Most of the money they did get was spent on food and lodging along the way.
No doubt without proper monitoring the government\'s free medical program could face a similar fate. There is a big risk that the free medicines will be past their expiration dates, or of low quality. Last year in Dailekh we saw antibiotics and anti-inflammatory drugs made by dubious companies that looked like counterfeits. Local doctors said they knew the medicines were fake, but the administration said those were the only available drugs.
In Sankhuwasabha in the east, the deworming medicine Albendazole which costs 79 paisa per tablet was bought by the District Health Office for Rs 8 per tablet. Amoxicillin was bought for double the retail price. The government distribution network in Biratnagar bought Brufen for three times the market price and sent it to the health post. It may not seem like much, but with 676 health posts and 3,129 sub-health posts all over the country the leakage due to corruption is huge.
It's not just the free medicine, how is the government going to ensure the availability of motivated and trained health workers? Even in Lalitpur district south of the capital, health post staff go to their stations only once a month to collect their salaries.
In Mugu last year we observed a health post that was running well, but that was because it was staffed by a voluntary group. But even here, the auxiliary nurse midwife didn't know that prolapsed uterus was a serious problem. No one had told her the women would be hesitant to volunteer information on such a sensitive affliction.
We'd all like to see the free medicine scheme work. But there are many hurdles, and it needs determination and integrity on the part of the government health delivery machinery.