Nepali Times

‘Every citizen shall have the right to primary health care and emergency services free of cost.’ That is Clause 1 of Article 35 of Nepal’s new constitution. While the bill’s emphasis on equitable health care has brought hope especially among rural Nepalis who lack access to even basic health care, implementation is going to be tough given the state’s track record.

Despite the government’s earlier policies ensuring free services at district hospitals, patients still have to pay for consultation and medication. Another policy demands that 41 essential medications be made freely available at health posts and 71 at district hospitals. But that rarely happens.

Another problem in public health care is the lack of proper infrastructure and clinical capacity. Most well-equipped hospitals are concentrated in Kathmandu and this centralised health system is too expensive for most Nepalis.

The implementation of the constitution’s commitment to provide free health care services will require an enormous on-the-ground effort, especially in the rural areas. The Ministry of Health and Population (MOHP) first needs to ensure availability of all essential medications in health posts and district hospitals at all times. This will require improving the logistical aspects of the MOHP supply chain mechanisms throughout the country.

Secondly, the MOHP needs to upgrade the infrastructure of every health institution to ensure these institutions are capable of providing the required services. This will require building new facilities, rehabilitating old ones, and adding or replacing medical equipment and supplies. Thirdly, the MOHP needs to ensure that there is adequate staffing within these health institutions.

If the MOHP is truly committed to its vision of providing health care services to all Nepali citizens, it must work hard to achieve these tasks. It will require great planning and cooperation at the inter-ministerial and National Planning Commission (NPC) levels. Additionally, work must be coordinated with external development partners who will help finance our health sector. However, leadership must come first and foremost from the MOHP. In order for there to be any true chance of success, the MOHP must own the idea of free health care, and under its direction, provide these needed resources in the immediate short-term.

As we move forward to build a health care system that will provide free services for all Nepali citizens, the MOHP must identify mechanisms to optimise use of the limited resources it has available. One model for such a system is public-private partnerships – the government partnering with non-governmental organisations to provide health care services to the people of Nepal.

One model is the Bayalpata Hospital in Achham District, which has been providing free primary and comprehensive health care in a public-private partnership with the MOHP since 2008. More than 285,000 people have benefitted from the free services, including outpatient, inpatient, surgical, laboratory, radiology and pharmacy services.

Through the public-private partnership, the MOHP regulates and oversees health care services implemented by the Nepali NGO, Possible. This model ensures accountability to the public while simultaneously leveraging the extra capacity for health care service implementation in the private sector.

The number of patients visiting Bayalpata Hospital keeps increasing day by day, as there remains limited access to quality services for those in rural areas. With our country’s new constitution, and the guaranteed right of free health care for all Nepali citizens, innovative public-private partnerships led by the MOHP, like Bayalpata Hospital, can act as a model for addressing Nepal’s health care needs.

Considering the constitution’s impressive aims with regards to health care services, the MOHP needs to work seriously and urgently with the National Planning Commission and other ministries to plan and coordinate its strategy to deliver on these promises.

We have the opportunity to learn from, and collaborate with, non-governmental organisations within Nepal, and from other governments and organisations around the world, but we must move promptly. The people of Nepal have waited a long time, this is the time for action.

Bikash Gauchan is the Medical Director of Bayalpata Hospital in Achham.

bikash@possiblehealth.org

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