Health Sector Reform: crucial for better healthcare

The Constitution of Nepal has ensured basic health care for every citizen as a fundamental right. However, affordable and accessible healthcare is still a far-fetched notion for Nepalis. Government hospitals have been facing a heavy influx of patients. Healthcare services at private hospitals is unaffordable for low-income and middle-income people in the country. There are altogether 109 government hospitals with total 5,411 beds according to Department of Health Services. The government has been carrying out various healthcare programmes through private hospitals as well to make the healthcare facility accessible, according to Dr Ramraj Panthi, Deputy Health Administrator of Department of Health Services.

"I/NGOs are spending on the health sector massively. The Social Welfare Council Nepal, which supervises and monitors the works of I/NGOs in the country, has estimated the expenditure of I/NGOs only in the health sector hover around Rs 7 billion as there is intensive involvement of I/NGOs in health sector programmes from awareness to quality enhancement of health services."

The government has been distributing 70 types of life-saving drugs for free and bearing the cost of the treatment of catastrophic diseases such as cancer, heart, kidney, head injury, sickle cell anemia, spinal injury, Parkinsons, Alzheimer. Currently, the government has been providing services through government hospitals and 62 private hospitals under the government scheme to treat patients battling with serious diseases. Healthcare is a booming business in the country. The government, private sector, I/NGOs have been involved in providing health care facility to people. Private hospitals (including nursing homes and medical colleges) in the country have 12,000 beds. The tax administration has estimated the total turnover of private hospitals hovered at Rs 10 billion in the last fiscal based on the taxes filed by private hospitals. Though there is not any factual database regarding investment in health sector, the cumulative investment of the private sector in health is around Rs 200 billion, according to private sector players. “Investment in the pharmaceutical industry hovers around Rs 12 billion,” according to Hari Bhakta Sharma, President of Confederation of Nepalese Industries and Executive Director of Deurali- Janta Pharmaceutical “Investment in health sector is on the rise each year as the business expands along with people who can afford better health services.” The expenses for quality health care increased along with rise in the income levels of people, as per Sharma. Private hospitals have yet to reach remote areas. Even government hospitals are running without doctors in remote areas, said Dr Yashobardhan Pradhan, former Director General of Department of Health Services and member of the high level panel formed by the Ministry of Health to restructure the country’s health sector. Gagan Thapa, Health Minister for the previous government had proposed a mandatory provision for all health professionals who studied under government fellowship to serve the initial two years in hospitals in remote areas. “The concerned directives are yet to be amended from the Cabinet. Once approved this will be instrumental in supplying the required doctors and health technicians to remote areas,” said Pradhan, adding, “Subsequently, we have to focus on providing quality service at the local level.” Due to lack of proper health care services, there is obligation for people living in rural areas to travel to major cities or to Kathmandu to get proper healthcare facility. Pradhan, however, said that along with the formation of local bodies, their priority should be on improving health care facilities at the local levels. The number of medical colleges is increasing as well. There are already 20 medical colleges including three dental colleges. The government should promote investment in medical colleges out of urban areas, shares Dr Pradhan. I/NGOs are spending on the health sector massively. The Social Welfare Council Nepal, which supervises and monitors the works of I/NGOs in the country, has estimated the expenditure of I/NGOs only in the health sector hover around Rs 7 billion as there is intensive involvement of I/NGOs in health sector programmes from awareness to quality enhancement of health services.

Health sector reforms

Despite the huge investment from the government and development partners to make the health care facility affordable and accessible, health care service is becoming expensive despite government effort. However, experts opine that government’s expenditure is insufficient to deliver better results. “Government should increase its investment from a mere three percent of the total budget to at least 10 percent because around 23 percent of the country’s population is still below poverty line,” said Dr Praveen Mishra, former Health Secretary, “Insufficient investment cannot deliver results; the government should not compromise investing on this sector.” Likewise, middle-income people could also come below poverty line if their expenses on health care increase sharply. “Only four to five per cent of the total population can afford health care facility in private hospitals and foreign hospitals,” said Mishra. If the government increases investment in the health sector it can carry out various healthcare programmes through private hospitals to minimise the pressure on government hospitals so that people have access to affordable health care, says Mishra, adding, “If the government reduces the investment in health sector gradually, the middle-income and low-income people will take the maximum blow.” Along with an increase in investment in the health sector, the government also works for management of human resource and logistics and developing proper information system. “The government has various programmes to provide health care facilities to the public, however due to lack of a proper information system, human resource and logistics management, government’s investment is wasted to a large extent,” said Mishra. On the other hand, there is duplication in programmes run by I/NGOs. Government should encourage them to join forces to work towards a common cause. The government has to make health insurance scheme effective, says Mishra. The government has launched health insurance scheme in 25 districts. The insurance scheme covers health care facility up to Rs 50,000 for each of the five-member family at an insurance premium of Rs 2,500 per annum.