The promises of Public Sector Healthcare in Nepal

Analyzing the opportunities and challenges of Primary Health Care

The Opportunity

Nepal has very recently been divided into 753 autonomous municipal units.

Nepal has recently been divided into seven Provinces and 753 Municipal Units.

This is a golden opportunity to restructure primary health care delivery.

The state of the proposed Municipal Health System

The municipal office will be in-charge of the health of the Municipality.

A. Clinical Care

Proposal:

15 to 25-bedded Municipal Hospitals will provide 24-hour emergency and inpatient care besides the usual outpatient care.

Situation on Ground:

Only 90 municipal units have 25 bedded hospitals. About 200 municipal units have Health facilities with 3 emergency beds and provision of a doctor.

Over 400 municipal units have no setups (infrastructure, human resources, and equipment) to start even basic round the clock services. This massive undertaking might take decades.

B. Community-based Care

Proposal:

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Each ward in each municipal unit will have a sub-municipal health clinic. Several Community Health Units will be established in each ward.

Outreach clinics and Female Community Health Volunteers (FCH Volunteers) will provide community-based care.

Situation on Ground:

Government needs to make an almost impossible input of infrastructure, human resources and operations costs.

One one hand, FCH Volunteers have very little training and support. On the other, they are not held accountable.

C. Integrated Health Care Systems

Proposal:

Modern (Allopathic) and Traditional Systems will be developed together.

Electronic Systems will be developed.

Situation on Ground:

There is no evidence of integrated systems development.

Electronic Systems will deliver to little, and only add to costs in the current facility-based approach.

Medical “shops” like these are often the first contact to the health sector in Nepal. For-profit sector accounts for the majority of healthcare visits and the majority of healthcare financial transactions. But these institutions have largely been unregulated. They receive minimal or no encouragement to report health services provided by them into an integrated public system.

Conclusion

While the systems will take to develop, the introduction of Municipality as the unit of Healthcare system is definitely a step ahead in decentralizing healthcare.

Similarly, the introduction of Health Insurance is definitely a promising towards decreasing financial catastrophe due to healthcare expenses to the public.

Evidence based interventions, tested and proven, to guide each step of this endeavor are necessary.