10-16 March 2017 #849

Reviving the health sector

Rameshwor Bohara and Ramu Sapkota in Himal Khabarpatrika, 5-11 March

When Gagan Thapa was appointed Minister of Health six months ago, his Ministry did not have a proper working system. For example, there was no record of the number of doctors across the country. Since assuming office, Thapa has worked on policy and institutional reforms to improve the performance of the health sector. It has been nearly a decade since the government declared free distribution of medicines from government hospitals and health posts, but it has not happened.

As soon as he assumed office, Thapa delegated Rs 311.5 million to regional health directorates and Rs 1.8-8 million to district hospitals to buy medicines directly, bypassing an otherwise cumbersome procedure. The Ministry also gave district hospitals the authority to purchase Rs 500,000 worth of medicines for emergencies, and to buy medicines directly. Because of this, government hospital pharmacies are now well stocked.

In the past, 70 per cent of the total budget allocated for the purchase of free medicines went to the centre, 10 per cent to regional health directorates and 20 per cent to district hospitals. But the process of purchasing the medicines was time consuming and irregular, and stopped altogether after interference from the Lokman Singh Karki-led CIAA.

To ensure that the medicines reached all the districts, Thapa established a central coordination committee headed by an expert and appointed a focal person in each region, the budget was allocated on time and the process simplified. For years, the management of the human resources fell off the radar of the Ministry, which has around 800 permanent medical officers, 475 doctors who studied in government scholarships and 150 additional medical officers. But because they don’t want to go to rural areas to serve, many health posts and hospitals have been without doctors for long.

Private hospitals and clinics wishing to appoint government doctors before 9 am and after 5pm now need to take permission from the Ministry. To address the scarcity of specialist doctors in government hospitals, the Ministry has made it mandatory for post-graduate medical students to serve in government-appointed districts for three months. The ministry is also working to provide free treatment for heart and arthritis patients, free kidney transplantation in government hospitals and establish the Sushil Koirala Cancer hospital in Nepalganj. The ministry is also starting a program in 500 health posts outside Kathmandu for similar services. To reduce the risk of renal diseases, the ministry is starting a free urine test program in schools from next year.

When Thapa was appointed, he announced his commitment to open dispensaries in all government hospitals, and so far central hospitals including Kanti and Bir, some zonal hospitals and 29 district hospitals have opened their own medical stores.

But Thapa’s journey hasn’t been without hitches, the main one being the budget. The only source for the ministry is the health tax fund. The ministry has asked to utilise the Rs 600 million from the fund. “If the health sector is to work effectively, the ministry has to be allocated around Rs 2 billion from next year,” says Thapa.

Thapa has also come under fire for making decisions without proper homework. Samir Lama, MDGP of Pyuthan hospital says that with the current human resources, it is not possible to keep the doctors and healthworkers in the hospital from 9 to 5.

Maybe because Thapa wants to do so much in such a short time, he has made some inappropriate decisions. A day before the dates for local elections were announced, for instance, he appointed people in key positions in the health sector. He has admitted privately that he was under immense pressure from his Nepali Congress hierarchy to push those nominations.

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