Here’s some good news on the health front. Nepal is well on its way to achieving the related Millennium Development Goals by the deadline of 2015 in a number of areas, while in others, it can be said that progress has been quite satisfactory, with exceptions.
The details as of 2010: Around 85.6 per cent of one-year-olds were immunized against measles. The under-five mortality rate and infant mortality rate were brought down to 50 and 41 per 1,000 live births respectively as against a target of 38 and 32 by 2015. The incidence of clinical malaria was 5.7 per 1,000 population as against a target of 3.8 per 1000 population. Likewise, prevalence rate and death rate associated with TB was 244 and 22 per 100,000 population. The targets here are 210 and 20 respectively.
In view of what has been achieved from 2000, when United Nations Millennium Declaration was signed till 2010, achieving the aforementioned MDG health targets should not be such an uphill task in the next five years, though the difficulty in bringing down the prevalence of HIV among the 15-49 age group and increasing the proportion of births delivered by skilled birth attendants will be considerable. HIV prevalence has to be brought down to 0.35 per cent from 0.49 and births using the service of skilled birth attendants has to go up from 29 per cent to 60 per cent – quite a tall order, indeed considering the funding gap.
While it does give cheer to know that most of the MDG’s will be met, the ground reality of the overall status of health in the country calls for greater attention.
Firstly, there is an almost unbridgeable rural-urban divide where health is concerned. The figures speak for themselves. According to health expert Dr Nirakar Man Shrestha, the total fertility rate for rural areas is 3.3 and 2.1 for urban areas. Skilled attendance at birth is 14.3 in rural areas and 50.6 per cent in urban areas respectively. Likewise, contraceptive prevalence rate in rural areas is 43 and 54 in urban areas. Vaccination coverage under two years of age among uneducated mothers and in mothers with SLC or higher level education is 73.4 and 90 per cent in rural and urban areas respectively.
Two major failings of health expenditure in Nepal have been the inability to utilize the available health budget and failure or lack of effort to reach the poor and disadvantaged sections through affordable health services. To increase the volume and quality of health services, the state has to allocate at least 10 per cent of its total budget to health service and have provisions in place to extend health care facilities to rural people.
Meager as the budget may be, the problem lies in the lopsided distribution of health resources. It seems the government has forgotten that though 83 per cent of the country’s population lives in rural areas, health facilities, services and human resources are concentrated in urban areas. For example, around 70 per cent doctors are based in urban areas. Of the 3,000 Nepal Medical Association-affiliated doctors, only around 940 serve in government hospitals. No wonder, health services are spread thin across the country and the poor have little access to medical care. The doctor-patient ratio in Kathmandu is 1:200 while the ratio in the hills and remote areas is 1:3,000. Unless this situation is remedied, the remote areas will perpetually remain deprived.
Then there are instances of mismanagement of resources. For example, around 25 per cent of the doctors serving in government hospitals have been on study leave for the last 17 years.
Obviously, it is the Health Ministry’s responsibility to manage the leaves for doctors, but the issue has not been examined. One only needs to refer to a recent news item to showcase mismanagement of health personnel. Six months ago, the government transferred 34 doctors and 250 health workers from the far west region. Till date, these vacancies have not been filled. The result: not only have people been deprived of health facilities, but the risk of patients succumbing to curable ailments has increased by many times. Every once in a while there are news reports of health facilities running out of drugs in some remote VDCs forcing patients to either go to neighbouring India for treatment if the affected area is near the border or to go to other districts. Only very recently, Khotang, Kanchanpur and Dailekh districts came under the grip of viral fever. The hospitals and health centres ran out of beds as the patients multiplied.
No doubt, the achievements in health MDGs will go a long way in improving the status of Nepal, but for overall and balanced development in this sector, district and regional hospitals must be upgraded with greater investments in medical equipment and resources in health posts. There must also be enough training programs for doctors, health workers and community health volunteers. Doctors practicing in rural areas should get sufficient incentive to continue working there. Then there is also the urgent need to reach remote areas with like facilities and health workers. Stress must be laid on equitable distribution of resources.
Singh is a researcher with Center for Research