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Nepal Invests In Health Care But Slows Equal Access – Global Issues

Medical staff pose in the new maternal care ward at Melamchi City Hospital, Nepal, in November 2021. Source: Marty Logan/IPS
  • by Marty Logan (kathmandu)
  • Joint press service

“People with limited income can’t afford to get tested and imagine if four members of a family had symptoms, PCR testing alone would make a loss in their income.” Dr Baburam Marasini, former director of the Government of Nepal Epidemiology and Disease Control Department, told Kathmandu Post.

Per capita income in Nepal in 2020 is $1,190, according to international Bank.

Noting that free treatment for diseases such as tuberculosis, malnutrition and malaria has saved many lives in the country, Marasini argued that “the government should make PCR testing free nationwide for those with symptom.”

While the government has not taken that step, in recent years it has provided free treatment for a growing number of chronic diseases to members of groups in need, such as the elderly. , children and the poorest in society. However, equality in health care is still a promise on paper.

In a summary report on the right to health in Nepal during Covid-19, International Committee of Journalists argued that the government must “ensure that health services, facilities and goods are available to all without discrimination” and “ensure access to the least especially the ‘minimum essential’ of medical services, facilities and goods.”

Originally released in November 2020 and updated in September 2021, the ICJ article notes that a plan has been made to distribute a COVID-19 vaccine to members of vulnerable groups. hurt first, but “According to various media reports, for example, some vaccines are allocated to older people being used to transplant political party leaders , local representatives, military personnel, their families and friends, administrators, business families and their loved ones. “

Article 35 of the Constitution of Nepal guarantees the “right to health care” and its third clause states: “Every person shall have equal access to health care. “The Directive Principles of the Constitution, State Policy and Obligations also require Nepal to “continue to increase the necessary investment in the public health sector of the State to make the population healthy” and ” to ensure easy, convenient and equal access for all to quality health services. ”

However, as the ICJ has pointed out, research conducted before Covid-19 shows that “high-quality healthcare services are not widely accessible in Nepal, but are generally enjoyed by only a small fraction of the population.” is relatively small and elite, and in general, access to health care in the country is unequal and the health system faces long-standing shortages in resources, essential medicines and medical facilities. necessary medical infrastructure. ”

Senior cardiologist Dr Prakash Raj Regmi says he sees the impact of inequality in healthcare every day. “During the investigation, during the treatment, even middle-class people face some difficulties.”

In an online interview, the doctor noted that most of his patients are burdened with multiple non-communicable diseases (NCDs), such as cardiovascular disease, diabetes, and kidney problems. and heart, whose diagnosis requires extensive testing. After that, these patients often require multiple treatments. “Patients need to go through many investigations: tests, x-rays, ultrasounds, echocardiograms. People may need a coronary angiogram or a CT or MRI scan — all of these investigations are expensive. ”

While the quality of existing drugs is improving, they are also becoming more expensive, so some patients have stopped taking them prematurely, Dr. Regmi said. “For example, one patient was given a follow-up period of three months, but they only arrived after six months. during that time they stopped taking two of the four drugs, so they developed complications. ”

Although he is able to provide financial assistance, both at the private practice and the nonprofit community clinic where he also serves, Dr. Regmi is unsure how many other doctors do. “I call myself a social worker… in my private clinic too, people come for treatment, if they can’t afford tests and treatments, I’ll find a way; I support those patients.” Some tests can be done for free, and for others he says he can direct patients to government labs; Drug samples may be provided free of charge and cheaper versions of the drug may be prescribed.

Despite the need for these informal mechanisms, Dr Regmi says that fewer patients are asking for financial assistance today than in previous years and those who can afford it often choose to go to private facilities less often. more crowded.

Various developments have helped to improve services in the government system: a new national health insurance scheme, which transfers some health care responsibilities to provinces and cities after Nepal’s transition federalism in 2017, and free treatment of some chronic diseases for the poorest of the poor, children and the elderly.

“A lot of money is being invested in this… This is great for patients who cannot afford treatment: most of the patients are poor and these NCDs need lifelong treatment.” But the doctor says one thing is missing: “Governments should focus on prevention alongside treatment, but not invest in prevention,” he argued.

Inequality is also evident in maternal health care services. For example, Sindhupalchowk is a predominantly rural district a three-hour drive from the capital, Kathmandu. Although there are 79 medical facilities, families who can afford it still come to the capital to give birth or to larger facilities in neighboring counties. In fact, by 2020, more than 70% of pregnant women leave Sindhupalchowk to give birth outside the district.

About half of Nepal’s hospitals, including intensive care centers, such as the national maternity center, are located in the Kathmandu Valley.

ONE recent report An analysis of data from 2001 to 2016 shows that maternal health progress has “improved significantly” across the country, across all affluent groups. But diving into the statistics shows that the poorest of Nepal’s seven provinces “have made minimal progress to zero.”

“Special investment to address barriers to access and use in lagging provinces to make progress in reducing inequality is urgently needed. Further studies are needed to understand the strategies needed to address the gaps in these provinces and deliver equity improvements,” the study adds.

© Inter Press Service (2022) – All rights reservedOrigin: Inter Press Service

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