Tuesday, 7 February, 2023

Decentralising The Health Services

Mukti Rijal


The government has come up with a plan to build the viable health infrastructures at the local level. The work has been initiated recently in around 400 local governments - both municipalities (Nagarpalika) and rural municipalities (Gaupalika) - where, according to the news reports, hospitals equipped with residential medical treatment facilities will be put in place. According to the media reports, local hospitals endowed with the bed facilities from five to fifteen are being constructed depending upon the local government's size and capacity. These health facilities, as reported, will be manned by expert physicians and nursing staff to cater services to the local populace.
The health facilities of the type to be set up and operated in the rural municipalities and municipalities had been stated to be the basic minimum infrastructures requirement at the local level defined by the Local Level Restructuring Commission (LLRC). The Commission had rationalised, consolidated and cut the number of the local bodies from above three thousand to seven hundred fifty three only according to the provision of the federal constitution. Pursuant to LLRC recommendations, the local level elections were held in 2017. Though it has been delayed, the step to create and set up viable health infrastructures at the local level should be commended and appreciated.

The current crisis presented by COVID-19 and the intractable challenges it has generated shows that public health should receive an utmost priority and well-equipped and resourceful health infrastructures need to be created at the local level. This is also evidenced by the active managerial and logistical support of the local government to take on the corona crisis. Local governments have come forward to set up quarantine facilities, coordinated the efforts for reaching out to PCR tests to suspected corona patients at the local level. They have also complemented to the efforts to put the information, education and communication strategies to fight coronavirus into action. Barring some exceptions, the local governments have thus swung into action to mitigate the risks and challenges triggered by the pandemic.
This goes to establish the fact that the decentralised health service delivery management has been more effective and efficient than the centralised service provisions. However, the case of private hospital has been rather bleaker in this respect. When the country is in dire need of medical facilities and logistics to meet growing challenge of coronavirus infections, the plum private hospitals and health institutions seem not forthcoming to meet their responsibilities. Most of the private hospitals and health service providers have not been cooperative enough to extend their helping hands to provide services to the people.
But, of late, after the government liberalised, allowed them to conduct the paid PCR tests and admit and treat the COVID-19 patients fixing hospital tariff on their own accord and terms, they have started to shed their inertia and welcomed the patients with deep pockets who could foot the expensive bills. The lukewarm and reluctant response of the private hospitals that have occupied prominent place and enjoyed dominance in health service delivery landscape has sparked a debate questioning the rationale of the private sector in health service delivery in an effective and affordable manner.
Private hospitals are believed to be more equipped, competitively managed and resourceful relative to the government-aided public hospitals. In fact, the cooperation and participation of private hospitals with their pool of experts and capacity of medical facilities and logistics in handling corona crisis was natural to be expected. Mention needs to be made of the fact that government-aided health institutes and facilities are also not in proper shape, and many of them are operating in a shabby manner. Moreover, according to a report, the government hospitals has a limited number of intensive care units (ICU), ventilators and other vital equipment which are necessary to treat the critically ill corona affected patients.
But at this time of crisis, government-aided public hospitals alone had been fighting the corona battle with private sector acting as a hesitant bystander until few months ago. Now as the approval of the anti-corona vaccines for use has raised some optimism and hope, there is a need to work to ensure that the vaccines are imported and procured with a greater sense of urgency and responsibility to make it affordably available to the people. Since the constitution guarantees right to basic health services to citizens saying no one shall be deprived of emergency health services, time has come for the government to show that it really means to stand by and care the needy people.

Good beginning
In the emerging context, the government needs to enhance its greater involvement in quality health services delivery as people are entitled to take the government to task if their fundamental health rights are not taken care of and satisfied. Moreover, the corona crisis has shown that health services should be provisioned by the government as permitting the private sector to operate in its own conveniences puts public health at greater risk. The initiative to set up hospitals at local level across the country is a good beginning to ensure the delivery of public health services at the grassroots. However, given the plight of primary health centers and the government aided hospitals at the district levels, there is a need to plan to ensure that the new medical establishments will deliver services with a difference.

(Rijal, PhD, contributes regularly to TRN and writes on contemporary political, economic and governance issues. rijalmukti@gmail.com)