Fixing the basics

February 11, 2017 00:25 AM Gagan Thapa


Can you imagine? We don’t have statistics on how many health workers we currently have and where they are placed
We have all the right ingredients necessary to dramatically improve health and wellbeing of our citizens. But we have not been able to work out the right recipes to make significant inroads in the health sector.

This became apparent to me almost immediately after I assumed my duty as Health Minister in August last year.  It became apparent to me that severe deficits within the basic building blocks of our health systems are not only impeding our progress forward but also threatening to compromise the achievements made so far. Therefore, we have made it our mission, for the last six months, to what I often refer to as “fixing the basics.”Alongside this, we are also focusing on instigating longer-term systemic reforms and putting in place right policy and legal environment as our top priorities.

Let me discuss some of the accomplishments and future directions we plan to take on addressing these priorities.

Restructuring the health sector as part of broader state restructuring agenda is my top priority. We have already proposed new functions and structure for the health sector in federal form of governance and submitted it to Council of Ministers for review. We have proposed the new structure suitable not only to respond to the constitutional provisions but also to our current and emerging health challenges and to position health in the centre of overall socio-economic development. Besides we are drafting a Public Health Act that operationalizes the aspirations of our constitution, establishes Ministry of Health as a lead ministry to drive multi-sectoral actions in health, and awards the ministry greater authority to enforce public health regulations and laws. We plan to submit this Act within the next two months for endorsement. 

This Act allows us to expand the coverage of our existing health insurance program and to gradually make insurance mandatory starting with migrant workers and those employed in the formal sector. It also allows us to better define treatment protocols and referral mechanisms. It is the state’s obligation and responsibility to ensure that the insurance clients receive high quality and reliable health care services, which is currently lacking. To address this, we have put in place special provision to procure necessary drugs, medical commodities and equipment as well as to place required human resources. 

We are working on consolidated safer motherhood bill, ambulance policy, revised regulations for health councils and regulations to protect health workers and health institutions.

Many basic elements we are trying to fix may appear as short-term stop gap measures and in many instances they are. While we are working out long-term reforms measures to address these, the bitter truth is that the lack of basics has almost created an emergency situation that requires urgent action. Many of our health facilities are operating without the required health workers, medicines and equipment. Many public hospitals are on life-support—they are not adequately managed or governed. And for far too long, we haven’t listened to our citizens and their needs. 

Can you imagine? Currently 30 district hospitals are not performing caesarean sections as they are mandated to do. Can you imagine? We don’t have statistics on how many health workers we currently have and where they are placed. I was stunned by the fact that no one could provide me information as to how many medical officers we have currently under scholarship schemes.

The fact that we are not able to avail even essential medicines in health facilities is embarrassing. Can we really expect to create a healthy new generation if we don’t fix these deficits? Therefore, to deal with this emergency we need both quick fixes as well as long-term reform.

While we are working on procurement and supply chain reforms to ensure the availability of medicines and commodities in our facilities, immediately after I came to the Ministry, we delegated necessary financial authority to the regions and districts to procure medicines. And the result after six months is that all districts have already procured essential medicines. 

No central level procurement had taken place for the last two years, but now letter of interests for many procurement lots have already been issued. I personally lobbied with the Public Procurement Monitoring Office to make the Public Procurement Act more facilitative to ensure timely procurement of medicines and health commodities and they have already revised the Act to do so. 

The Act now allows the district health officers to procure medicines and commodities up to the value of Rs 500,000 directly without competitive bidding at the local market. We have already informed our district health officers of this provision.

On human resources front, while we are trying to improve our human resource information and registry system, we have now prepared the list of medical officers employed in the public sector. Most of our time in Ministry is currently spent on adequately mobilizing health workers and on solutions to retain them. 

But recruiting and deploying specialist doctors is still a big challenge. Few months ago, we announced a vacancy for specialist doctors but very few people applied. To address this we have now prepared a Memorandum of Understanding to be signed with both public and private medical colleges to place their resident doctors at district hospitals. We are also working on a regulation to make the community service mandatory for one year for all MBBS doctors graduating from the private medical colleges. 

There is frequent transfer of health workers prompted by undue political interference and other ulterior motives. To mitigate this malpractice, we are trying to put in place an automated system, as in Nepal Police, which minimizes human decisions in transfers.

We have also put in place standards to curtail the unnecessary foreign travels and training of health workers. We are now working on a similar standard to govern the domestic training better which we hope will reduce the absenteeism of health workers because of poorly coordinated training and orientation programs.

When I joined the Ministry of Health, I found that many private hospitals and clinics were operating outside the purview of the Ministry and without registering with the government. I have already taken action against this. We have now secured an Executive Order from the Council of Ministers to close all private hospitals and clinics that have not been registered with the Ministry of Health. Similar rule now also applies to government health workers that practice in private institutions: they are only allowed to work in private facilities outside of the government working hours.

Construction of health facilities is our top priority. A simple calculation showed that if we were to construct the facilities in current pace, it would take nearly a half a century to complete all of them! This is not acceptable. We are now aiming to complete all currently planned construction by the next five years.  We have started an exercise to reclassify our health facilities. Now, we may not be restricted to have just one hospital in each district but our facilities will deliver health services according to the people’s need, taking into account the catchment population and accessibility. 

There are high expectations from my tenure in Ministry of Health. I shoulder the aspirations of the country’s youth. This has further hardened my resolve and I remain committed to improving the health and wellbeing of our citizens. In this arduous yet exciting journey, I consider all of you my fellow travellers and am confident of your support.

(Edited version of Health Minister Gagan Thapa’s speech delivered in Joint Annual Review held in Kathmandu early this week)


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