The impact of COVID 19 on Health Care in Nepal

Madan Raj Thapa -
Health is an integral part of Development .
The ultimate aim of the development is the constant improvement of the well being of the entire population on the basis of the peoples participation in the development process and a fair distribution of the benefits therefrom. It is an integral process embodying both the economic and social objectives and must promote human dignity. If undue privilege , extreme social injustice persist, then development fails in its essential purpose . Thus , in essence,  development is organized growth – the growth which is brought about economically, efficiently and growth which is associated with the desired changes in attitudes, institutions , conditions of production and the level of living of the people . So, popularly, development is known as growth and  social changes .  
Concerning of  health  , it  is both a means and an end of development. In a much broader sense, the end of development is human welfare of which health is an essential part. A health population in turn provides the moving force for higher productivity. The work force , which applied to  productive  work must have a certain level of health , supported by adequate nutrition, which enables to contribute efficiently to the development of a country  and to its own social development  and to the social development of those who depend on it. So health is essential for the generation of this critical mass of human energy. It is thus not only a fundamental rights as stated in the constitution  it is also a pre requisite to human development.  Health development is thus therefore essential for social and economic developments   
Health system  
A health system consists of interrelated component of in homes, health educational institutions, workplaces, communities , the health sector and other related governments ministry and sectors. The system includes a health infrastructures which delivers a variety of health programs and provides health care to individuals, families and communities and health care consists of promotive,  preventive , curative and rehabilitative measures. In Nepal, the system which is based on the principle of Primary Health Care (PHC) is composed of various levels.  The Primary Health Care  is an approach,  can define as a service, and as a structure ( various level of health care system)  . The first point of contact between individuals and system is the Female Community Health Volunteers (FCHVs) where a general information and preventives services are delivered, then comes Sub health post (SHP) providing first aid and as acts as a referral center ,  Health post (HPs) , Primary Health Care (PHC) Center and Hospitals. The hospitals provide more specialized services.      
Key Issues in the health service delivery : 
Despite many efforts , there are still many issues /constraints , exists at the micro and macro level. The key issues  facing the health service delivery is the poor coverage and accessibility of service especially for the poor and the vulnerable. There are numerous reason for this. Major among these are poor quality of the rural health service and inadequate number of qualified health workers in the rural areas.  On the other hand there is a curative based hospital centered approaches in the urban areas. 
Services are not geared to the current epidemiological profile. There is imbalance service given by the secondary and tertiary services resulting in much duplication. 
The other main areas  of concern is the current referral system. There is inefficient performance of hospitals because there is no clear effective sector-wide packages of essential and complimentary services. In addition to this, there is acute shortage of drugs ( problems of logistics) , laboratory chemicals , basic medical care equipment and other supporting utilities, funding for maintenance, and also routine expenditure. 
 Besides these, there are various  interrelated factors  such as unequal distribution health workers and facilities , inadequate funds for program support and training, low wages of health workers, Other includes, existing government policies on health are unrealistic and discriminatory against  the poor and marginalized, poor management of health service, There are also cultural blocks that includes, existing cultural beliefs and practices , too much dependence and health workers and on government efforts. And  scarcity of resources has been always of problems , 
COVID 19 pandemic crisis . 
 The current crisis of COVID 19 pandemic  is also hitting Nepal severely and seriously . As we have seen, it has serious disastrous effects on around the world . This has been the most economic downturn in modern history as well. It has brought to unrivaled level of unemployment, underemployment, loss of income and national growth, business bankruptcies and some of the economic disasters. In this scenario, we expect the Government to engage in the strategic planning and coordinated actions to maintain essential health service delivery, come forward to stabilize the economy and to prevent sufferings. We also believe that, if we fail to apply correct policies, the second great threat would have occurred and collapse of health sector would occur again, this will be more apparent among the poor families . It will affect babies, children, pregnant women, and old people. This really reduces the quality of life of the people, especially the poor and marginalized.   This , in turn, will seriously inhibit the efforts to attack  the rising poverty . 
What should be done 
My general suggestions is that everyone should be open minded , and be open to new and innovative idea. Government should review their health system with the aim of reshaping them as necessary to conform with the desirable characteristics as to encompass the entire population on a basis of equality and responsibility.  Redesign strategies for improving level of health and  I proposed to focus on the following areas such as : 
A) Social justice and equity  : 
The health care system must adopt a “preferential option” for the poor, deprived and underserved people . Social justice demands that health care be made accessible, available, affordable and acceptable to the majority who have long been deprived of their rights health on account of poverty and their low status in life. 
B) Inter sectoral / community or people’s participation: 
Provision should be made in such a way that community are relatively involved in decision making on health matters affecting them.  
C) Stop inefficiency:  
In order to stop inefficiency, establish a team, outside the present system which will be responsible to monitor  nepotism,  manipulation and corruption  (NMC  team ) . Results of this team should be channeled directly to the Provincial ministry of health. Strict measures should be taken against the people involved in the NMC. To be able to do so, there should be political will at high levels of decision making .
D) Accessibility and affordability:  
In fact the really poor are still not able to access the services they need. The private hospitals should also be accessible and affordable to the poor people. Allocation of some beds, at least 25% should also  be made.  Review the existing health insurance system and could be expanded to cover cost for hospitalization.
E) Subsidize public Hospital :  
Public hospital should be subsidized for  at least six months after the COVID 19. And this should be targeted for special purpose such as basic medical equipment and drugs in relation to epidemiological disease patterns in certain areas. The drug scheme should be reinforced with providing clear guidelines to all hospitals on how to financially manage patients. A monitoring system should be setup to evaluate whether the actions taken by the government are effective . 
F) The cost efficiency team: 
A cost efficiency team (ET) should be established in all the public hospital. The task is to provide management with advice on areas for efficiency and monitor the activities. Advice should also include efficient use of available hospital resources such as electricity, water, Gas and closing of inefficient utilized wards and services, optimizing hospital manpower, improving the quality of services and overall service quality. 
I have highlighted only some points, there are many areas needs to be addressed and many things to do with regard to the private hospital as well. Government has to allocate more funds and a resilient budget to cope with the COVID 19 pandemic .The number of poor and near poor will be increased because of this COVID 19 pandemic . If the government in this case do not respond quickly and positively, this will backlash and put the government in a very difficult position.
The impact of COVID 19 on Health Care in Nepal

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