Editorial
Teleultrasound: A step in the right direction
The Sudurpaschim Provincial Health Directorate’s plans to install the machines at health posts in each local unit is laudable.Nepal had made significant strides in attempting to curb infant and maternal mortality rates in the past. By reducing the maternal mortality rate in the decade between 1996 and 2006 by 50 percent, it won the country for its progress towards Millenium Development Goal 5, Reducing Maternal Mortality. However, as things stand currently, it is unlikely to repeat its performance in meeting the Sustainable Development Goals that relate to these issues by 2030. Over 2,000 newborns and 208 new mothers died due to childbirth-related issues in the fiscal year 2018-19 alone—and these only account for the registered deaths in state-run health facilities.
So, any attempt by provincial bodies to improve healthcare, in this case specifically increase access to quality healthcare for the rural populace, should be commended. The Sudurpaschim Provincial Health Directorate’s plans to install teleultrasound machines at health posts in each local unit is laudable. However, as always, such news should be taken with a grain of salt. It remains to be seen whether the training given to technicians at the local level and the budget allocated to keep the telemedicine features active will be effective.
When Nepal adopted federalism, all essential state-provided services—of which healthcare and education are arguably the most important—should have reached the people near where they live. Yet, many challenges have stopped the needed transformation in the sector. One has been the lack of an adequate budget to run essential programmes, such as the provision of subsidised services for the disadvantaged and the safe motherhood programme, even in a centralised fashion. Another has been the inability of the stakeholders to delegate responsibilities and divvy up the budget to support decentralisation. Qualified personnel continue to pile up in Kathmandu, with staff transfers to the provincial and local levels not happening in an efficient manner.
Even as other provinces face major hurdles—such as Province 3 failing to implement its health budget for the first 10 months of the last fiscal year, and Province 2 channelling its health budget towards non-health related infrastructure projects, the development in Sudurpaschim is exemplary—at least in this aspect. The province has one of the highest infant-mortality numbers in the country—316 newborns died in the last fiscal year. At the same time, the province also charts a high number of maternal deaths, even as it ranks fifth out of seven provinces in terms of the total population. Given this, the province’s attempt at such a bold feature is definitely a major step in the right direction.
Yet, there are many reservations. In the first phase, the health directorate has handed over the teleultrasound machines to health posts in nine districts. But to truly fulfil its aim of complete coverage, the province has to provide such machines to all 88 local units—a significant budgetary and planning jump. Moreover, it seems that the technicians have not received training yet. But the effectiveness of this service will always depend first on its implementation.
The benefits of telemedicine cannot be overstated; Nepal successfully had implemented it in the past. But the reason it did not work out, in the long run, was the lack of an adequate budget and proper planning to run it consistently and effectively. Should Sudurpaschim be able to jump the hurdles to bring back effective telemedicine, even only in this one diagnostic aspect, it will definitely be a step worthy of emulation by other provinces. Hope remains that the province is successful in this endeavour.