Pound foolishThe government should cut its unnecessary costs while maintaining essential health services.
The massive budget cuts in maternal health in Nepal are most unwelcome. The Ministry of Health—as per the directive from the Ministry of Finance—is reducing its annual budget by up to 42 percent owing to the negative growth in revenue collection in the country in the first six months of the fiscal year. The decision will affect, among other areas, maternal health, which is already facing a crisis with more mothers dying during and after childbirth. A recent new report by the National Statistics Office showed that in every 100,000 live births, 151 women die of maternity-related complications. How will the country improve on this outcome with a smaller budget?
Health experts and officials worry that one of the most immediate consequences of the budget cuts will be seen in institutional delivery service, antenatal care visits, and postnatal care visits. Additionally, the training of health workers on the prevention of pre-eclampsia (pregnancy-related high blood pressure) and excessive bleeding after childbirth (postpartum haemorrhage) will be impacted. We must not forget that many pregnant women in Nepal succumb to home delivery, postpartum haemorrhage, unsafe abortions, lack of emergency obstetric care, delayed healthcare, and poor airlift services in remote areas. With more budget cuts, the state of these services will only worsen.
This comes at a time the ministry was preparing to start multiple programmes to improve maternal health in the fiscal year. Health officials say most of their regular programmes will be affected. For example, postnatal care visits, which trained nurses provide at home, will be disrupted. These visits save precious lives. Another important and effective programme to prevent maternal mortality is the maternal death surveillance and response (MDSR) system, which the government has yet to implement in 42 of the 77 districts. The expansion of this programme will now be halted.
Until some years ago, Nepal was persistently lowering the maternal mortality rate for which it received the Millennium Development Goals award. It cut the rate from 539 per 100,000 live births in 1996 to 239 per 100,000 live births in 2016. The low budget could reverse this achievement. It will also jeopardise the country’s chances of hitting the Sustainable Development Goal of reducing maternal mortality to 75 deaths per 100,000 births by 2030. Moreover, the decision will widen the access gap to maternal care services. Mothers who rely on government healthcare institutions and service providers will be disadvantaged as doctor fees in private institutions are on the rise, and private care is unaffordable. In 2017, maternal healthcare service expenses pushed 46.6 percent mothers in India into poverty.
It is time for the government to rethink its decision and explore ways to cut unnecessary costs while maintaining essential health services, including maternal health. A reversal in the country’s vital health indicators will make it harder rather than easier to meet its fiscal targets. The federal Parliament's budget session, which has just commenced, would be the perfect opportunity to debate (and hopefully roll back) these kinds of short-sighted policy measures.