The year was ridden with outbreaks of contagious diseases that stretched the underprepared health authority to its limit and beyond. Beeju Maharjan/TKP
Nepal's healthcare sector witnessed several setbacks and challenges in the past year. While the year was ridden with outbreaks of contagious diseases that stretched the underprepared health authority to its limit and beyond the country missed several health targets that it had set to meet. Meanwhile, there was no significant improvement in people’s access to health services. The situation, if anything, was made worse by the staff adjustment process that was launched to redistribute health workers in health facilities across the country.
In 2019, the country witnessed the first human death caused by bird flu (H5N1). It was also the first H5N1 human infection in the world since February 2017. The H5N1 outbreak was first detected in farms in many parts of the country that killed hundreds of thousands of chickens.
With the report of human death there were immediate concerns whether the virus was making a resurgence. The authorities concerned, however, were too slow to respond and recognise the seriousness of the issue, which laid bare the country’s lack of preparedness and resources in case of a major disease outbreak.
The Ministry of Health and Population had to seek expert help from the World Health Organization's headquarters and its Delhi office to contain the further spread of the virus. Hundreds of samples were collected from the hospital where the patient was admitted, the hospital staff and the patient’s family members, which were sent to the WHO reference laboratory in Japan for the test.
The country’s lack of coping capacity against epidemic control was further underpinned as the country was struck by an unprecedented dengue outbreak in 2019, which killed at least six people and infected thousands of people. Out of 77 districts, the deadly virus was detected in 68 districts. The Epidemiology and Disease Control Division, however, seemed ineffective in containing the virus’s spread; in some places, their entire population was infected. The virus, which was first reported in Dharan Sub-metropolitan city, has still not come under control completely, with at least six new cases being reported daily.
Health experts warn the coming years could prove even more challenging to the authorities concerned to contain the possible outbreak of dengue, as the presence of dengue carrying mosquitoes— Aedes aegypti and Aedes albopictus— have reached almost every corner of the country.
As Nepal lurched from one public health crisis to another, the country missed several health targets set for 2019, as well as failed to do enough to achieve the targets for the new year ahead. Reducing maternal mortality rate, eliminating measles, filariasis are some of them.
Kabin Adhikari/TKP
Nepal had committed to eliminating measles by 2019, but could not. The immunisation section at the family Welfare Division under the Department of Health Services has extended the deadline to 2023.
Measles outbreaks were reported in Morang, Dang and Kapilvastu, among other districts, in 2019. Officials said due to the frequent measles outbreaks, they could not achieve the desired results.
The Epidemiology and Disease Control Division is still launching mass vaccination drive against measles, which should have ended years ago. Officials at the division said that despite launching measles campaign for up to 12 consecutive years, the disease has not come under control due to poor coverage of the campaign. Coverage rate of second dose of measles vaccine in Nepal stands is at 73 percent. To achieve the target, the coverage rate should be over 95 percent.
Nepal has also committed to reducing and limiting maternal mortality to 125 per 100,000 births by 2020. However, officials at the concerned agencies under the Health Ministry say that achieving this target is impossible now.
Data provided by the Family Welfare Division show that for every 100,000 births, 229 women die during or after childbirth. Nepal had previously reduced the maternal mortality rate from 539 in 1996 to 239 in 2016—for which the country was commended with the Millennium Development Goal award.
Health experts say unless effective intervention measures are immediately implemented, there is a high chance of Nepal missing the health target under the UN’s Sustainable Development Goals to reduce maternal mortality rate to 75 for every 100,000 births by 2030.
Another critical issue that dogged and dominated Nepal’s health care sector in 2019 was of staff numbers and their deployment.
Due to transfer of doctors and health workers, services such as cesarean delivery, normal delivery service and minor operation in many health facilities across the country were—still are—affected.
Due to preference of health workers to serve in their own places, many health facilities in Province 5, 6 and 7, have been left to deal with the shortage of crucial health workers.
The lack of doctors and health workers was already depriving hundreds of thousands of people from getting basic health services. Their plight has been exacerbated by the employment adjustment process. The Health Ministry’s decision to allow all health workers to choose the place of their deployment apparently led to this situation.
Health facilities across the country lack over 5,000 health workers. It’s been months since the Health Ministry presented a proposal to the Office of the Prime Minister and Council of Ministers on hiring the required number of health workers, but nothing has come of it so far. With many health facilities across the country lacking health workers and doctors, people are either forced to travel for hours to big cities for the treatment spending thousands of rupees or stay at home without treatment.
The year 2019 was also a tough one for the country’s executive head health wise.
Prime Minister KP Sharma Oli's health issue became a matter of concern in the latter end of the year when he visited Singapore for a medical check-up. The subject of his well-being became particularly perturbing as government officials withheld information to the public regarding his condition. Following his return, the 67-year-old prime minister publicly declared that he was fine. But soon it was revealed that all was not well with Oli. His kidneys, transplanted in India in 2007, were compromised for which he needed regular dialysis. Doctors attending to the prime minister suggested second renal transplant for him to get off the dialysis regimen— two to three times a week. The recommended course of action, however, became inadvisable after Oli was struck down with appendicitis in November and had to undergo a surgery. As things stand now, Prime Minister Oli is not in the pink of health and nor is the country’s healthcare sector.
Arjun Poudel is a health reporter for The Kathmandu Post.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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