Last year, before the second Covid wave hit the country, the Ministry of Health and Population called a meeting of elected local representatives to discuss the risks.

The importance of coordination and cooperation among the three tiers of government—local, provincial and federal, the need for setting up quarantine and isolation centres, contact tracing and enforcement of the health safety measures were among the issues on the agenda of the meeting.

“But very few elected representatives took part in the meeting,” said an official at the Health Ministry. “Even those in attendance did not take the issue of healthcare seriously.”

As the local elections are at the doorsteps, concerns have been growing about how much priority political parties are attaching to healthcare issues. Experts say it is unfortunate that no serious discussion has been held on healthcare issues in the run-up to the local level elections, although the country is still struggling to return to the pre-pandemic normal.

“It will be a big relief, if local governments implement the central policy and do not transfer healthcare funds to development work,” said Dr Binjawala Shrestha, a public health expert. “Most local governments neither make their own policies on healthcare nor work seriously to implement those of the federal government.”

As local governments get up to 90 percent of their health budget from the federal government, local election candidates and their parties must come up with practical and realistic plans on health care, according to doctors.

Most local governments in the Kathmandu Valley did not set up quarantine facilities and isolation centers, nor did they enforce safety measures or carry out contact-tracing during the second and third waves of the pandemic. Due to their failure to do the needful, the virus spread throughout the country.

“Health of the general public determines the overall health of the country. Health is the main indicator to assess social developments, educational status, development and economic growth,” said Mahendra Prasaad Shrestha, former chief specialist at the Health Ministry.

“But it is very unfortunate that health care is not a priority of any political party in the local elections.”

In the elections–whether local, provincial or federal–political parties make vague mention of health care issues in their manifestos, but experts say that does not help tackle the problems.

“There remains much to be done at the local level,” said Dr Bikash Devkota, secretary at the Health Ministry in Lumbini Province. “But very little is being done because willpower is lacking.”

Last month, a local health facility in Manthali Municipality of Ramechhap carried out screening of uterine prolapse for women residing in temporary homes set up near the banks of Bhatauli River in ward 7 of the municipality.

Among 13 women screened, 11 were diagnosed with uterine prolapse.

Uterine prolapse occurs when the pelvic muscle and ligaments stretch and weaken and no longer provide enough support for the uterus.

In 2018, a cervical cancer screening was carried out in a ward of the Kathmandu Metropolitan City. Of the 312 women who took part in the screening programme, 13 were found suffering from cervical cancer. Of them, two women, who were diagnosed at a late stage, died and 11 women got cured.

“There are multiple health care problems and it is not only at any particular local level but throughout the country,” said Shrestha, former chief specialist of the Health Ministry. “Local governments can address those problems, save lives, and improve overall health care status if they really want.”

Apart from implementing the federal government’s health care programmes, local levels can make their own programmes and allocate budget on their own. Local governments can work to ensure that all children in their jurisdictions are immunised, they can work to minimise malnutrition problems, ensure free essential medicines, raise awareness drives about particular problems and promote health seeking behaviour.

Some political parties have announced plans to construct 50-bed hospitals, intensive care units, and reduce home deliveries to zero, but these are impractical and unnecessary pledges, say doctors.