Health assistants across the country are worried that a new government provision might put them under the supervision of less qualified officials.

A Cabinet meeting on January 13 passed the employee adjustment proposal of the Ministry of Health and Population, as per which sixth level health staffers would be leading the health posts.

There are over 4,000 health posts across the country, which are run by health assistants.

Moreover, health assistants have been also serving in district, regional and central hospitals and district health offices.

“I do not know where I will go after the adjustment process,” Prakash Pariyar, a health assistant serving at Sukraraj Tropical and Infectious Disease Hospital, said.

As per the new provision, auxiliary health workers and auxiliary nurse midwives as well as lab assistants—who entered the job as a fourth ranked officials—after years of service will lead the health posts if they are sixth ranked officials now.

This, health assistants said, might affect their career prospects.  

Jagat Nepali, a senior health assistant serving at Alapot Health Post of Kageshwori Manohara Municipality, said the health ministry has created confusion among health assistants.

“The health ministry’s decision to let auxiliary health workers lead the health posts could also affect the chain of health system,” he said.

Nepal’s health system is of referral type—auxiliary health workers refer patients to health assistants who then refer patients to the doctors serving at the primary health care centres. The referral then continues to district hospitals to zonal hospitals to central hospital, depending upon the case.

If auxiliary health workers start leading the health posts, health assistants say, the referral system—or the health system chain for that matter—gets broken at the very primary level.

“Auxiliary health workers or auxiliary nurse midwives enter the job as fourth ranked officials, while health assistants enter the job as fifth ranked officials. But just because auxiliary health workers are now sixth ranked officials for being in service for a period of time, they cannot be allowed to become in-charge of health posts,” said Nepali.

For one to become a health assistant, he or she has to complete a three-year course, while it requires only a 15-month training to become auxiliary health workers, auxiliary nurse midwives and lab assistants. Health assistants have claimed that since they study for three years, they are more qualified than auxiliary health workers and auxiliary nurse midwives.

Krishna Kumar Khatri, another health assistant serving at Chapagaun Health Post in Godavari Municipality, said that those auxiliary health workers and others—even if they are sixth ranked officials—cannot replace health assistants.

“We have submitted a memorandum to the health ministry to address our concerns,” said Khatri.

Mahendra Prasad Shrestha, chief of Health Coordination Division at the Health Ministry, told the Post that the ministry would correct the mistakes if there were any in the employee adjustment provision passed by the Cabinet.

“Experience matters. If those who entered the job as fourth ranked officials have moved up to the rank to sixth, then they should get an opportunity to lead health posts,” Shrestha said.