Anil Thapa was the coordinator of the National Prevalence Survey at the National Tuberculosis Centre until last week.

Thapa and his team had carried out a study on tuberculosis prevalence throughout the country for three years. But at the time of writing the report, the government transferred Thapa to the Finance Ministry.

The findings of the study are yet to be made public.

“My team spent three years studying tuberculosis prevalence in the country,” Thapa told the Post. “I am not sure what kind of report we will have if it is written by some other people based on our findings.”

The National Prevalence Survey on tuberculosis is a public health priority. Nepal has committed to containing new tuberculosis infection rate to 10 for every 100,000 population by 2030 to meet the Sustainable Development Goals targets.

The World Health Organisation estimates that every year 45,000 people get infected with tuberculosis in Nepal.

Like Thapa, tuberculosis and leprosy officers serving in the 77 districts have been transferred to the health facilities of rural municipalities, municipalities, sub-metropolises or metropolises, and programmes on tuberculosis and leprosy control have been severely affected.

“They are not merely technical staffers. They have 20 to 30 years of working experience,” Dr Sagar Kumar Rajbhandari, director at the National Tuberculosis Centre, told the Post. “The network of the tuberculosis programme is in a shambles, and several tuberculosis and leprosy programmes have been affected due to the transfer of staff.”

According to the Centre, the government has also transferred lab technicians, radiologists and medical officers serving at tuberculosis treatment facilities.

“It would be difficult for the Centre to retain these officers, as they have been adjusted to provincial and local level governments,” said Rajbhandari. “How can we achieve the goals when we keep on changing the entire set of technical manpower?”

Now, the Health Ministry has scrapped altogether the posts of District Tuberculosis and Leprosy officers.

The government has also transferred vector entomologists and focal persons for malaria prevention and control. According to the Epidemiology and Disease Control Division, it does not have entomologists to carry out a study on mosquitoes.

“All entomologists who were trained to study the presence of mosquitoes and other vectors are transferred to the local level,” said Dr Sameerr Adhikari, an official at the Division. “Neither doctors nor other health officials can do what entomologists do.”

Surgery services in several hospitals across the country have been affected due to the transfer of anaesthetic assistants and staff nurses trained to work in operation centres. Even cleaning staffers, who are trained to contain the spread of infection, have been transferred.

“All minor and major surgery services at our hospital will be stopped if the transfer of anesthetic assistant is not stopped,” Dr Jagadish Chandra Bista, medical superintendent at the Baitadi District Hospital, told the Post over the phone. “We have requested all agencies—provincial governments and the Health Ministry—to halt the transfers.”

According to the hospital, Khem Raj Bhatta, an anesthetic assistant serving in the district, has been transferred to a health facility of Jogbuda Rural Municipality in Dadeldhura district.

Complicated delivery cases and patients from Darchula and some parts of Doti are taken care at the Baitadi District Hospital for caesarean section and other surgeries.

Bista said that patients will have to travel 15 hours in an ambulance to reach Nepalgunj for the service if surgery services are halted there.

In the east, Bhojpur district hospital has issued a notification about the halt to caesarean section delivery services for an indefinite period.

The move came after anesthetic assistant Suresh Thapa serving at the hospital chose to go to Province 5 during the employee adjustment process.

“We had requested the concerned ministry of the provincial government and the [federal] Health Ministry not to transfer the anaesthetic assistant,” Rajendra Prasad Raut, spokesperson for the hospital, told the Post over the phone from Bhojpur. “No one paid heed to our concerns and we are compelled to halt services.”

Family planning programmes have also been affected due to the transfer of family planning officers in all districts. The government has also scrapped family planning officers’ posts, saying that the provincial and local governments would hire staff to carry out their works. None of the provincial or local governments have appointed such staff.

“I have requested Health Ministry officials to not effect the transfer of technical staff,” Dr Bhim Singh Tinkery, director at the Division, told the Post.

Health experts say the achievements made in the health sector over the decades could collapse if decisions are made without contemplating their repercussions.

Dr Mingmar Sherpa, an expert on public health, said all sectors of public health have been affected by health staffers’ adjustment process.

“The government does not seem to be serious about possible consequences while making decisions on the transfer of health staff,” Sherpa told the Post.

The Family Welfare Division of the Department of Health Services also said the Health Ministry’s decision to implement the adjustment process has put the lives of new mothers and infants at risk.

“Reforms should be made to improve the service quality and ease the suffering of patients,” said Dr Baburam Marasini, a former director at the Epidemiology and Disease Control Division. “Thousands of people are going to suffer because of the employee adjustment process.”

According to him, Health Ministry officials must halt the transfer of technical manpower until it sends their replacements.

Dr Guna Raj Awasthi, director at the Sudurpaschim Provincial Health Directorate, said the government has created a mess by transferring technical manpower.

“We are just talking about the immediate health impacts of the transfers of technical manpower,” said Awasthi. “The long-term effects will be even more dangerous.”

In a country like Nepal where health care services have never been up to the mark, such haphazard decisions could make the entire health care system even more chaotic, said Professor Sarad Onta, assistant dean at the Institute of Medicine.

“It is not only the question of consultant doctors. The government actually has created more mess by transferring lower-level technical staff,” said Onta. “The government should not transfer health staffers without giving alternatives.”