Health inequalityConstitutional provisions do not mean much if they are not implemented
Nepalis have two choices before them to prevent or cure ill health, and one’s choice depends on one’s financial capability. There are two kinds of health service providers in the country—the private and the public. People who are financially well-off go to the well-equipped private nursing homes or hospitals. On the other hand, those who cannot afford such a costly treatment approach the public health care centres. Such public health service providers are the government’s health posts and hospitals. Unfortunately, many of them are in a dire condition with poor services, facilities and equipment.
The services provided by the public health care centres in remote areas are even worse. There is not a single doctor at many public health care centres. In many circumstances, health assistants and other minimally trained staff members look after the patients who require medical care. But unavailability of doctors in the government hospitals is a big problem even in urban areas. Most of the doctors serving in the government hospitals spend a limited amount of time there, insufficient to meet people’s needs. This is because most of them prefer working for private hospitals and spend more time there. The rule which prohibits the health professionals assigned to the government hospitals against working in private health centres has not been strictly enforced. But recently in Chitwan, a bold step was taken by the police. They arrested two health professionals of the BP Memorial Cancer Hospital on charges of working in a private clinic during duty hours.
Public versus private
There are many differences between private and public health centres in terms of services, facilities and costs. Private health care centres are established with a commercial mindset; they are therefore profit-oriented. As a result, services and facilities are comparatively better in private health care centres than in state-run hospitals.
But the benefits of going to a private health facility come with a price. It has become common practice in all private health centres to overcharge for their services. They levy a high service charge on a minor medical or surgical treatment, and their medicines and medical supplies are also quite expensive. Though it is beyond the financial capacity of many people to go to private health centres, they are compelled to do so.
Unlike private hospitals, government hospitals are inexpensive and are therefore overcrowded. People have to spend long hours in a queue for a medical checkup. The doctors serving in the government hospitals do not pay much attention to the patients; some of them even convince patients admitted in the government hospitals to shift to private institutions. It is really an unfortunate scenario to have such money-minded health professionals. A few months ago it was reported how private hospitals in the Capital were bribing ambulance drivers to bring in patients.
There is a clear disparity between the haves and the have-nots as far as receiving quality health services in Nepal is concerned. And this difference has prevailed in the country since the privatisation of health services. After the restoration of democracy in 1990, the government accepted a more liberal policy with a view to promote a competitive market in different sectors. As a result, a large number of private institutions in the health sector were established, creating a sharp division between the rich and the poor in the face of growing health concerns.
Right to health
The low quality of service in the public health care centres, lack of easy access to health services for a majority of the people and cartels in the private health care centres have widened health inequality in the country. This is a major concern that needs to be addressed. It is the responsibility of the government to ensure equal health access to its populace. The Constitution of Nepal has guaranteed the right to health. As per the article 35(3) of the constitution: ‘Each person shall have equal access to health care’. But it is not enough to just write this in the constitution. It will only matter if the government takes solid actions to improve the ailing health sector of our country. While the government health facilities need to be strengthened, private institutions need to be strictly monitored for financial irregularities.
Khadka is chairperson at Prakriya Nepal, an NGO working in health, education and consumer rights