Recently, Kantipur Publications’ news outlets published an appeal to help Mansara, a four-year-old child from Kalikot who has developed a terrible tumour in her right eye. It is commendable that such cases of extreme vulnerability receive such visibility and are known by the wider public. These cases are a reminder of the huge challenges that need to be faced before creating a true public health system in the country.  

There is no doubt that the overall national health system improved in the last year under the administration of Gagan Thapa. Many policy-related initiatives took place that will have a tangible impact on the lives of millions of people throughout the country. 

Foundations laid

One major achievement is the formulation of a new health system based on the upcoming federal model: with more and more resources devolved and managed at local levels, it will be vital to ensure that the budget allocated for human development will be spent in the right way and according to clear transparency benchmarks.

Recently, Thapa had announced that a new mental health policy will be formulated. If this happens, millions of people suffering from mental health problems who have been completely neglected by the system so far will find some new hope and recognition. 

During the past year, the foundations for a stronger national public health system were laid; however, much more needs to be done with the overall goal of ensuring that pictures of children like Mansara will no more appear in the national newspapers because there is a system in place to take care of them.

Of course it is not wrong for the society to chip in and contribute for the medical expenses of Mansara and many other children and adults living in precarious and life threatening situations. There is no doubt about the generosity of the common people in the face of such tragedies. 

The point here is different: we need to work towards a public health system that is able to identify and take care of cases like Mansara. Mansara’s family brought her to the Teaching Hospital, the nation’s premier public health institution, and yet her treatment was possible only because some people created a bank account to help collect money. 

If a poor family that has experienced a tragic situation affecting a small child cannot be treated for free in the major national hospital, I am wondering how likely it is that the private health institutions will abide to the new regulations giving them quotas to treat indigent and vulnerable citizens. Based on the provisions, private hospitals will have to welcome and accept patients who cannot afford the treatment. This is a positive step towards a more equitable national health system. Yet without a strong monitoring system, there is a risk that vulnerable citizens will be denied their constitutional right to health care. 

Accreditation system

It is true that implementation of a national health insurance policy will drastically improve the situation but at the same time, we need stronger and better coordination with the private health institutions based on an accreditation system where the costs of treatment of vulnerable citizens will be directly reimbursed by the government. This can initially be carried out by the central level and then progressively by the health governing bodies at the provincial level.

In order for such systems to function, the government must accelerate the process of issuing identification cards for persons living below the official poverty line. 

It will take time for such a complex endeavour to happen on a national scale. Meanwhile, a more traditional system of presenting a letter from local authorities validated by a special desk at the Ministry of Health should be enough to persuade private hospitals to provide free care for those who cannot afford treatment. 

While it can be relatively easy to get a letter from a municipality affirming the authenticity of the request for free treatment, the Ministry of Health should have an easy, hassle-free procedure in place to approve the case within a very reasonable timeframe. The same goes for the reimbursement of private hospitals for their service to indigent people unable to pay their health costs. 

We need to involve private health institutions and make them part of a national health system where they can act, not just out of generosity, but as partners in the delivery of a public service, stopping the “outsourcing” model of public health that is currently dominant. 

The health sector is attracting more private investments such as those used for the recently inaugurated Nepal Cancer Hospital and Research Center in Harisiddhi, Lalitpur. The hospital has a strong social mission as it was set up by the families of cancer victims and will be able to accommodate the needs of those who cannot afford the treatment. 

Yet we cannot only rely on private or not-for-profit initiatives. Instead, renovating or building new public hospitals should be a top priority for the government.

It was welcoming to hear that the Bir Hospital will be renovated. The same should happen throughout the nation where public hospitals are in terrible conditions and able to offer only limited services. 

What is needed is a National Public Hospitals Investment Plan with an appropriate budget to be included in the list of national priority projects. Why not start from Kalikot district where little Mansara comes from?

- Galimberti is co-founder of ENGAGE, an NGO partnering with youths living with disabilities