Naradevi Gurung, 52, who had elevated blood pressure and high fever, died on March 31 after private hospitals in Biratnagar of eastern Nepal refused to see her/ AMN ARCHIVES
“Every citizen shall have the right to basic health services from the state, and no one shall be deprived of emergency health services,” states Article 35 of the new constitution. Despite the constitutional provision, in reality, there is no assurance of people’s access to even basic health services in many parts of Nepal. After the government announcement of a lockdown to contain the possible spread of the novel coronavirus, the public right to basic health services has been even more restricted. There have been instances of deaths of patients presenting themselves with corona-like symptoms after private hospitals refused to admit them.
This callous behavior of private hospitals and clinics during the coronavirus pandemic has sparked a debate on the kind of health policy the country needs. There are also voices that private hospitals should be nationalized, temporarily during the corona crisis, if not permanently. Spain recently nationalized all its private hospitals and healthcare service providers after they were deemed uncooperative in the country’s fight against the coronavirus.
Nepal opened its door for private investment in health with the start of the era of economic liberalization in 1990. The National Health Policy 1990 advocated the role of the private sector, and led to the opening of private hospitals and other health related services. Private sector is now involved mainly in two areas of healthcare: first as service providers, and second as producers of medicines and equipment. But has time come to revisit Nepal’s privatization policy?
Regulate, don’t close
Former multiple-time finance minister and central working committee member of Nepali Congress Ram Sharan Mahat, who is thought of as one of the architects of the new era of liberalization and privatization, says there is no need to rethink the current policy. “It is also untrue that the government has pulled back from the health sector. In the past three decades, there has been rapid expansion of government hospitals in districts and rural areas,” he adds. Since the private hospitals complement rather than compete against government hospitals, they should be better regulated rather than closed, he advises.
Mahat says those with little knowledge are questioning the rationale behind the privatization of health. “People should get to choose which hospital, private or government, they want to go and get treated. Some may even opt to go abroad for the same purpose. It is their right,” he adds.
Madhusudan Subedi, a Professor at Patan Academy of Health Sciences, says the issue of rethinking Nepal’s health policy came to the fore mainly after Dr. Govinda KC’s recent campaigns for drastic reforms in the health sector. “The demand for nationalization of private hospitals is emotional and impractical. The problem again is that after 1990 successive governments failed to regulate the health sector properly, and not necessarily that our private hospitals are not working,” he says.
On the coronavirus pandemic, Subedi says what is missing is coordination between government agencies and private hospitals. “And before accusing them of callousness, the government should provide Personal Protective Equipment (PPE) to doctors and nurses in private hospitals. But even the doctors working in government hospital don’t have these basic protective gears,” Subedi says.
Nay, involve the state
But according to Khagaraj Adhikari, former Health Minister and central committee member of the ruling Nepal Communist Party, this is the perfect time to rethink the post-1990 health policies. “The private hospitals have done some good. But their response to the coronavirus pandemic suggests they will be accountable to the public and the state only when it suits them and not when they are most needed. There is thus a strong rationale for greater government involvement in healthcare,” he says.
Many private hospitals are also openly flouting set criteria. For instance, they must set aside 10 percent of their total beds for free treatment of the poor and marginalized communities. But according to last year’s Auditor General’s report, most private hospitals are not implementing this provision. Similarly, the facilities they provide to senior citizens are also short of the legal requirements. The same report says private hospitals have not hired the required number of doctors and nurses; nor do they have adequate labs, equipment and beds.
Says Uma Kanta Chaudhary, another ex-health minister: “The state should be bold. If private hospitals shy away from their responsibly during a health crisis, they should be penalized. Yet it is not just their fault. Traditionally, the Nepali government has also failed to effectively monitor and take action against those who violate rules.” He advises that the private hospitals be made “more service-centric rather than purely business-centric”.
The neglected lot
In the past three decades there has been insufficient investment and effort in improving the state of government hospitals and decentralizing them. Right now they are desperately short on vital staff and equipment, and disproportionately concentrated in urban pockets.
There are four types of hospitals in Nepal: public hospitals (known as government hospitals), private/NGO hospitals, nursing homes, and medical colleges. Around 700 big and small private medical establishments are in operation, along with 19 medical colleges. In terms of government hospitals, there are three federal level hospitals, seven regional hospitals, and 77 district hospitals, in addition to smaller health and sub-health posts in local units.