Populist budget could cripple health sector, warn experts

Medical experts have expressed concerns about the challenges in providing quality healthcare, citing that the budget allocated to the health sector for this fiscal year is not enough.

The government has allocated a health budget of Rs 83.99bn, which is lower than the sums allocated in the previous two fiscal years. In the fiscal year 2021-22, the Ministry of Health and Population received an allocation of Rs 122.77bn. The figure was Rs 90.69bn for the fiscal year 2020/21. 

The government has decided to make healthcare accessible and qualitative to all. It has also pledged to expand public access to specialized healthcare, and prioritized the prevention, control and treatment of Covid-19 along with other infectious diseases. Funds have also been allocated for the prevention of dengue, malaria, kala-azar, encephalitis, and other seasonal and insect-borne diseases.

As per the plan to treat and prevent infectious diseases, the government has announced plans to upgrade Sukraraj Tropical and Infectious Disease Hospital into a 300-bed facility. A Rs 460m plan has also been outlined for the construction and operation of provincial communicable disease hospitals in Pokhara, Surkhet, Doti, and Bharatpur. A budget allocation has also been announced to upgrade all provincial hospitals into teaching hospitals with super-specialty facilities. 

But health experts say the ambitious plan announced by the government to improve the country’s health sector and the budget earmarked do not complement each other. Many of the plans, they say, also seem rushed and overlook some crucial aspects such as hiring medical professionals and training them.

 “If the government wants to upgrade and operate infectious disease hospitals, then it must recruit specialized human resources and train them,” says Dr Anup Bastola, tropical and infectious disease expert. The recruitment and training parts do not figure in the budget.  

The government has also earmarked Rs 1.28bn to provide 98 types of medicines, vaccines, and basic health services free of charge from primary health service centers in 6,743 wards throughout the country. 

“Instead of purchasing medicines, the government should focus on maintaining quality healthcare,” says Dr Ajay Kumar Jha, Consultant Hematologist, Vayodha Hospital.

The government has also decided to give continuity to the provision of Rs 5,000 monthly medical allowances to individuals who have undergone kidney transplantation, are undergoing dialysis, have been diagnosed with cancer, or have spinal paralysis. The scheme was introduced in January 2018 by the government led by Sher Bahadur Deuba. It was briefly discontinued by the KP Oli led government.

Likewise, Rs 2.50bn has been allocated to continue grants for the treatment of heart disease, kidney disease, cancer, Parkinson’s disease, Alzheimer’s disease, spinal injuries, head injuries, and sickle cell anemia to poor citizens.   Some health experts and medical professionals like Dr Jha are of the view that a distributive approach to healthcare budget is no way to improve Nepal's health sector. 

“It would have been better to strengthen the services rather than distributing monthly allowance to the patients,” says Dr Jha. Arrangements will be made to provide kidney transplantation services at all provincial hospitals as per the Finance Minister Prakash Sharan Mahat. 

“If the government can provide such services in all the federal hospitals then it will help patients to seek the health care in their hometown. Additional financial burden of the patients will be lowered and crowds in hospitals in the federal capital will also be decreased,” says Dr Jha.

The government has also allocated Rs 820m to purchase health equipment for 100 hospitals that are set to be completed next year. Again, another myopic plan that could end badly, say health experts, pointing out to the fact that many expensive health equipment remain unused in hospitals and other health facilities due to a lack of proper space for their installation and untrained human resources to operate them   

There is also an allocation meant for procurement of medical equipment and and infrastructure development for BP Koirala Memorial Cancer Hospital, GP Koirala National Center for Respiratory Diseases, Sushil Koirala Prakhar Cancer Hospital, Manmohan Cardiothoracic Vascular and Transplant Center, Suresh Wagle Memorial Cancer Hospital, Ramraja Prasad Singh Academy of Health Sciences, and Bhaktapur Cancer Hospital. In addition, Rs 8bn has been announced to give continuity to the construction of 5-, 10-, and 15-bed hospitals in 322 local levels across the country. 

Dr Dipendra Pandey, consultant orthopedic surgeon, Koshi Hospital, says with an allocation going for healthcare infrastructure development, there is also a need for health professionals to run them, an issue that the government didn’t address while announcing the budget.  

“The government has talked only developing healthcare infrastructure, but has not said anything about human resources,” he adds.

The government has also announced that special programs will be conducted to save the lives of mothers and their newborn in areas with high infant and maternal mortality rates, but health experts say such programs must be run across the country.

According to Nepal Demographic Health Survey 2016, maternal deaths are a subset of all female deaths. They are defined as deaths that occur during pregnancy or childbirth, or within 42 days after the birth or termination of a pregnancy, but are not due to accidents or violence. The maternal mortality ratio for the period 2009-2016 is 239 deaths per 100,000 live births. About 12 percent of deaths of women, age 15-49, are maternal deaths, the survey reports.

“In order to prevent maternal and infant deaths, the government must come up with plans to deliver maternity services from all health institutions. It should not be limited to a few ones,” says Dr Manor Din Shaiyed.  He is of the view that the healthcare allocation should be at least 10 percent of the total budget. 

To make the geriatric wards in government hospitals more effective, the government has announced plans to set up necessary arrangements for screening and treatment of age-related diseases, including dementia, and Alzheimer's disease, in coordination with the nearest specialized hospital. Similarly, Rs 1.15bn has been set aside for the “Tuberculosis-free Nepal Campaign” to identify patients and provide free distribution of medicine.

The government has also said that Geta Medical College will be operated as the Shahid Dashrath Chand Institute of Health Sciences. A budget has been allocated for infrastructure construction, equipment purchase, and manpower management to upgrade Geta Hospital into a 100-bed facility. A budget has also been allocated for the development of infrastructure to expand the services of Rapti Academy of Health Sciences. Plans and budget have also been announced to initiate the process of establishing a 100-bed satellite hospital in Rakam, Aathbis Municipality, Dailekh under the Karnali Institute of Health Sciences.

Allocations have also been made for the capacity expansion of the National Trauma Center, and setting up primary trauma care centers in Lamki, Kailali; Saljhandi, Rupandehi; Bardaghat, Nawalparasi West; Gaindakot, Nawalpur; Bhiman, Sindhuli; and Belkhu, Dhading.

The government has also announced plans to make arrangements for specialty doctors who have completed their MD and MS under state scholarship programs to serve in government hospitals outside Kathmandu Valley. 

To improve the quality of health services, Rs 240m has been allocated for the implementation of the “one-doctor, one-hospital” program. 

Dr Pandey, from Koshi Hospital, says the government has come up with a list of plans in the name of improving the health sector and healthcare accessibility, but has not announced any program to encourage health professionals. 

“There are no proper plans to stop health professionals from migrating to foreign countries for better opportunities. Construction of hospital buildings and adding medical equipment alone is not enough.”