Challenges of Providing Primary Health Care

CONTENTS

1) Introduction

2) Objective

3) Overview of Nepalese Health Profile

4) Economics of Health Sector

5) Challenges of Providing Healthcare in Nepal
5.1) Physical Geography
5.2) Highly-centralized Health system
5.3) Lack of Institutions, Resources and Funding
5.4) Immigration
5.5) Cultural Issues

6) Challenges of Providing Healthcare during Violent Conflicts
6.1) Overview
6.2) Safety of Health Workers
6.3) Destruction of Infra-structures and its Consequences
6.4) Re-construction and Long-term Impact

7) Conclusion

Abbreviations

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Abstract

A challenge in providing Healthcare for all is a universal phenomenon. Especially developing countries lack the resources to fulfil this challenge. Additionally there are obstacles created both by the nature, due to complex geography which includes high mountains or hot desserts and by human themselves due to inefficient health policy, lack of proper manpower etc. Nepal is one of such countries that face serious challenge in delivering healthcare. It is not able to provide even a basic healthcare though it has signed every international treaties regarding health for example Alma-Ata Declaration. However, there has been some selective positive development. Still, multi-faceted challenges remain. Physical geography, its in-efficient bureaucracy, under-development, highly centralized health system and instable government contribute more to these challenges. A decade long civil war jeopardized the supply of healthcare taking the health system near to complete collapse in rural areas where majority of Nepalese reside. The burden of re-building is immense and fulfilling the Millennium Development Goals is unlikely. Given the direct and indirect cost incurred by a violent civil war like in Nepal, it turns to be a real tragedy where the most vulnerable are hit hard. Consequences of not being able to get proper care especially during and after childbirth for women and the lack of treatment facilities for those who need the most like TB patients, HIV positives, and millions of others who suffer from prevalent diseases l ike Malaria, Pneumonia, Measles etc. are immeasurable. It gives us a lesson that especially in such a poor setting, avoiding the conflict at any cost is vital. Moreover, there should be laws and treaties that ensure the security of health personnel who choose to save lives of others even in dangerous circumstances. It should be generally accepted that health is wealth and healthy citizens means a high potential of further economic development. 4

1) Introduction:

The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable and affordable healthcare of appropriate quality (WHO, 2013). However, billions of people especially in developing countries lack any Healthcare services for various reasons. The vibrant challenges countries face hinders the supply of healthcare that is terribly necessary for rural population of poor countries. Consequently, the ‘health capital’ of poorest of the poors is dire. Most of the developing countries lie in tropical areas, between the tropic of cancer and the tropic of capricorn. These areas are prone to diseases. So, developing countries al so face the lion’s share of the burden of diseases and at the same time lack the financial means to tackle the problem.

Nepal is one example of such countries that face severe challenges related to healthcare. Its physical geography that consists of mostly hills and mountains and hot regions of Terai impose a serious challenge to provide healthcare. This problem is worsened by the given traditional values that are reluctant to adopt scientific ways of treatment. Additionally, there are issues like political instability, war, violence, gender discrimination, poverty etc. which add oil into the fire. In this paper I will mainly focus on the challenges to provide primary healthcare for all in such setting like that in Nepal and how it is worsened by violent conflicts like war. After mentioning some basic health characteristics of Nepal, I will discuss further about the challenges we face due to the factors like geography, culture, governance and economic issues. In the following part, I will illustrate the main points about this essay namely the challenges during a violent conflict or civil war. In Nepal’s case it was the maoist-led civil war. Finally, I will conclude the main points again.

2) Objective and Methods:

Objective of this essay is to incorporate the challenges to provide healthcare in a poor country with the violent conflict to give a message of why such conflicts should be avoided with all means if we want to ensure the availability of healthcare for everybody in the present and in future which contributes to the overall economic development observing the case of Nepal. The objective is also to highlight the direct and indirect cost Nepal faces because of the civil war.

Literatures were searched and reviewed with the help of google, google scholar and medline. Additionally, an access to scientific papers was made available by the help of Kathmandu University medical school which allowed access to literatures about health that was related to Nepal and its system.

3) Overview of Nepalese Health Profile:

Nepal is one of the least developed countries in the world that lies between two giants China and India. The following statistics have been provided by the World Health Organisation (WHO)

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With a GNP per capita of $1470 and a total expenditure on health per capita of $68, it shows that 4.6% of national income is spent on health. Comparing with developed countries with the help of following figure, it shows that in real numbers, the per capita expenditure is meagre but in terms of percentage of GDP, the number does not deviate much from those of richer countries.

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( Source: OECD statistics, 2013)

However, due to political instability and frequently changing government, healthcare expenditure in total as well as per capita also changes with it. The following two figures shows the expenditure related to GDP and Per Capita. From this, we can conclude that health spending is very inconsistent and imbalanced.

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(Source: OECD Statistics, 2014)

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( Source: OECD Statistics, 2014 )

4) Economics of Health Sector:

There are 20 medical colleges in Nepal. Most of them are private. These 20 colleges can accommodate roughly 2000 students per year. However, roughly 8000 students want to study medicine. Those who cannot make the entry examination either opt to study something else or go to foreign countries mainly to China, India, Bangladesh, Pakistan and Germany (because of its free education). Average fee for the entire medical education is around 4.2 million NPR (~ 35,000£) (Dixit, 2008)

There are 0.24 physicians per 1000 individuals and estimated 1.9 hospital beds per 100,000 people Regarding Nurses, there are 117 Nursing campuses till date. There are 40,000 nurses currently employed which includes roughly 1000 foreign nurses ( Marahatta,Dixit,2008) who came to Nepal to do volunteering through charities or other international cooperation programs. Additionally, following relevant data is available from the Ministry of Health (2014):

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(Source: Nepalese Ministry of Health, 2014)

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(Source: Nepalese Ministry of Health, 2014)

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