Access to Proper Health Care and Essential Medicines: Perspectives from Nepal 

by Bikki Gautam

Scenario 1: A remote village somewhere in the hills of Nepal

A nine year old boy has been having a fever and cough for the last 5 days. His parents think it is just a simple cough and cold and do nothing about it. The child starts to deteriorate. That’s when the parents start getting concerned. The nearest health center is 2 days away on foot. By the time they get there, the child’s state is really critical. There are no intravenous antibiotics available. The child is referred to a district hospital which is still 2 more days away. The child dies on the way. The parents mourn for a few days and life moves on.

Scenario2: The capital city- Kathmandu

A 55 year old man gets sudden chest pain on the left side which radiates to the jaw. Immediately an ambulance is called for and he is taken to the nearest hospital. Quick investigations are done and the ECG reveals a myocardial infection. Necessary interventions are carried out and his life is out of danger.

The two scenarios presented above try to put into perspective the vast differences in health accessibility among different parts of the country itself. Almost all of the modern and proper health care system has been centralized to the major towns while the people in the remote villages are living in extreme poverty and lack of basic health care. The access to proper health care and essential medicines comes into the picture here.

The provision of essential drugs was put as one of the eight elements of Primary Health Care by the Alma Ata conference. The eight elements including the provision of essential drugs were mainly targeted towards the betterment of the health situation in developing countries like Nepal. But has the goal been achieved? As we reflect upon the mortality and morbidity indicators, still infectious and simple curable diseases like tuberculosis, pneumonia, and diarrhea and malnutrition problems pose a significant problem.

What add to the gravity of the problem is the lack of skilled health professionals and the provision of the basic essential medicines to the people in need. 

Impact of corruption:

Millions of dollars are being poured in. But is enough being done? The data tell a different story. And the recent civil war that gripped the country for more than a decade didn’t help matters. Even the few doctors who were willing to go the remote places to work were unable to do so because of security reasons and the instability of the governments made it impossible to implement long term health related plans. On top of that, the widespread corruption rampant in the country has engulfed the health sector too. This has led to the funds being deviated away from the real needy people. The money that should have been utilized for the implementation of newer health projects and the procurements of essential drugs is being pocketed by the politicians and other top government officials.

What can be done?

So this brings us to the bigger question, what can be done? It would be unfair to be absolutely pessimistic and state that nothing is being done. There is always light at the end of the tunnel and there are ways of improvement even in the direst circumstances. Here are a few suggestions that can be pondered upon:

1. Proper Planning:

Even though lots of short term and long term projects have been put in place, lots of them haven’t been able to deliver the goods. One of the major reasons behind this has been the lack of proper research and planning. Either we have overlooked the places and the people who are in real need or we have failed to identify the areas of priority. It is highly recommended that the government hires experienced health professionals who have worked in the remotest parts of the country and take necessary suggestions from them. Also forming small task forces to gather health related data from all over the country and careful analysis before implementing projects is a must.

2. Collaboration and partnership with National and International Organisations: 

No doubt there are lots of national and inter national organisations that are putting a genuine effort. But it has been often seen that most of the projects overlap on certain diseases and concentrate on a certain part of the country. This has led to many important health problems and many parts of the country being neglected. If there was to be a proper understanding among the government and all the organisations working for the common cause of a healthier nation, the expertise and the budget would be distributed evenly throughout the country and cover all relevant diseases. Furthermore, it would be better if the donor agencies or countries would show stronger responsibility and be accountable for the proper utilization of the funds that are coming in.

3. Production of more skilled health manpower and stopping the brain drain:

The situation is a strange one. First, there aren’t enough skilled health professionals to cater to the need of the vast population living in the remote areas. Secondly, most of them are opting to go to other countries looking for better financial rewards. The government should take this seriously. More people should be trained so that they can go and work in the periphery and a provision should be made that will encourage the young health professionals to serve in their own country. This will definitely be a way to ensure that the people have access to essential medicines because what are use of medicines if there aren’t people to give them away.

Lastly, In this way, if the afore mentioned suggestions can be implemented, it will be a positive step towards a better future for thousands of people who are dying young due to the lack of proper health care and essential medicines. Yes, change can’t be brought overnight but definitely a journey of a thousand miles starts with a single step.