Before the demise of the Constituent Assembly, the Ministry of Health and Population (MoHP) had drafted a national health policy and sent it to the Constituent Assembly for approval, but the CA failed to do that on time. As a consolation, we get to further discuss the draft. Personally, I have been advocating for through reform of our national health policy and the larger health sector for the last few years.
In the 20-odd years since the advent of democracy in 1990, there have been sea changes in Nepal’s social, economic and political landscapes. At present, two issues are likely to affect our health policy the most. One is the prolonged political transition. Because of the long transition, our health sector has suffered a lot. A related point is that in the post-conflict scenario, the burning issue of mental health should have been given top priority, but that has sadly not been the case. Two, constitutionally, Nepal is already a federal republic. Therefore, new health policy should offer clear guidelines on how health issues of the people will be addressed in the federal set up.
The old health policy was based on the 1990 constitution. Since the 2006 interim constitution has established health as a fundamental human right, the health policy should be drafted from a rights-based perspective and resources channelized with due respect for the constitution. In keeping with IC, the new health policy should guarantee basic health rights of marginalized communities, including people with disabilities.
Theoritically, health policy should be reviewed and revised every 10 years, but our health policy has been the same for the last 20 years. The 1991 national health policy was drafted with the target population of 18 million in mind. But now the country’s population has reached 26 million, and taking care of health needs of this great mass calls for a new policy.
Having already served the country in the capacity of Health Minister (2007), I realize fully well that it’s not always fair to single out the ministry and its staff. If you have a bad policy, the quality of manpower may count for little.
For instance, from human resource viewpoint, it could be difficult for Kathmandu’s manpower to go to Dolpa or Humla and provide quality health care on a permanent basis. Because of this, we need a policy with its focus on development of local-level human resources to serve individual communities; federalism may help us make such a policy a reality.
There is also an urgent need to change our education policy for medical personnel. We need to discuss the matter of their education from a human resource perspective as well. It is important to realize that medical professionals (doctors) are taking undue advantage of political transition. Rather than providing their services at government hospitals throughout Nepal, in keeping with true medical ethos, they tend to spend most of their time in private hospitals in major urban hubs. In the absence of a new health policy, there is no mechanism to correct this aberration, although the current government seems to have made some effort to get the medical professionals to work in rural regions before they can get their pass-out certificates. Perhaps there can be broader dialogue with the medical community in this aspect.
Having occupied the top health office in the land, I have gained some valuable experience, which I am now using to raise health-related issues in UCPN (Maoist), my mother party where I occupy the portfolio of the chief of health affairs. One of my important realizations has been that mental health needs to be among the top priorities of the new national health policy; and the ministry of health needs to own this agenda. In today’s day and age, mental health problems have become as big an issue as other problems related to physical health. Everyone has to realize that mental health is an inseparable component of overall health. Given the geographic and manpower constraints of Nepal, I also believe community-level initiatives will be the most effective in tackling emerging mental health challenges.
Another much-needed change of approach would be to start viewing mental and overall health not just through medical lens. Devising social, economic and cultural approaches to tackle them will be as important. Since the interim constitution has already guaranteed health as a fundamental right of every citizen, now it is up to us to develop an accessible and affordable health system and services for the poor, the vulnerable (with disabilities) and the marginal communities. In the absence of good policy, it will also be hard to ask for a larger health budget and divide it equitably.
Nonetheless, our party had actively lobbied with Bharat Mohan Adhikari, the Finance Minister in the Jhalanath Khanal government, to increase health budget to seven percent of national budget. Though Adhikari had agreed with our external development partners to increase health budget to 7 percent, it would be another two years before the provision was implemented. Without proper policies, it will be difficult to increase investment in health sector and to develop relevant human resource and infrastructure.
In my view, only when we meet three criteria (reasonable budget, capable manpower and functioning system) can our healthcare sector be revived and our health goals met. Again, I would like to emphasize the importance of giving due priority to mental health. While drafting new health policy, mental health should be treated as a crosscutting issue linked to education, poverty alleviation, social welfare and disability. This is so because, like I said, mental health is as much a social problem as it is a medical issue.
However, the failure of the medical professionals to recognize mental health as crosscutting issue is creating many problems. If mental health is dealt with from the medical approach alone, medical professionals will dominate this issue. Another hidden challenge is created by pharmaceutical companies. If mental health problems can be established as chronic problems, drug makers will be able to reap billions by making people dependent on medicines. We need to bring this issue out in the open for serious discussion. We must be clear about our goal: do we want to develop mentally healthy people and a healthy society, or do we want to produce people with mental health problems who are dependent on medicines throughout their lives? Policy-level interventions, I believe, will also be helpful in promoting alternative treatment methods like yoga, meditation and traditional methods of healing.
A broad debate over the country’s health needs is long overdue. Now would be the perfect time to start.
The author is former Minister of Health and a member of the Nepal Mental Health Policy Group