Perpetuating Imbalance
IT IS fair to say that the state of health services in Nepal has always
remained sick. Slogans like Health for All et al notwithstanding, Nepal is still one of
the countries where the people have extremely limited access to health care. No wonder
then that health indicators of the nation on various fronts are at rock-bottom. Infant and
child mortality rates are one of the highest in the world. So is maternal mortality rate.
People die like flies when epidemics break out. They die simply because the most basic of
the basic health care needs are not accessible to them. The conditions of the mountainous
districts are particularly serious. Access to the health services in some of these
mountainous districts is practically nil. It seems, the adage – out of sight, out of
mind—works here well. Regional imbalance in establishment of health services is
glaring. According to figures made available at an interaction the other day, there are
some 4389 health facilities throughout the country but only 608 out of them are in the
mountainous and the Himalayan region. What’s more, 50 per cent of these health
facilities are sub-health posts, meaning staffed by health workers, not fully qualified
medical personnel. Juxtaposed with the fact that two thirds of the country is mountainous,
the above figures indicate the magnitude of the imbalance.
Would more health posts ensure better access to health care ? Not quite
likely. Here is another set of figures: Of the country’s 977 doctors working in the
government sector. Only 46 are deputed in the mountains. The health facilities in these
remote regions exist only in name. Rarely are they stocked with the needed drugs of
equipped with skilled health personnel. What does it tell ? It says that large zones of
the mountainous region are without any kind of health facilities and that if there is one
at all, it is not a functioning health facility. No wonder easily preventable diseases
exact a large human toil year after year. A viral influenza last year killed over a
hundred people in Karnali zone itself. Such being the situation, it further boggles the
mind when news story comes in that says infrastructural health project funded by the World
Bank has ignored the remotest districts and that the new health facilities, numbering 225,
under the 20 million-dollar project have come up mostly in the more accessible areas. The
entire Karnali zone gets only two health facilities while some Terai districts get as many
as a dozen. If this is not a classic case of imbalance in project formulation and
implementation, what is ? An investigation into the way this project was drawn up and
implemented is in order.
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