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12 January 2010

Medical professionals at the forefront: The hidden pangs

Dr. Angel Magar

Nepal Medical Association (NMA) was not going for a strike for its own benefit but to sensitize the people and the government to act effectively for a peaceful and healthy Nepal. Is it wrong to advocate for the improvement of health services in this country? Health should not be limited to words or any slogan confined to any political party, instead it has to be practical. NMA movement is to improve the health services, and it is advocating health equity in this country. All the people in this country must enjoy quality health.

Who does not need security and protection of their property? More than fifty cases of physical assault and vandalism in various hospitals have been reported in the media within a few years. There have been many unreported cases of controlling chaos by paying under the table by the hospital personnel, because they know that the government will not be able to

provide them security as needed. After years of lobbying and fighting for

this cause, the Nepal Health Professional Protection Act has been passed, but the government has failed to implement it. The government has to maintain law and order in the country. This is an era of performance, failure cannot be a reason to tolerate.

The health budget should be according to WHO standard (US $ 16). The government talks about free health in this country but very few people know that the total health budget is less than US $8 per capita in Nepal. NMA demands WHO standard for the country. Therefore, the minimum two digit budget should be allocated for health.

When our first president was in the Ministry of Health, the health human resource was analyzed and accordingly their number increased according to then population in 2047 BS. That had been done when the population was merely 15 million, but now it has gone up to 27.5 million yet the number of health professionals has remained stagnant. How can the same manpower provide quality service to an increased population. Why does not the government evaluate its work in this regard on a yearly basis or at least every five years. On top of that, 2 per cent of the health manpower are leaving the government sector to join the private sector, according to a report published on strategic plan for human resources for health by Health Ministry in April 2003. This rate is assumed to be increasing in recent years.

The current infrastructure has to be upgraded. We raised the voice for the doctors who have completed their studies through government scholarships by adjusting them in the vacant posts when the scarcity of doctors was discussed in a meeting in 2003. We also asked the government to upgrade the existing infrastructure. Although the first request has been fulfilled, the infrastructure has not yet been upgraded. Similarly, sending a doctor, that too inexperienced right after the internship, is not the solution. The government should come up with a mechanism to help them perform at their best.

Abolishing the 5 per cent tax paid by consumers in the name of the doctor is another mistake of the finance ministry done without proper homework. It seems that there is no coordination between the ministries. The government has come up with the scheme of free health, while they are asking doctors to get the 5 per cent tax from the patients and give it to them. The doctors are willing to come under the tax parameter but the government has to come up with the appropriate mechanism.

We are always in favor of National Academy of Medical Science which is providing postgraduate medical education in the country. There has been series of talk between NAMS, NMA in the presence of Ministry of Health officials. Even NAMS dignitaries felt that it was wrong to include Bir Hospital inside NAMS and showed their willingness to cooperate with the government. When NAMS came into existence, Bir Hospital came to be included due to some vested motive. That means not a single doctor from the periphery can be transferred at Bir. It means a doctor who is working in the periphery will always remain there, and there will be no opportunity to come inside the valley. If there is no such provision to work for one of the best hospital in Nepal once in their career then who would go to work in the periphery? Bir Hospital has to be developed as a center of excellence for patient care.

There should be increment of non practicing allowance for doctors working in the periphery. The allowance is 150% for very remote and 100% for remote areas, fixed in 2053 BS. But this allowance is provided according to the 2053 BS salary not at the current rate of salary. The government should adjust it according to the present salary and ought to do more homework to motivate doctors to work in such places. Then only people in the remote areas can have access to quality health care.

We have been advocating for these and other such issues personally and professionally for the past many years. The government’s assurances are there but very little has materialised in real terms. That sums up why NMA opted for the extreme measure.

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