Nepal can learn from the NHS experience: Dr Gautam
A leading Nepali doctor based in UK has said despite being a developing country-- Nepal can learn a lot from the British system of providing quality health services to the entire population.
Addressing a talk programme organised by the London Chhalphal at the London Camden College (http://www.londoncamdencollege.co.uk/) last week, chairman of the Nepalese Doctors Association UK, Dr Prasanna C. Gautam, said 60 years ago, when the National Health Service (NHS) was established in the UK, the health conditions of majority of the population was poor. Britain was just emerging out of the Second World War and despite being a rich, industrial country most of the people could not afford health services.
Introduced by the Labour government in 1948, the NHS was designed as a service available to all, funded largely from central taxation, and a service free at the time of need. “NHS is about the interaction of three main parties involved: those needing care, those who deliver skilled care and those whose task it is to raise the money and see it properly spent,” said Dr Gautam—who retired two years ago from active practice after working under the NHS in various capacities for over two-and-half decades.
According to Dr Gautam, despite profound managerial and funding challenges and questions being raised about its sustainability, the NHS has largely succeeded in the UK because it is one of the components of the welfare state, the state has been able to support it, every part of the country is accessible, infrastructure is well-developed and now it is more or less self-sufficient in terms of the medical manpower.
Successive governments in the UK have accorded top priority to fund and improve quality services being delivered by the NHS. When the Labour government took over in 1997, the annual budget allocated for the NHS stood at around 35 billion pounds. Over a decade, it has increased three-folds and the annual budget now is well over 100 billion pounds per annum, said Dr Gautam.
The study of Nepali health system with that of the UK would be a study in contrast. The per capita GDP of UK stands at nearly 32,000 USD while that of Nepal stands just at US$ 1,500. According to a report published by the Department for International Development (DFID) of the British government in October this year, only 1.18 percent of Nepal’s GDP of US$ 115 million is spent on health. Estimated expenditure on health in Nepal is $ 14 per person out of which an estimated $10 is spent by individuals while the government’s expenditure on health per person is just US$ 4.
According to the DFID report, around 50 percent of the Nepali children suffer from malnutrition. Eight out of 100 children in Nepal die within five years whereas among the dalit community, the death rate of children below five years is more than double (17 out of 100).
The official website of Ministry of Health and Population (MoHP) said poverty, lack of clean water and poor hygiene were the main causes of diseases in Nepal. But Dr Gautam said this hypothesis was fundamentally wrong. “The poverty breeds poor health, not the other way round. The MoHP should get it right,” he asserted.
When asked what would be his top priority if he was appointed Health Minister of Nepal, Dr Gautam said besides raising investment on the public health, he would emphasise on developing infrastructure across the country. “How can you provide quality health services in remote areas where there is lack of basic infrastructure?” asked Dr. Gautam, who had worked as a medical officer in Jumla district some three decades ago. “It is the duty of the government to provide basic minimum health care and primary education to the people,” he added.
Responding to another query, Dr Gautam said the government of Nepal should legislate to ensure that people who can’t pay should be protected and had access to health services. “All curative services have to be given to the private sector. In fact they are already doing it,” said Gautam, adding, “If the government comes up with right policies investment in health sector would not be a problem.”
Dr Gautam said that with the government’s policy of allowing private sector investment in the health services, 12 medical colleges were already operating adding nearly 6,000 hospital beds in the country and creating 20,000 new jobs.
Recalling his visit to Singapore in 1972, Dr Gautam said at that time people in Singapore were poor and did not have good education and health facilities. Now, it has one of the best health services in the world. “There are a lot of success stories. All we need is vision, correct thinking and learning from others’ experiences,” said Dr Gautam adding, “In Nepal, we don’t need hand-outs. We should be providing facilities for investors to come and invest in the health sector.”
The full text of Dr Gautam’s presentation can be accessed at http://www.digitalshristy.com/lc/
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