Monday Sep 25, 2023
Monday Sep 25, 2023

Public Health Risks and the health system in Nepal

Despite centuries of national health system development, geographical disparity and the rise of new health risks highlight the weakness of Nepal’s health system.

2023 Mar 23, 7:10, Kathmandu
Although the Constitution of Nepal mentions health as a fundamental right of the citizen and Article 35 of the constitution provides provisions for free health care, information about health care, equal access to health care and access to clean drinking water and sanitation, the nation’s weak health system deprives many Nepali citizens of their constitutional privileges.
Tracing back the history of health systems in Nepal, several dynasties kept on introducing new changes in the national public health system. The 2020 study, ‘ Health System Development in Nepal’ mentions how health systems were developed and systematised according to the resources available in the Lichchavi, Malla and Shah periods.

In early times, several ‘Aarogyashalas’ established in parts of Nepal, provided traditional medicinal care. In the modern period modern medicine or allopathy started gaining more significance in Nepal. Since then, civil medical schools, mission hospitals and welfare clinics have contributed significantly to providing health facilities to the Nepalese people.
Similarly, projects were launched to control infectious diseases like malaria and smallpox. Community participation has always been a major part of the Nepalese health system. Female community health volunteers and mother’s groups add up to the several charity works done by Nepalese and foreign nationals to strengthen the health system in Nepal. Likewise, health centres in electoral constituencies, districts, zones gave nationwide services.

The opening of the Institute of medicine (IOM) in the early 1970s inaugurated medical education in Nepal. And in order to revive and systematise the ancient traditional medicine practices, an autonomous body, the Nepal Ayurvedic Medical Council (NAMC) was established under the Ayurveda Medical Council Act. The council has been acting as the regulatory and legislative body for Ayurvedic courses, human resources, institutions, practitioners and traditional healers in Nepal.

After the devastating earthquake of 2015, Nepal faced a second setback during the extended lockdown periods enforced during the pandemic which affected several of Nepal’s welfare policies that could support the poor and malnourished of Nepal. Being one of the poorest countries of the world, Nepal has high maternal and child mortality rates which is an outcome of lack of access to health care services. The geographical disparities are widened when looked at in terms of health infrastructures in Nepal. While cities may introduce globally acclaimed health services and update it each year, the rural areas lack even the simplest of the modern health services.

Besides high maternal mortality rates, Nepal has significantly higher female suicide rates as well. Among women between, 15–45 years old in Nepal, suicide is the leading cause of death, accounting for more than 15 percent of the total mortality. This is despite the lack of a strong suicide surveillance system in Nepal.

Although in the past, most of the resources were directed towards treating infectious diseases, mental health problems and non communicable diseases is the biggest health risk in the postmodern age. “Heart diseases are increasing every year in Nepal. Poor diet, lack of exercise and sedentary lifestyle are contributing as the key causes of the rise of heart problems in Nepal,” says Dammar Kumari Khanal, Public Health Nurse at the National health training centre of the Government of Nepal. Lack of health education and awareness, consumption of alcohol increase the risk of cardiovascular diseases and further burden Nepal’s weak health system

Despite continuous historical developments in the betterment of the national health system in Nepal, studies mention the lack of health institution management and effective health policies in Nepal. On the matter, public health expert, Radhika Ghimire says, “ The national policies and guidelines should be formulated and implemented through the meaningful engagement of the local governments as well. The special health task force for every thematic area should be trained and continuously motivated by onsite coaching and mentoring. Similarly, good practices of health system strengthening should be documented and shared in a larger community to further plan evidence based specific health programming.”


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