National Health Policy 1991 and it's travelouge

It's been 22  years after the National Health Policy (1991) was formulated with a framework of 14 components. More or less, it wouldn't sound wrong that it is in the tip of our tongue. There's no doubt it's a fundamental base of Public Health in Nepal. 

NATIONAL HEALTH POLICY, 1991

The National Health Policy was adopted in 1991 (FY 2048 BS) to bring about improvement in the health conditions of the people of Nepal. The primary objective of the National Health Policy is to extend the primary health care system to the rural population so that they benefit from modern medical facilities and trained health care providers. The National Health Policy addresses the following areas:

1. Preventive Health Services

Priority is given to programs that directly help reduce infant and child mortality rates. Services are to be provided in an integrated manner throughout the health system to sub health posts at the local level.

2. Promotive Health Services

The programs that enable people to live healthy lives will be given priority.

3. Curative Health Services

Curative health services will be made available at all health institutions-central, regional, zonal and district hospitals; primary health care centres (PHCC), health posts (HP), and sub health posts (SHP); and, at health institutions at all levels of the healthcare system. Hospital expansion will be based on population density and patient loads. Mobile teams will be organised to provide specialist services to remote areas. A referral system will be developed to direct the rural population to well-equipped institutions.

4. Basic Primary Health Services

Sub Health Posts will be established in phased manner in all Village Development Committees (VDC). One Health Post in 205 electoral constituencies will be upgraded in a gradual manner and converted to a Primary Health Care Centre.

5. Ayurvedic and other Traditional Health Services

The Ayurvedic system will be developed and other traditional health systems (such as Unani, homeopathy, and naturopathy) will be encouraged.

6. Organisation and Management

Improvements will be made in the organisation and management of health facilities at the central, regional and district levels. This will include the integration of the district hospitals and the public health offices into District Health Offices.

7. Community Participation in Health Services

Community participation will be sought at all levels of healthcare through the participation of female community health volunteers (FCHV), traditional birth attendants (TBA) and leaders of various local social organisations. VDCs will provide sites for the location of SHPs.

8. Human Resources for Health Development (HRH)

Technically competent human resources will be developed for all health facilities. Training centres and academic institutions will be strengthened.

9. Resource Mobilization in Health Services

National and international resources will be mobilized and alternative concepts (such as health insurance, user charges, and revolving drug schemes) will be explored.

10. Private, Non-Governmental Health Services and Inter-sectoral Co-ordination

The Ministry of Health will co-ordinate activities with the private sector, non-governmental organisations (NGOs), and non-health sectors of HMG. The private sector and NGOs will be encouraged to provide health services.

11. Decentralization and Regionalization

Decentralization and regionalisation will be strengthened; peripheral units will be made more autonomous. District Health Offices (DHO) will have a prominent role in the planning and management of curative and promotive health services from district to village levels.

12. Blood Transfusion Services

The Nepal Red Cross Society will be authorized to conduct all programs related to blood transfusion. The practice of buying, selling, and depositing blood will be prohibited.

13. Drug Supply

Improvements will be made in the supplies of drugs by increasing domestic production and upgrading the quality of essential drugs through effective implementation of the National Drug Policy.

14. Health Research

Health research will be encouraged for better management of health services.

   

Mesmerizing the fact that we have crossed two decades and two years since the date it was unveiled, it is worth to raise or argue on its relevance at present day context. We have made so much progress on the different sectors, may it be family planning [Contraceptive Prevalence rate (Overall) is almost 50 %, counting just modern contraceptives, it's 43% NDHS 2011 Full Report) , may it be maternal [Maternal Mortality have reduced to 229 per 10000* Nepal Maternal Mortality and Morbidity Survey 2008/09] and child health. In fact, we are so much closer in achieving many of the MDG goals. Pinpointing we have made such a remarkable progress in reducing maternal deaths. For that, Nepal was even honored at MDG Review Summit. But still, it's not an epitome. There are still so many pitfalls, so many hurdles to overcome. 

Plans are inked in right way but implemented in wrong directions. Though preventive Health Care services were kept at top out of various components but in reality we have missed salt-sugar-water  (नुन चिनि पानिको composition, we have addicted more to ORS sachets. We have missed भात बहादुर and साँग बहादुर posters in roadways. Truly speaking, it was mind-catching and long lasting in the sense i.e it is capable of staying in conscious mind for many years once it get visualized. Successful pilot programs are not even upgraded to larger scale solely due to vested interests of policy makers, politicians and by the money-hoarding nature of health workers. School health program is its vivid example. We have traveled a long journey from free breakfast to free oil distribution, campaigning for school health programs. Such programs were neither geared up nor got success.

We are still so much confused on styles and models of decentralization that suit best in Nepalese context. Few SHPs in Nepal experienced devolution model of decentralization but in the lack of full-fledged local level governing committee it couldn't get well-shaped like what it would have to be.

Despite mushrooming medical colleges with huge production of medical graduates every year, curative health services sector is yet in limbo.Centralized human resources in so called well-furnished cities of country, while on the other side rural health institutions of Nepal rarely get it operated by those who are assigned to. Those people who are in greater need of health care services are at least access to what they sought. It's a fact. Despite it's totally a government responsibility but to greater extent it depends upon health worker's morality.
Referring this article डा. भगवान, जवाफ देऊ, मेरो बच्चा कसरी मर्‍यो? - कमला थापा  as a reference out of so many unheard, unpublished & suppressed stories like this, it seems, medical doctors are in dire need of moral studies, and sociology than any others. It's necessary for them to understand  doctor-patient relationship as a holy-bond  and is more beyond the monetary value. It's a humanity. It's a religion.

* 281 per 10000 was the finding of NDHS 2006 later it was not among the components surveyed by NDHS 2011. So, previous one is stated as National Data in many Occasions.
The opinions expressed herein are personal.