Nepali Congress youth leader Pradip Poudel has assumed office as the new Minister of Health in the KP Sharma Oli-led cabinet. The health ministry is considered a highly attractive post due to its extensive nationwide network, direct connection to citizens’ health, and substantial budget.
Upon assuming office on Monday, newly appointed Minister Poudel announced plans to publish a list of immediate and long-term tasks within a week. He also promised to implement a system within a month to eliminate the need for queues in government hospitals and to introduce a program that would encompass all Nepali under health insurance.
The effectiveness of these plans remains to be seen. Ministry officials believe that only someone who can manage the entire health ministry team effectively can achieve success.
Immediate plans and promises
Citizens grappling with overcrowded government hospitals long waits for surgeries, and the necessity to sell property for medical treatments would greatly benefit from even minor improvements in the health sector.
Health ministry officials state that key tasks in the health sector include implementing the health insurance programme, providing easy and affordable treatment for serious diseases, and improving services in government hospitals. Focusing on these areas would make Minister Poudel’s tenure productive.
Expectations are high for Poudel to deliver results in the health ministry, especially with the support of Congress General Secretary Gagan Thapa, who previously held the health ministry portfolio and made significant political strides.
During his approximately nine-month tenure as health minister in 2016, Thapa implemented mandatory health insurance, provided free or low-cost quality medicines, launched an integrated health infrastructure development project, expanded free dialysis and transplant services, mandated pharmacy operations in all hospitals, initiated urban health promotion centres, ensured one hospital per municipality, and regulated private health institutions.
“A lot of the policies and frameworks set during former Minister Thapa’s tenure still need strong implementation,” a senior ministry official stated. “If Minister Poudel can build on those efforts with a fresh approach, tangible results may follow.”
Former Health Secretary Dr Kiran Regmi considers Poudel to be a motivated individual, which gives rise to hope. “Former Minister Thapa made significant contributions to establishing the foundation for health insurance. Focusing on making health insurance successful would be key,” Dr Regmi remarked. She also suggested that Minister Poudel should advance the concept of urban health clinics.
Challenges in the health sector
According to ministry officials, past health ministers have failed to address basic, immediate tasks, causing ongoing public suffering. The government’s health insurance programme has not been effective, with ministers themselves undermining it, leading to eroding public trust.
The primary challenge of health insurance is providing quality services. Citizens’ trust in insurance has diminished due to difficulties in accessing services at health institutions. The former chairperson of the Health Insurance Board and former health secretary Dr Senendra Raj Upreti noted that the insurance programme, intended to provide social security, has not been operated effectively.
“Providing quality services with the current approach is difficult,” Dr Upreti said, “Most service-providing health institutions lack sufficient manpower, infrastructure, and equipment.”
Health insurance and programmes for severe diseases are being run separately, causing duplication in the government’s health service relief programmes. To make the benefits for poor citizens and health insurance effective, clear guidelines need to be established to avoid redundancy among various programmes like the treatment of severe diseases, the mother security programme, and social security programmes.
Ministry leaders have not been able to distinguish between health insurance and social security programmes. Dr Upreti emphasises the need to integrate all programmes under health insurance.
Despite the constitution ensuring basic health services, in practice, citizens have not received these services. Ensuring the constitutional promise of free basic health services would allow 70 per cent of patients to receive care at the local level, reducing the burden on central hospitals in cities.
Currently, government hospitals still have a two-year waiting period for surgeries. Previous health ministers have pledged to reduce this burden, but the problem persists. Reducing the waiting time for surgeries will be a critical test for Minister Poudel.
According to Dr Sushil Nath Pyakurel former chief specialist at the Ministry of Health and Population, many policy decisions needed for the health sector have already been made, but strong implementation is required. This necessitates a clear vision, the right team, and a willingness to work hard.
“Basic health service packages, minimum service standards for hospitals, and an integrated health insurance programme are already in place,” Dr Pyakurel stated. “Implementing them is the challenge. It’s high time to plan and work long-term.”
Need to prevent the emigration of skilled manpower
Government health institutions have been operating based on staffing levels from three decades ago, leading to a lack of quality services for citizens. The health ministry projects a need for over 92,000 staff nationwide. Currently, there are around 100 vacancies out of 793 positions for specialist doctors and about 30 per cent of 890 positions for MBBS doctors remain unfilled.
There is also a significant shortage of nursing staff, with 14,099 positions available nationwide but only 9,951 filled, leaving 4,148 vacancies. Many hospitals are operated by contractual staff.
Dr Pyakurel stresses that the health minister needs to make policy decisions to fill the necessary positions in hospitals. He suggests that Minister Poudel would be recognised as a capable health minister if he can secure staffing approvals by bringing the Prime Minister, Finance Minister, and General Administration Minister together.
Infrastructure construction in the health sector is also lagging due to budget shortages. The government aimed to build hospitals at all local levels within two years, but even after three years, construction and operational work remain incomplete.
The health ministry has not approved the staffing proposal for basic hospitals, leaving local levels to bear the burden. However, it is not feasible for local levels to manage the necessary staff and operate hospitals on their own.
The foundation stone for basic hospitals was laid during Prime Minister KP Sharma Oli’s previous term, and with him returning as Prime Minister, it should be easier for Minister Poudel to work in this area, according to Dr Pyakurel.
Most government health institutions, with a few exceptions, lack positions for specialised services for complex diseases, causing issues for citizens in disease diagnosis and treatment. On the other hand, doctors returning from studying abroad are migrating abroad due to a lack of a conducive working environment in Nepal. The trend of doctors leaving the country has doubled annually.
In 2023 alone, nearly 400 more doctors applied for good standing certificates from the Nepal Medical Council compared to the previous year. A total of 2,318 doctors obtained certificates to work abroad in 2023. Preventing the emigration of skilled manpower is another challenge for the health minister.
Health indicators in Nepal have been neglected for years, resulting in poor conditions. Ministry officials say that significant efforts will be required to change these indicators. According to the Nepal Demographic and Health Survey 2022, out of every 1,000 live births, 33 children under five years and 28 infants under one year die. The neonatal mortality rate within 28 days is 21 per 1,000 live births.
Adolescent fertility rates in Nepal are also high. According to the Nepal Demographic and Health Survey 2022, 14 per cent of girls aged 15-19 become pregnant. Although the law prohibits marriage for women under 20, the fact that 14 per cent of girls in this age group become pregnant indicates a serious situation.
The 2015 Urban Health Policy shows that children under five from poor urban families are 4.5 times more likely to die than those from wealthy families.
The government has not been able to implement the program to incentivise doctors and health workers in federal hospitals, where one doctor/health worker is assigned to each health institution. Without this programme, most departmental heads, consultant doctors, and medical officers in Kathmandu Valley hospitals continue to work in private hospitals and clinics. Many private hospitals use the names of government hospital doctors for branding.
The government has neglected infectious diseases to the extent that there is no coordinating body to fight epidemics, despite the country suffering significant damage from various outbreaks. Whether Minister Poudel will address this issue remains to be seen.
Dr Pyakurel considers one of Minister Poudel’s challenges to be bringing all health workers and institutions under a single command system, as was not done during past epidemics.
Most health ministers who have led the health ministry have been influenced by power centres and medical business interests, resulting in continued disarray in the health sector.
Persistent issues in the health sector include the unavailability of doctors in government hospitals, long waiting lines, the need to use private laboratories for tests, and the lack of free medicines specified by the government. Increasing commission-based practices, unnecessary tests, and prescribing medicines for profit have made medical treatment expensive for the public.
Ministry officials believe that the health minister should focus on solving these problems rather than engaging in publicity-focused inspections.
