Although Nepal's population has doubled in the past four decades, there has been no significant increase in the number of health workers within the public health system. There are only around 1,400 doctor posts under our various health agencies.
While the Civil Service Bill is being discussed in the State Order and Good Governance Committee of the House of Representatives, a debate has started on whether it is appropriate to keep the health service under the civil service or not.
As it is a matter of great public interest, it is welcome to discuss it in the Legislative Parliament. But for such a debate to be fruitful, it is also necessary to have a deep understanding of the real content and issue.
Looking at the debates in the parliamentary committee so far, it does not seem that the main point has been reached. Because from the point of view of state management, whether health services should be kept under the civil service or not is not the main question. This is only helpful. The main thing is whether our state or the public sector under the state needs to participate in providing health services.
If this question is clear, then the answer to all the questions, including whether the health service should be kept under the civil service or not, will become clear.
In many countries with social democracies, essential health care is considered a 'public good'. It is believed that every person in the society should have access to it. It seems that many countries including Nepal have adopted this belief by defining health as a fundamental right in the constitution.
Therefore, if citizens need health services to be healthy, it is the responsibility of the state to arrange the proper provision of services. If the state intends to fulfill this responsibility, it is necessary to focus the debate of the parliamentary committee on how to provide health services in an equitable manner in order to benefit many citizens, taking into account the limitations of resources.
In the past three decades, the role of the private sector in this sector has increased significantly with the opening up of the health sector to private investment in Nepal. During this period, the number of private hospitals alone has increased by four hundred percent. Although the participation of the private sector in the health sector has brought significant benefits to increase the availability of health services and health education, many disadvantages have also been seen.
Our overall health system is becoming more concentrated in private hospitals and health institutions. Two-thirds of the health services provided in the country are provided by private health institutions. Due to this, health services are expensive as well as out of reach of common people. About 60 percent of the total expenditure on health is covered by private expenditure.
In fact, spending on health services has become one of the main causes of poverty in Nepal. According to some previous research, the proportion of people who are in the grip of poverty due to the cost of consuming health services in Nepal is more than 11 percent.
Therefore, it is important to discuss how to make healthcare affordable and accessible to achieve equitable access to healthcare. It is difficult to develop an affordable health system and provide health services without significant participation of the public sector, which has a non-profit character.
Although our efforts to strengthen the public health system have increased in recent years, this effort is also limited to the construction of physical infrastructure. Therefore, the effort to improve the quality of our public health system is entangled in the collection of physical infrastructure and endowments. This alone is not possible to increase the quality and quantity of health services.
No health system can run effectively if trained and capable health workers are not assigned to health institutions. We have not been able to pay attention to managing the health workers who are the most important part of the health system. This is where we have failed to improve our public health system.
Although the population of Nepal has doubled in the past four decades, there has not been a significant increase in the number of health workers in the public health system. There are only around 1,400 doctor posts under our various health agencies. The situation of other health workers is also similar. If health services are to be made accessible to the common people, the number and number of doctors and other health workers is very low.
In the current situation, the recruitment, professional development and remuneration of health workers in public health institutions are done as directed by the Health Services Act. This Act, which was drafted in 2053, is almost identical to the Civil Service Act except for a few sections. Therefore, if the public health organizations want to recruit health workers, they have to do it by completing the cumbersome and slow process of the Public Service Commission, just like in the civil service. Therefore, most of the public health institutions cannot easily fill the required manpower positions.
A very challenging task in terms of management like providing health services cannot be done under the provisions of the Act designed for other government offices. Therefore, despite the need and availability of health workers, our public health institutions have not been able to recruit health workers due to the cumbersome recruitment process under the Public Service Commission. Because of this, consumers have been deprived of getting proper and accessible health services, and thousands of health workers produced in the country have to go abroad in search of employment.
Many countries including Britain, Germany, Sweden, and Thailand, which provide excellent health services from public health institutions, have embraced this truth and have been adopting a creative and efficient process in the recruitment process, professional development and service facilities of health workers.
If our goal is to make health care universally accessible by making maximum use of the expenditure on health care, then our main effort should be to make it a practice for public health institutions to recruit and employ health workers quickly.
Therefore, if we want to make public health institutions strong, not only should the health service not be kept under the civil service, but there is an urgent need to make the recruitment process of health workers faster and more creative than at present.
As suggested by some parliamentarians in the parliamentary committee, if the health service group is merged and kept within the civil service, then the possibility of our public health institutions to easily recruit health workers as needed will be very low and the state of our public health system will be even worse than it is now. If the posts of health workers cannot be filled according to the requirements, it will be pointless to try to develop the public health system or to participate in the work of providing health services by the public sector.
