Kailali, the capital of the Far West Province, has seen impressive progress in health indicators. But this district, which used to be affected by outbreaks of communicable diseases like cholera, diarrhea, and malaria in the past, is now forced to bear the new burden of non-communicable diseases.

According to Ramesh Kunwar, head of the Kailali Health Office, the change in the nature of the disease has become a new challenge for the district. ‘Yesterday, the burden of communicable diseases was high. But now the burden of non-communicable diseases related to lifestyle such as heart disease, diabetes, and cancer is increasing,’ he said. In addition, due to the open border, there is also the risk of various infections that can enter from India.

The district has made commendable improvements in the control of communicable diseases. The number of diarrhea infections seen in 28,420 people in 2079/80 has recently decreased to 9,149. Dengue infections have also decreased from 1,081 to 224, according to the data from the health office.

According to the health office, there are currently 183 health institutions operating in the district. Of these, only 5 government and 34 private hospitals are providing specialist services. The presence of 81 basic health service centers and 24 community health units has made efforts to expand access to villages. However, due to geographical remoteness and lack of resources, there is a huge gap in the quality of services.

Geographically, while access to specialist services is increasing in urban areas like Dhangadhi and Tikapur, citizens of hilly areas like Chure and Mohanyal still do not receive even basic services. There is no single primary hospital in these two rural municipalities. As a result, residents there are forced to travel for hours to reach Dhangadhi for general medical services.

The presence of specialist doctors is increasing in municipalities like Godavari, Lamki and Bardgoria in the district. This seems to have eased health services. But even though ambulance services have reached the entire district for emergency services, it is still challenging to provide services during the 'golden hour' in the hilly and remote areas. Even though health access is available within half an hour in the Terai, it is difficult for emergency patients to get timely treatment in places like Chure and Mohanyal.

The most positive aspect seen in Kailali's health services is the significant reduction in maternal and neonatal mortality rates. According to the health office's statistics, the number of maternal deaths, which was 15 in the fiscal year 2079/80, has decreased to 4 by the fiscal year 2082/83.

Similarly, there has also been a significant improvement in the neonatal mortality rate. While 153 newborns died in 079/80, this number has recently decreased to 34. This confirms the improvement in maternity services and child care in the district.

There has also been improvement in maternity services. In particular, Dhangadhi Sub-metropolitan City has become the center of maternity services in the district. Where more than 9,000 women have taken institutional delivery services annually.

The role of private hospitals is also important in improving the health indicators of the district. Due to the specialist services provided by the private sector in Dhangadhi and Attariya areas, many patients have been freed from the compulsion to go to India or Kathmandu. However, the head of the health office, Kunwar, says that there are complaints about the private sector charging high fees, unnecessary laboratory tests and illegal activities such as fetal gender identification.

According to him, although the government has adopted a policy to provide 98 types of medicines free of charge in the context of drug supply, there is no coordination between the expectations of the service recipients and the government list. The demand for common medicines that are not on the list but are run by private clinics has created tension in health institutions.

Although the health situation in Kailali appears to be strong in statistics, in practice, the citizens here have not experienced complete improvement due to the shortage of medicines, geographical remoteness, and lack of manpower.

Unstable health insurance program

A large institution like Seti Provincial Hospital in the government sector is overloaded beyond its capacity. This hospital is forced to provide services equivalent to 300 to 400 beds with a manpower of 50 to 100 beds. This seems to have destabilized the government health mechanism.

Kailali district is the first district in Nepal where a health insurance program was launched. But ironically! Now this program is in crisis in Kailali itself. The decline in public interest in health insurance and the failure of service providers to receive reimbursement on time have raised questions about the future of insurance. The Insurance Board's 2081 report shows that only 11 percent of the Far West has been covered by health insurance. According to Ramesh Kunwar, head of the health office in the district, only 20 out of every 100 households have access to insurance. Service recipients complain of having to wait in long lines at hospitals and not getting medicine, while hospitals complain of not receiving payment from the Insurance Board. In particular, Seti Provincial Hospital alone has yet to receive payment of Rs 50 million for the services provided under health insurance. Even though the Insurance Board pays the money in installments, the amount is very low, which has seriously affected the operation of the service. Kishor Shrestha, information officer at Seti Provincial Hospital, says that due to the withholding of the amount due, there is a problem in providing the medicines prescribed by the insurance to the patients. 'We are forced to provide only one month's worth of medicines that should be given for three months.' The hospital does not have stock of medicines. Where will we buy more medicine after not receiving payment?,’ Shrestha said. The board’s failure to pay the amount on time has directly affected the patients covered by insurance. Those who come to the hospital for treatment on the basis of insurance.