HEALTH INEQUALITY: How poverty destroys lives in Nepal 2023

Health Inequality : How poverty destroys lives in Nepal. Let us talk about the fact that the state had promised “Health for all” by 2000 A.D. with its first Health Service Sector Policy back in the late 1980s (2048 B.S., more than 30 years ago) and let it sink in. Despite the persistent assurances of a well-established, comprehensive healthcare system in basically every manifesto one can find during the general elections, and the heavily increasing pressure on subsequent stakeholders, the country is yet to achieve the health apparatus that it dreams of. 

There have been some remarkable advances, certainly, but there are more aspects that downshadow them. Here’s an example: There’s just one doctor for every 11,000 of the population in the country, and that’s only the generalized case, because the proportion falls to less than 1 doctor for every 150,000 of the population in rural areas, which is BRUTAL. Given such a figure, it is more than doubtful that anyone can argue against the health inequalities prevailing in the country.

Where exactly do the have-nots suffer? Concrete evidences of Health inequality:

The median monthly income in the country lies somewhere around NRP 6083, and this very vital indicator shows that the average folk stands next to zero chance of being able to afford costly nursing homes and private hospitals, which are known to sweep such figures of 6000’s out of their patient’s hands in just one go. The only option left for the average folk then is to look for the government’s health posts and sub-health posts, which generally are not just devoid of equipment, but even qualified health professionals. 

Nepal has adopted a 6-tier health service apparatus after the 2015 declaration of federalism in the country; devolved as central level, provincial level, district level, electoral constituency level, Ilaka level, and village level. As ideally decentralized as this sounds, one cannot but be disappointed when he assesses the health situation of the country thoroughly. To give an example again, there are just over 3700 health posts, and 3100 sub-health posts operating at the levels of Ilaka and village, but they’re usually headed by only a Health Assistant, or a Certified Medical Assistant instead of an MBBS graduate. Only a District Hospital (77 in number) can guarantee an MBBS doctor, OPD/IPD services, and perhaps remotely, advanced screening and diagnostic technologies.

What breeds such Such inequality in Nepal apart from income differences?

Geographical disparity

The difficult terrains, particularly in the high Himalayas, and the hills, make the expansion of health infrastructure, as well as the transportation of equipment, extremely complicated and costly. For many, it is only when some very generous individual or organization comes up with a “Nationwide Swasthya Ghumti Shivir Camp”, i.e. community health outreach programs that they get to experience modern medicine and its abilities. As a consequence, the health outcomes for people living far from urban areas in the remote areas are particularly poor.

Low Literacy and Cultural Orthodoxies 

With an estimated 29% (as of 2023) being unable to read and write, illiteracy poses a great problem in the face of health equality. Not only does this impact individuals’ ability to assess and understand health information to make informed decisions, but it cuts off the link between logic and action right at the very core with cultural orthodoxies. For example, as we go downwards in the socio-economic hierarchy, with decreasing levels of education, people are more and more susceptible to holding beliefs such as “menstruating women shouldn’t be allowed inside the house”, and values like, “children are the gift of god and so contraception is a sin”. Consequently, over hundred and fifty mothers die in every 100,000 pregnancies. 

What Communities Suffer and How?

To some, it might sound terrifying, or even absurd, that someone waits days, or even weeks in a never-ending queue for their “basic right” of a medical checkup, and ends up with a “doctor” who suggests that they admit themselves to his private clinic with thousands of rupees to cover for “the necessary expenses” in their hands instead. However, it is an unfortunate reality for some. And oftentimes, it’s evident that other people who accounted for such “expenses” ended up funding for the glass of rum kept on his table. 

Ventilators in a government-backed COVID-19 hospital starting to malfunction one after another in less than three months, even though the state had funded millions for the purchase, or officials of the central hospital located right at the heart of the capital being accused for embezzling billions of NRP, are no longer surprising news. Private hospitals bribing ambulances to bring in patients and including all sorts of sophisticated “charges and fees” to swindle thousands off their pockets for something which could be done for a few hundreds is also almost a norm. The usual reaction is, “It is what it is. This is the country we’ve been born into, unfortunately, and there’s nothing that can be done.” 

Health: A Fundamental Right

Let’s reflect on this disparity from the statistical and economic angle. The mean monthly income in Nepal is around NRP 80,000, and in the meantime, the median is less than one-tenth of that, as earlier mentioned. The reason that this is important for us is because the deviation between the mean and the median is often considered a viable factor in determining how heavily wealth is concentrated on the rich in a society. And from given figures, it is presumably that the disparity is HUGE in Nepal. With inflation rates skyrocketing all over the country, the poor grow in poverty, and this manifests itself in the form of health inequality over anything else. 

Regardless of the state’s ambitious promises at international levels, the fact that people in the remote villages think helicopters are required to access primary health care proves to be a joke in their faces, and the article 35 of the Constitution of Nepal, the Right to Health. So, it then becomes the inevitable duty of the government to coordinate its finances, attract all prospective investments in the health sector, delegate strict and committed regulatory bodies in the health field, audit and assess money irregularities and inefficiencies in such bodies, reduce the installment costs of health courses like MBBS to produce more professionals and also incentivize such people to work for their own country, and basically every other thing to ensure an optimum, efficiently inclusive health system.

FAQs

Site. Ministry of Health and Population

Also Read. The Negative Impact of Social Media on Nepali Society

Author

Dr. Samridhi Shrestha