Hundreds of kilos of chemicals are imported into Nepal every day, the vital ingredients of medicines produced by the local pharmaceutical companies. The medicines of over 250 Indian drug manufacturers flood the country as well. The imported chemicals are supposed to be checked for their authenticity and date of manufacture. The imported stuff needs to be monitored and substandard products banned.
But recent news reports in various media outlets point to a dismal government track record in this vital area of public concern. The oversight body, the Department of Drug Administration (DDA), enumerates a long list of responsibilities that burden its puny shoulders: “To prohibit the misuse or abuse of drugs and allied pharmaceutical materials as well as the false or misleading information relating to efficacy and use of drugs…” among many-many other tasks. In reality, DDA does precious little. In a recent BBC program, its head had a legion of excuses for the inefficacies of his department, but few answers to the public’s health queries.
The substandard medicines that pervade the Nepali drug market are only an indicator of all that’s wrong with the Nepali health sector. Tens of thousands of pregnant women around the country have been denied the iron pills that are vital for proper development of fetus.
The reason: some caches of the pills being distributed by the government were found to be substandard; the pills had crumbled to dust inside the blister packs or were infected by fungus. Of the 4,750 health care centers in Nepal, only a handful have adequate medical staff. Essential medicines and vital equipment are in short supply in most rural health posts.
The problems, as we see, are many. It will not be easy to address them all at a time. A good beginning would be a shift in government policy, which till date has been focused on combating communicable diseases like diarrhea and pneumonia even while 80 percent of out-patient visits to hospitals in Nepal are related to non-communicable diseases like diabetes and heart ailments. Nepal Health Sector Program-II, which is supposed to deal with this shift, has for months been stuck somewhere in the opaque Health Ministry bureaucracy. It is long past the time someone dusted it off.
As is the case with most other public sector establishments, the major problem in the health sector is buck-passing. Complain to DDA about substandard medicine, and it will point the finger at the drug manufactures, who in turn easily pass the buck back to the government. The shortage of iron pills is due to the inadequacies of the Logistics Management Division (LMD), complains the DDA.
The LMD, meanwhile, is confused whether to recall all pills in the market or to let pregnant women have some from the remaining stock. Until this blame game stops and unless the healthcare sector gets serious about addressing perhaps the most important concern of the public, their health, Nepalis will have to continue to put up with a system that is, even if it sounds a little harsh, as good as nonexistent.
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