Think big and bold

Published On: April 4, 2020 08:44 AM NPT By: Simone Galimberti

Nepal should build an excellent but inclusive health system not just for these scary times but also for normal times. In times of crisis, we need to think big and bold

Ashish Jha, director of the Harvard Global Health Institute, shared in his recent story for The Washington Post that while the epicenters of COVID 19 will remain Europe and the US for the next few months, it will surely expand to places like Mumbai, Rio de Janeiro, and Monrovia. Kathmandu may be added to the list.

Yet this is not the time to panic but keeping ourselves focused and determined to avoid the worst come to the country. The fact that the lockdown, at least in all the major urban centers, has been effective and well-observed by people, is something positive, showing how the citizenry is not underestimating the potentially devastating effects of the virus. It also shows how governments at all levels are taking the prevention of a pandemic outbreak very seriously.

Come to think of it. Just a month back no one was expecting such a massive toll in Europe and America. My dad was a healthy 76 old retiree with many years of life ahead, full of energies and passion for life. Tragically he could not survive the virus.

After some days of fever and cough, he started showing shortness of breath. Unfortunately, the health system in Lombardy (Italy) that is internationally recognized as one of the best in Europe, was too overstretched and testing was only carried out for those more serious. Only after some days, the emergency service came to pick him up. He tested positive but after some days he was showing very encouraging improvements and family members were optimistic about his full recovery. Last Friday, he was doing even better and we all thought that this nightmare, this terrible scare would be soon over. But in a few hours, we still do not know why or how his health went worse. He could not fight back anymore.

This personal story is meant to give one message: we should not relent on the precautionary measures taken by the government. It should also help reflect and envision a different way of understanding the public health system here in Nepal.

Focus on health

It is always hard to impose a lockdown. There are simply too many implications, economically, socially with the income of so many people at stake. Thus federal government should ask local governments to provide relief to all the daily wage laborers.

Experts have warned that the pandemic could hit developing countries soon. Leadership in Nepal is in a dilemma as to whether to ease the movement or keep maintaining the lockdown. I think it would make sense to encourage “smart” working practices from home for all those in a position to do so. Starting of new academic year should be postponed. Even if lockdown is lifted in a few days, it should be done carefully and social distancing should be enforced everywhere for a foreseeable period of time.

But in the long run, Nepal should enhance its national health system. This is what we wish for Europe because in the last decade economic austerity measures have weakened the health system of Italy and many other countries. Possibly an outcome of this tragedy will be massive health investment everywhere.

This global effort should also include Nepal. First, the micro health insurance that has been piloted in a few districts should be scaled up throughout the country with higher levels of coverage for each family member. Second, we need to make sure that private hospitals are going to be part of the solution to the problems of the national health system. Yes, we need to protect the investments made by those business persons who set up first-class hospitals. But we also need their partnership to allow a system where, for example, health services paid through micro health insurance schemes are fully delivered by private hospitals too. This will require a total, transparent standardization of prices for each kind of health services to be provided.

Private hospitals could maximize their profits by offering extra services like individualized services and other extra-facilities catering the better off of population who do not mind paying a premium.

Third, for certain major diseases or health conditions like cancer or burn injuries or rare conditions like thalassemia, the treatment should be totally covered by the government. If you have a family member with cancer, you are lucky if you have land to sell in order to cover the costs of the treatment. Such is the situation in Nepal.

Just recently we all read about a citizen who suffered severe burn injuries and whose family was not in a position to pay the cost of the treatment. This is outrageous. The government should enforce provisions where private hospitals would be carrying out these essential services and then be reimbursed by the government.

Engineering such type of public-private partnerships is certainly going to be a daunting task but given the political will, it can still be achieved.

Forth, private hospitals should be properly assessed and also categorized based on the level of facility, expertise, and equipment. Many of them are actually operating more like clinics and unable to provide essential emergency services. Those lacking the best resources should play a role as community health centers through private-public partnerships. Those who have top standard facilities and expertise should be considered as the national center of medical excellence and receive financial support from the government.

This is what has been done quite effectively in Lombardy, the epicenter of the pandemic. Fifth, the country cannot just rely too much on the private dimension of the public-private partnership. The government must resuscitate its moribund public hospitals. Colossal investments are needed to equip public hospitals in all the provinces but it is outrageous that people have to come to Kathmandu for quality but expensive health care.

Donors have been putting a huge amount of money for Nepal. They can be asked to provide financial support to build new medical centers that could be also run by not-for-profits or through hybrid models like Patan Hospital or Dhulikhel Hospital.

Nepal should ensure that it does not become another Lombardy of Italy. Nepal should build an excellent but inclusive health system not just for these scary times but also for normal times. In times of crisis, we need to think big and bold.

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