Budget crunch affects safe motherhood program at Tikapur Hospital

December 25, 2018

Yogesh Rawal, My Republica, 25 December 2018

TIKAPUR: Safe Motherhood is one of the government’s topmost priorities. For this, maternity units have been opened at several health centres across the country where the service is not just free but women are even provided with allowance after delivery. Despite being a part of it, the Tikapur Hospital is not able to provide all the facilities that the program promises.

“We are no more in a position to provide services for free. The authorities concerned have not released enough budget to support the safe motherhood project the hospital,” said Medical Superintendent of the hospital, Dr Narendra Kumar Khanal.

According to Khanal, only Rs 800,000 was allocated for safe motherhood this fiscal year which exhausted early on.

“We were providing the services to expecting mothers while we had the budget. But since that exhausted we have been not able to do so. And then there came a time when we were not able to provide the services for free, let alone providing the allowance,” he said.
Khanal said the hospital has to buy the delivery kits and it does not have a budget of its own to purchase them. As such, he said that the hospital is unable to support the safe motherhood project. 

“We can provide our services for free. But we cannot buy materials like syringes, medicenes, bandages etc that we require during deliveries.

This costs around Rs 1,500 for each delivery. As the hospital does not have the budget to buy them, we have been asking the concerned family to pay for it. But they do not understand,” he said.

The issue is indeed complex. While mothers clearly know that they are entitled to get maternity allowance, the need to pay back to the hospital has been just agitating them. When asked to pay the amount, not only they refuse to do so, they even protest.

“They have protested. They have even charged me of being corrupt. They say the entire hospital is corrupt. It is a very difficult situation,” Khanal reported. “We have no solution in hand.”

After the restructuring of the nation, there are three levels of government that help in the functioning of the public services. The central government, the provincial and the local government. And there is confusion over the authority and responsibilities of these three levels of governments.  Though the hospital board shows that it is under the direct authority of the provincial government, it has not received the budget from it, Khanal said.

“Established working processes have been dismantled by the implementation of the federal structure. A new structure and workflow are yet to be established. Because of this, there is a lot of confusion. It is still unclear if this hospital is under the local government or the central or the provincial government,” said Khanal.

This fiscal year, the hospital has so far handled 900 delivery cases. Last year, the number was 1,800. The government has doubled the maternity allowance from this fiscal year. Earlier women from the mountain districts would get Rs 1500 and women from the hill and tarai districts were entitled to Rs 1,000 allowance after delivering their babies.

“This year, they have doubled the allowance, but this has not become functional,” Khanal said. “So far, we are somehow managing to give service to the mothers, but if the budget is not released soon, we won’t be able to do so,” he added.

The hospital has been in touch with the provincial and central level authorities for resolving the issue. “If they pay attention to our concerns,  it is not a very big deal to resolve. We have contacted senior officials at the center and expect them to address the issues very soon,” he said.

Social Development Ministry of the province recently provided Rs 2 million to the hospital to buy tools. Similarly, it has been receiving budget under other heads.

“We are spending the budget we recieved for one purpose to another purpose. But that is wrong. We cannot do that for long,” said Khanal. “We have not touched the budget allocated to the hospital for purchasing ICU equipment. But we have slightly used the budget that came under other heads for maternity services,” he added.

The hospital was first established as a health post in 1978. In 1993, it was upgraded to a primary health post with a capacity of three beds. A few years later, the then Tikapur Development Committee took initiatives to upgrade it 12 bedded health center. A decade later, the government added a few more facilities and it was registered as a hospital. In 2015, it turned to 51-bedded hospital. The hospital is visited by people from remote villages and towns of Kailali, Bardiya and other western districts.