Geha Nath Khanal, The Himalayan Times, 27 June 2017
There is still a debate whether the government should invest in health or in infrastructure like roadways, irrigation, and agriculture in a developing country like Nepal. To what extent can the government invest in health in a country like Nepal?
Earlier, there was the dissemination of Key Indicators reports of Demographic and Health Survey (NDHS) 2016, where public health experts claimed a significant drop in neonatal deaths and increase in institutional deliveries as major public health achievements in the past decades. This was possible only after implementation of maternal and neonatal health-specific programs after the Millennium Development Goals (MDG) initiation. For instance, a multi-year plan in immunization, national neonatal health strategy and community-based newborn care package (CB-NCP), increase in birthing centers, training the nursing staff with Skilled Birth Attendants (SBAs), legalization of abortion, safe delivery incentive scheme, nyano-jhola programs were implemented in past 15 years which helped to increase institutional delivery from 11% to 58% and reduced under-five mortality from 91 to 39 per 1000 live births during the MDG era. This shows that the investment in maternal and child health was satisfactory to bring about improvement in maternal and child health.
There is still a debate whether the government should invest in health or in infrastructures like roadways, irrigation, and agriculture in a developing country like Nepal. To what extent the government can invest in health in a country like Nepal? What would be the return for the state from such investments? These are the representative ‘frequently asked questions’ by budget allocators in resource-deficit countries like Nepal which compare the immediate return against investment. Comparing immediate benefits with investment are brokers and capitalist mindset, which would not work if one thinks about investing in health or education since the returns are usually not observed and often take a long time. Moreover, measuring the benefits would be even difficult.
The constitution has defined health as a fundamental right and directed the government to endorse necessary laws within three years. For this purpose, the government has to provide not only quality health care but also free of cost. Establishing the policy to practice such was the major priority of the previous Health Minister Gagan Kumar Thapa who did his best to implement health as a fundamental right in the recent constitution. There have been many policy reforms in the past nine months which can be considered as a great ‘paradigm shift’ in the health sector in Nepal. Now, it is high time investing in health to implement these policies.
The recently published Lancet reports that the health spending per GDP in Nepal is 5.8% which is highest among the South Asian countries except for Afghanistan. However, the proportion of government spending is 28.6%, while 47.7% is out-of-pocket (OOP) expenditure. This shows that almost half of the expenditure in health is from the patient’s pocket. This OOP expenditure would be against the constitution, which has assured free quality health care as a fundamental right. Thus, it is crucial to reduce this expenditure and guarantee health care expenditure through the state. Otherwise, a policy without funding would be nothing more than a poetry. Earlier, the Health Ministry proposed the budget amount of 1.07 billion rupees for 7 years to construct health facilities and supply necessary equipment which will ensure the availability of equipment, medicine, sufficient infrastructure resulting in a quality of health care. This has shown rays of hope the government would increase investment in health in the upcoming fiscal years. Moreover, positive signals in the allocation of budget from the Finance Ministry should be appreciated. This would be a great opportunity for the Ministry of Health to reduce the burden of healthcare cost from the patients’ pocket. Investment in social sectors like health or education is the key for development.
Several studies have analyzed the return on investment in health. For instance, according to Global Nutrition Report 2015, investing every dollar in nutrition yields permanent and inalienable benefits with at least $16 return. Likewise, British medical journal Lancet in its issue has reported that investing in the health of adolescents aged 10-19 years could bring 10-fold economic benefit. However, these economic benefits are not to be analyzed immediately, rather they should be looked at with aversion of malnutrition and nutrition-related deaths and disabilities, adolescence pregnancies and adolescence deaths, the economic productivity contributed, amount and resources saved after averting these deaths and disabilities and much more.
The initiatives taken to formulate policies have been a great paradigm shift in the health sector in Nepal. The initiations have been supported by all sectors except limited ‘rent-seekers’. Healthcare business has become a safe investment with the fast return in the recent years. Their actions on ‘privatizing the profit’ and ‘socializing the loss’ in the political transitional period have affected all sectors, including health. These ‘rent-seeker’ business would suffer a lot if the policies were practiced effectively. This can only be done through investing in health from the state. This is the best time to advocate for allocating more resources to the health sector, which not only shares the out-of-pocket cost of the public but also offers an opportunity to implement the constitution.