The issues that most political parties in Nepal raise with importance during election campaigns are education and health. If the state arranges for free treatment and education up to graduation in case of illness, then the main problem of every family will be solved. The argument that wealth must be earned no matter what the path is, ends with a calculation. There is also a reduction in the tendency to accumulate wealth through corruption and irregularity.

Our country’s economy is small. However, increasing state investment in education and health and prioritizing on the basis of needs and social justice is the concept of public welfare state government system.

If you ask those who are abroad, who have decided to go abroad or who are preparing to go abroad, many of them will say that they had to go abroad because of an illness due to expensive treatment and incurred debts.

Treatment of cancer, heart, liver and kidney diseases is very expensive in Nepal. Moreover, people suffering from such diseases are subjected to financial exploitation and fraud during treatment.

There is a situation where the patients who reach the hospital with barely any expenses are disappointed without getting proper treatment.

It is difficult to get a bed in a government hospital because of admission and treatment. Many citizens do not have access to private treatment. Deprived of treatment under various pretexts, common people are forced to die prematurely.

There are many middlemen who extort patients and relatives with the intention of obtaining financial benefits. They reach expensive private hospitals hoping to survive. Not only in the private corporate hospitals of the country, but the patients with normal economic conditions are also taken to expensive hospitals in India.

Not all private hospitals have financial exploitation of patients and poor quality treatment. Investors open hospitals after many administrative hassles and huge investments. Therefore, it is the responsibility of hospitals to devote themselves to humanitarian services with minimum profit. The state should identify those who are doing well and support them.

Many non-profit hospitals are operating in developed countries. Such hospitals have been established in various places in India.

In Nepal, there is also a tendency to drag patients to the hospital through unnecessary publicity and middlemen, and charge huge sums of money for unnecessary tests and treatments. There are cases of people treating themselves as long as they have money and then referring them elsewhere.

Not only in the country, there are also examples of Nepalis paying the fees for operations that were not performed in private hospitals across the border. Similarly, there are examples of victims of fraud and smuggling even in organ transplantation.

In order to eliminate such atrophy, discomfort, deformity and shortages seen in health care, at least for those who are financially unable to save their lives, the state should have ensured all kinds of emergency services. This is also the essence of the Constitution of Nepal-2072, which is said to be oriented toward social welfare.

But unfortunately, even though it is clearly written in the constitution regarding health and education, selfish power centers dominated during the drafting of the law. To put it more clearly, celebrities from the medical field who have personal interests that can influence even the political party were used.

Not only Nepal is the highest in terms of technology, but India’s public medical service was still in a weak state, but there has been a lot of improvement in the last decade.

AIIMS, which is limited in Delhi, has been expanded to various states of India, and there is a provision of support of up to 5 lakh rupees for the treatment of incurable diseases under the Ayushman programme.

While discouraging unnecessary private hospital referrals and establishing treatment protocols, hospital toilet hygiene is important.

By gradually converting government hospitals into medical colleges etc., concessions have been given in treatment to common citizens. When some government hospitals were converted into institutions to make treatment easy and convenient in Nepal, it helped in medical education, but the treatment service has become more expensive.

The health insurance, which was implemented in 2074 after many years, has also come to a standstill due to lack of resources. If the maximum utilization of funds, regulation, referral system, prioritization and simplification and refinement are done, health insurance can become a successful means of treatment services.

It has been suggested time and again that rather than premiums, the best option would be to have health care tax based on income at the starting point of each income. But the hearing did not take place.

The health points mentioned in the 100 points issued by the current government seem abstract. In those points, the improvement of health insurance and the points to increase the morale of health workers involved in treatment services are not seen. However, it is expected that the government will be serious about health care services.

The government has decided to strictly implement the system of providing at least 10 percent of the total beds in government and private hospitals free of charge. It has already been announced that all nurses in government hospitals will be free, but how much has that decision been implemented?

Who will regulate treatment services? The Ministry of Health that could not manage itself? That after the responsibility of medical education was transferred to the Medical Education Commission, various professional councils, including the Nepal Medical Council, have become white elephants in terms of expenses, even though they have limited responsibility.

The Ministry of Health itself is suffering from many distortions, inconsistencies, inefficiencies and inactions. The Ministry of Health is open to the political leadership in administrative, financial and technical issues related to health services. From the stage of pre-disbursement in foreign travel, foreign aid funds, development, construction, purchase, etc., due to excessive commissions and unnatural profits, the price of the service or product is expensive and the quality is high.

There is a need for a suitable referral system to facilitate treatment services for the general public. Especially, patients referred for emergency and surgical services from remote places should get priority in hospitals with specialist services. When such patients are referred to private or other hospitals, coordination facilitation and support is not available. It is positive that in the currently released list, it is mentioned to develop an integrated and interconnected health information system within these 3 months.

While discouraging unnecessary private hospital referrals and establishing treatment protocols, hospital toilet hygiene is important. It is not only the presence of health workers but also the remuneration according to performance is indispensable for them to provide maximum service during the hospital.

Extreme abuse of drugs prevalent in Nepal, lack of effective regulation of drug quality, level, price.

It is necessary to rescue not only pregnant women who have complicated problems, but also patients who have fallen from trees and who have been injured and who need emergency surgery.

Measures for financial management of treatment services – proper investment of the state, proper premium amount of health insurance and fixed tax on health treatment at the primary source according to the income of each citizen or businessman.

To adopt these measures, the trend of tax evasion and income hiding should be stopped. It is well known that most of the traders and businessmen in Nepal evade or hide their taxes.

As they are interdependent and complementary to each other, both medical education and services should be under the Ministry of Health. But in Nepal, only institutions are under the Ministry of Health. The proposed integrated institute or national medical university to carry out academic and educational activities instead of the hospital-style health institute has also failed to be mentioned in the agenda.

In the 600-bed Bharatpur hospital with more than 90 percent bed occupancy, 2,500 patients per day and more than 50,000 patients reach the outpatient and emergency rooms every year. There are many lessons that can be learned from this hospital, which is more powerful than other institutions in terms of resources and capabilities.

An exemplary model could be established in the field of medical education and service if an act is passed for the arrangement of a national institute of basic form of health treatment and education so that there is no scope for political appointment.

In 100 points, the suspicion that the government is not very serious about the treatment services of citizens should not turn into reality.

(Prof. Dr. Dhundiraj Paudel is currently the Chairman of Bharatpur Hospital Development Committee.)