Citizens’ Right To Health

Mukti Rijal

Dr. Govinda KC, the orthopedic physician known for his long and dauntless fight in reforming medical education in Nepal, has resorted to sixteenth hunger strike recently. This time he has travelled all the way to Ilam to stage hunger strike while his fifteenth round fasting unto death (Aamaran Ansan) was played off in Karnali. Dr. KC’s choice to alter the sites of the staging hunger strikes should have been presumably motivated to give new twist to his site. He seeks to make his fight more pronounced reportedly in favour of the decentralised health facilities and properly regulated medical education in the country.

Meaning
The choice of Karnali in the west and Ilam in the east as sites for hunger strike is definitely to convey the meaning that the issues raised by him represent the voices of the people both in the west and east of Nepal. This time there is a parallel orchestration of hunger strike played off by Dr. Bijaya Thapa who insists that the bill that has been tabled in the parliament should be endorsed without any alteration as argued by Dr. KC. As Dr. KC’s health condition has deteriorated, he is airlifted to hospital to save and protect his life. The same is done for Dr. Bijaya Thapa too.
Whenever Dr. KC goes for hunger strike, it does grab the attention of all civic stakeholders, and becomes a matter of concern for the government and the politicians. It also compels one and all to raise question as to why Dr. KC is forced to resort to strike to get his message across loudly. Why his demands to reform medical education and de-concentrate health amenities judiciously have not been met despite agreements? However, this time the scenario appears to be a bit different and confusing unlike in the past.
The government terms Dr. KC’s on-going hunger strike as futile, inappropriate and unnecessary since his demands have been , according to the government ministers, met through incorporation into bill tabled for deliberations in the Parliament. The prime minister, other ministers and party leaders are actively defending the bill. The government is determined not to give in to Dr. KC. But Dr. KC and many of his supporters counter the government claim and term the bill not conforming to the terms of the agreement entered with Dr. KC. The bill, according to Dr. KC and those rallying behind him, is intended to grant affiliation to those proposed medical colleges that are being set up by the ruling party colleagues or cronies.
Now Dr. KC’s hunger strike has been reduced into a contest between the ruling and opposition parties as Nepali Congress and may other groups are seemingly lending support to him. However, the issues raised by Dr. KC should not be politicised from any quarters, and the government should rather take it as an opportunity to curb rash commercialisation of health services and bring about reform in the rapacious tendencies of the private medical colleges .
Needless to say, the state of public health service delivery is very poor in the country. Poor people suffer due to the lack of basic and rudimentary services at hospitals both in the national and sub national level. The poor people who land in the hospitals for medical services have not only to face hassles but also made to pay fees even for basic and rudimentary services that are declared to be free. And the doctors, medical personnel and nursing staff assigned and posted for the district hospitals and primary health centres are often found not attending to their duties on a regular basis. The basic diagnostic equipment and appliances like X-ray tend to be allowed to go dysfunctional rendering the hospital assets non-performing and general services going bust.
The medicines supposed to be distributed to the common people for free in line with welfare based health services policy of the government have been allegedly swindled and sold out through private medical outlets in the market. The responsibility for management of primary health centres and health posts have been devolved upon the local government in line with the decentralised provision set forth in the federal constitution of Nepal. The decentralised service provision mandates local government to manage and monitor local public health services in the country.
The national public hospitals funded by the government like Bir Hospital, Teaching Hospital and the Chitwan Cancer Hospital and so on have also not been doing well. The services especially in Bir Hospital and Chitwan Cancer hospital have come under sharper public scrutiny. The nexus of the physicians working for the BP Koirala Chitwan Cancer Hospital and private pathological labs and clinics is said to be affecting the process of service delivery.
Despite much hue and cry over the poor state of service delivery at Bir Hospital, it has not improved. The political meddling in the appointment of the doctors and executives in Bir Hospital together with the discriminations and partiality in the provisioning and allocation of services have been central to the deterioration in the management of the nation’s oldest and premier hospital of the country.

Regulation
The Mathema panel report that is central to Dr. KC’s hunger strike has emphasised on curbing the alleged unscrupulous practices entrenched in the field of medical education. Dr. KC’s hunger strike resorted to time and again underlines the need for proper regulation and management of medical education and effective provisioning of health service in the country. The government should take care to ensure that the health services are better provisioned to fulfil right to health as fundamental rights of the citizens as enshrined in the federal constitution of Nepal.
(Rijal, PhD, contributes regularly to TRN and writes on contemporary political economy and governance issues)

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