In this blog post, QUALITY is the keyword. The subject of Quality of Care (QoC) and making sure the government provides high-quality "caring and healing" care to all citizens is the constitutional requirement that can be challenged at all level of courts if compromised or denied. For that matter, we talk of various requirements in terms of Health System Strengthening (HSS) and Evidence-Based Decision Making (EBDM), organizational culture (OC) and its interdependence and the list goes on as long as we dig deeper into these topics. Well, there are the whole team of dedicated health professionals (policy experts, health economist, public health experts, etc) working with our Ministry of Health and Population (MoHP) as Nepal Health Sector Support Program (NHSSP) with their core objective "to build a resilient health system to provide quality health services for all." In this effort, this NHSSP initiative in its 3rd cycle (NHHSP - 3) is managed by 4 core partners: Options, HERD, Miyamoto and Oxford Policy Management funded by UKAID consisting of 5 work areas: Health Policy and Planning (HPP), Procurement and Public Financial Management (PPFM), Service Delivery (SD), Evidence and Accountability (E & A) and Health Infrastructure (HI). Also, there are other organizations involved in this HSS efforts like WHO Nepal, Abt Associates (indirectly?), Save the Children Nepal.
Such a concerted effort to improve the health and wellbeing of our people is always welcomed, however, it is also the right time to plan for rigorous evaluation and measure the impact in the social wellbeing of common people. This is one interesting area that we have to look into and there is always a serious question that we have to critically ask ourselves, "whether all these efforts put on by External Development Partners (EDP) are actually strengthening our core capacity and capability or making us too dependent on EDP such that we are in contrary incapacitated even to write a simple technical report?" Rather than system building (sounds beautiful), there is always a risk of system destruction, which is historically relevant (colonising vs. occupation) and has happened not distant ago with lots of examples in Africa (keeping blind eye to foreign aid), so we need to be careful before we accept anything without understanding the core and hidden objectives of such initiatives. In all these doubts, however, my desire is that I am proven wrong and all the core objectives or intentions are always true to humanity. Why I am bringing up this subject of EDP and its role in HSS (which is a catch phrase popular these days) is that NHSSP - 3 by its nature is loaded with work areas that build a health system strong and in a way these elements that furnish each work area with expertise (national as well as internationals) is a huge win-win for both of us. In this endeavor, one of the key principle that we are striving to achieve is high-quality health services to all. For this to realize, all other elements such as the equitable distribution of health resources, improving service delivery to all corners of the country and reaching unreached all counts. All in all, it is our duty to serve our people with discipline, hard work, highly committed to professional ethics as well as moral values, and devotion. These are the core values, that will accelerate the goals we have envisioned, otherwise whatever we do, it may be just one big mirage.
Before we dive into the subject of trying to explore QoC issues, we also need to understand that global political order and its ideological interplay between various power centers is meaningful. When I say, socio-political dynamics that are open and freely interacting with our entry into the 21st century of new ideas with a free market, capitalism, neoliberalism, socialism, communism, technocracy as our playground, these are strong forces that are like invisible hands dictating our market, socio-political fabrics and our future. In this respect, our health and well being, which is our highest priority, could bring positive consequences that all of us can enjoy fullest provided our key principles of governance are aligned and balanced to our current socio-political climate within the country. With political change post-2046 BC from one party Panchayat Raj to multiparty democratic governance, it is widely said that we absorbed neoliberal free market principle into our system. This change brought free market principle into our governance policy and planning and its execution. Traditionally, our government was providing basic services like health and education through public service delivery network. But with new political leadership, however, there was an infusion of the free market forces, where basic health services are also considered "commodity" to be purchased in the market in contrary to popular belief that health, education, road, water, and sanitation, etc are social welfare to be provided by government.
Like we understand that health is a complex multifactorial effort. Meaning, it is not only health professionals who are responsible for providing health care. It is everybody's responsibility. In a similar fashion, the provision of quality health service is everybody's business. The question, therefore, whether "have we all realized this wisdom and work on it?" However, I feel strongly after my recent visits to some major hospitals and direct interaction with the system of health care delivery in the town, the provision of care that should be both caring and healing is in severe scarcity. We understand that there are rising constraints to the system every year from everywhere, but we have to be honest and ask ourselves, "Are we disciplined and working hard in the provision of quality care to all ?" After all, it is our caring attitude and the gift of listening to physical, mental and social as well as family suffering that people both rich and poor alike have to go through. And this gift and attitude don't cost much money. Like the old saying, "Smile is priceless." The consequence of those sufferings we all go through at least once in our life, we visit hospitals and clinic to get relief of all sorts of ailments and seek healing. Sadly, I am not able to share with you the best picture in terms of getting quality care despite we pay for the service. I have so many personal experiences to justify my point, not an exaggeration. With these changes, we are in a period of time when we are provided our health care by both public as well as private sectors. On top of these changes, the rising unemployment, poverty, social - economic instabilities, disasters, urbanization, climate changes, migration have brought socio-economic hardship to common people with rising prices of commodities for daily utility. Nowadays, getting ill is like a curse to oneself and the whole family. Without health coverage, the burden of out of pocket (OOP) expenditure has driven many of us into a vicious cycle of poverty. However, the recent effort by our government for social service care and financial protection through various insurance schemes is a welcome signal in a positive direction. We have a long way to go to increase the coverage of such as health insurance and protect our citizens from diseases and illnesses, so we need to work hard with no other options. To share a few experiences of our own hardship and challenges in getting everyday health care, we have so much to do and this is a universe with numerous challenges waiting for us to fix soon.
Such a concerted effort to improve the health and wellbeing of our people is always welcomed, however, it is also the right time to plan for rigorous evaluation and measure the impact in the social wellbeing of common people. This is one interesting area that we have to look into and there is always a serious question that we have to critically ask ourselves, "whether all these efforts put on by External Development Partners (EDP) are actually strengthening our core capacity and capability or making us too dependent on EDP such that we are in contrary incapacitated even to write a simple technical report?" Rather than system building (sounds beautiful), there is always a risk of system destruction, which is historically relevant (colonising vs. occupation) and has happened not distant ago with lots of examples in Africa (keeping blind eye to foreign aid), so we need to be careful before we accept anything without understanding the core and hidden objectives of such initiatives. In all these doubts, however, my desire is that I am proven wrong and all the core objectives or intentions are always true to humanity. Why I am bringing up this subject of EDP and its role in HSS (which is a catch phrase popular these days) is that NHSSP - 3 by its nature is loaded with work areas that build a health system strong and in a way these elements that furnish each work area with expertise (national as well as internationals) is a huge win-win for both of us. In this endeavor, one of the key principle that we are striving to achieve is high-quality health services to all. For this to realize, all other elements such as the equitable distribution of health resources, improving service delivery to all corners of the country and reaching unreached all counts. All in all, it is our duty to serve our people with discipline, hard work, highly committed to professional ethics as well as moral values, and devotion. These are the core values, that will accelerate the goals we have envisioned, otherwise whatever we do, it may be just one big mirage.
Before we dive into the subject of trying to explore QoC issues, we also need to understand that global political order and its ideological interplay between various power centers is meaningful. When I say, socio-political dynamics that are open and freely interacting with our entry into the 21st century of new ideas with a free market, capitalism, neoliberalism, socialism, communism, technocracy as our playground, these are strong forces that are like invisible hands dictating our market, socio-political fabrics and our future. In this respect, our health and well being, which is our highest priority, could bring positive consequences that all of us can enjoy fullest provided our key principles of governance are aligned and balanced to our current socio-political climate within the country. With political change post-2046 BC from one party Panchayat Raj to multiparty democratic governance, it is widely said that we absorbed neoliberal free market principle into our system. This change brought free market principle into our governance policy and planning and its execution. Traditionally, our government was providing basic services like health and education through public service delivery network. But with new political leadership, however, there was an infusion of the free market forces, where basic health services are also considered "commodity" to be purchased in the market in contrary to popular belief that health, education, road, water, and sanitation, etc are social welfare to be provided by government.
Like we understand that health is a complex multifactorial effort. Meaning, it is not only health professionals who are responsible for providing health care. It is everybody's responsibility. In a similar fashion, the provision of quality health service is everybody's business. The question, therefore, whether "have we all realized this wisdom and work on it?" However, I feel strongly after my recent visits to some major hospitals and direct interaction with the system of health care delivery in the town, the provision of care that should be both caring and healing is in severe scarcity. We understand that there are rising constraints to the system every year from everywhere, but we have to be honest and ask ourselves, "Are we disciplined and working hard in the provision of quality care to all ?" After all, it is our caring attitude and the gift of listening to physical, mental and social as well as family suffering that people both rich and poor alike have to go through. And this gift and attitude don't cost much money. Like the old saying, "Smile is priceless." The consequence of those sufferings we all go through at least once in our life, we visit hospitals and clinic to get relief of all sorts of ailments and seek healing. Sadly, I am not able to share with you the best picture in terms of getting quality care despite we pay for the service. I have so many personal experiences to justify my point, not an exaggeration. With these changes, we are in a period of time when we are provided our health care by both public as well as private sectors. On top of these changes, the rising unemployment, poverty, social - economic instabilities, disasters, urbanization, climate changes, migration have brought socio-economic hardship to common people with rising prices of commodities for daily utility. Nowadays, getting ill is like a curse to oneself and the whole family. Without health coverage, the burden of out of pocket (OOP) expenditure has driven many of us into a vicious cycle of poverty. However, the recent effort by our government for social service care and financial protection through various insurance schemes is a welcome signal in a positive direction. We have a long way to go to increase the coverage of such as health insurance and protect our citizens from diseases and illnesses, so we need to work hard with no other options. To share a few experiences of our own hardship and challenges in getting everyday health care, we have so much to do and this is a universe with numerous challenges waiting for us to fix soon.
Looking through the lens of the key principles (such as safe, effective, patient-centered, timely, efficient, equitable) that should drive our duty to provide quality health care services, let me start with our recent visits to a public hospitals in Kathmandu valley (i will not give a name for now) for the urological problem. Myself being a health professional, I was frustrated with the struggle and waiting we had to go through first even to get a ticket, and then get the doctor's consultation. On top of that the rude behavior, some of the staffs show to people waiting in line, would definitely make you angry. It is said that patient safety is one key pillar of quality care and for that matter, I am not able to comment here. But on the reservation, I can safely say that this should be our highest priority to explore and understand its burden and prevent unwanted unsafe practices. Such a huge flow of patient flow and top of that resource constraints that government hospitals have to go through along with poor incentives to work hard do definitely put the patient at risk. Here there is no room for finger pointing at each other. The only solution goes deeper into the problems and we all come together to solve the national issue and patient safety is the global health issue of huge magnitude even in USA, Europe, and other developed countries. So we should not be surprised at the daily news headline of mishaps in hospitals and health professionals thrashed by angry mobs. Unfortunately, this has become daily news.
Like in the political sphere, there was felt the need for political changes, regime changes, economic changes and so many interrelated based on ideological shift or drift injected in our social - economic landscape. In a similar fashion, it is the right time that we bring changes through health system reform and re-engineering of the structure, its elements, and functions. Too much political interest groups have mobilized and infected our current system paralyzing its command structure such that it has become difficult to translate the policy and its strategies into action in far-flung villages where it is needed the most. Only then if we are able to fine-tune the engine of health system functioning to its fullest capacity with the right person in the right place with reward and punishment put in place, we will be able to secure the target set to achieve our national commitment toward UHC and SDG.
31 May 2019
Hetauda
Like in the political sphere, there was felt the need for political changes, regime changes, economic changes and so many interrelated based on ideological shift or drift injected in our social - economic landscape. In a similar fashion, it is the right time that we bring changes through health system reform and re-engineering of the structure, its elements, and functions. Too much political interest groups have mobilized and infected our current system paralyzing its command structure such that it has become difficult to translate the policy and its strategies into action in far-flung villages where it is needed the most. Only then if we are able to fine-tune the engine of health system functioning to its fullest capacity with the right person in the right place with reward and punishment put in place, we will be able to secure the target set to achieve our national commitment toward UHC and SDG.
31 May 2019
Hetauda
