The Maoist party in Nepal sees free, public health care should be available to all citizens. When the constitutional deadline of May 28 passes unfulfilled, as is now apparent, the party is expected to release a proposed constitution. This document will serve to educate the public on the peoples’ rights that the Maoists wish to entrench, and will include the right to health according to Dr. Mangal B.K., the president of the All Nepal Public Health Workers Association (ANPHWA).
In a country where tens of thousands of people die each year from preventative and treatable conditions like typhoid, respiratory diseases and diarrhea, the notion of health as a right requires a transformation of the health system, including the way health workers are trained and deployed.
For one, the Maoists would require that all doctors spend at least two years in a rural area after their training says Dr. Mangal B.K..
“Doctors are in the main city, not in the villages,” says Comrade Bibas, who served as a barefoot doctor during the People’s War and currently works at a private hospital as a Maoist-affiliated physician. As a result, says Comrade Bibas, in the rural areas where more than 80% of the population resides, there may be only one physician for around one million people. The nurses and paramedics who work in these rural centres are understaffed and overwhelmed. (Paramedics are given a year and a half of medical training) According to World Health Organization statistics, less than 20 per cent of births in rural areas are attended by a skilled professional, while in the urban areas, more than half of labouring mothers are assisted by a health worker.
The main failings of the current health system lie in its lack of prevention measures and over commercialization, according to Dr. Mangal B.K. Private and non-government facilities, which provide about half of the health care in Nepal, poach health workers from the public system and disrupt central planning and economies of scale. Furthermore, rather than focusing on preventing the diseases and disorders that kill the largest number of people from occurring in the first place (for example, by providing awareness campaigns, clean water and proper sanitation to prevent diarrhea), health care is provided to those who seek treatment, and can pay for it. According to Comrade Bibas, a two or three-night stay in a government hospital can cost around 1000 Nepali rupees, more than the monthly income of most villagers.
The UCPN-M was unable to allocate more money to health in its nine months in government as the opposition parties thwarted the Maoist party’s budget. (The Maoists left government in 2008.) Today, Comrade Bibas argues, 90% of the donor money allocated for health is either corrupted or eaten up in bureaucracy.
The Maoists currently run a hospital in Rolpa district and organize Maoist-affiliated health workers to volunteer their time several times a year to take part in a mobile health clinic that is free and open to the public.
The ANPHWA represents approximately 8,000 to 10,000 doctors, nurses and paramedics. The number represents a small percentage of the workforce, as health workers can make more money in the private system and opposition parties pander to the elite and professional classes. Health workers who have joined the Maoist union have done so because they believe in free and accessible public health care for all, says Dr. Mangal B.K.
“The demands for health care are very high,” he says. “A lot of people cannot access it.”
By Comrade W.