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Reflecting Issues of Himalayan Nation
A Reflection on Nepal’s Health Services

A Reflection on Nepal’s Health Services

This article draws on experiences from interactions at five Health Posts in the rural and urban areas of Nepal.

Health Posts are a public health service provided by the Ministry of Health, available not just in rural areas but also in urban settings. Each Health Post features Female Community Health Volunteers (FCHVs). The paid staff, led by either a staff nurse or a Health Assistant, are in charge. The actual staffing may vary from the official records, reflecting the reality on the ground. Nurses who began their training after completing the eighth grade can be found, and historically, individuals with only primary education have held positions in government offices. In 2018, at a Health Post located approximately two hours from Dilasha Aviyan in the same district, the in-charge was a female staff nurse with a three-year course and a proficiency certificate. There were also Auxiliary Nursing Midwifery (ANM) staff, helpers, and interns from public health colleges. Political dynamics influence not only Health Posts but all sectors, with changes in ministers potentially leading to significant shifts in human resources. Consequently, employees in health, education, and other sectors are often more concerned about these changes than service delivery. The current scenario indicates that the intended management systems, human resource management, and service delivery have not been effectively executed. Since 2017, DiAv has noted that the services offered by Health Posts, particularly disease prevention for Soil-Transmitted Diseases (STH) in rural regions, along with psychosocial training for urban health volunteers, might be exactly what is necessary. And, it is clear that Health Posts are in need of support from NGOs. DiAv’s associates have observed the effectiveness of Health Posts, especially in disease prevention. However, over the past decade, issues have arisen that compromise the efficacy of public services. Consequently, beneficiaries and service recipients bear significant responsibility for addressing their needs. Although local governments and ward offices are not immune to political influence, it appears to have a lesser impact. Despite capacity challenges, it is essential for people to voice their concerns, and NGOs must play a pivotal role.

NGOs are composed of academically qualified and experienced individuals, recruited based on their competencies. Additionally, NGOs have the capacity to identify and cultivate potential human resources within the community.

On one occasion, Dilasha Aviyan conducted a survey. A question that garnered the attention of the locals was “What is your first preference for a health checkup?” The prevalent answer was visiting an urban hospital. Despite Health Posts being in existence for over three decades, they have not improved as expected. Consequently, DiAv’s principle is to introduce innovative ideas that operate independently of the government system and are unaffected by political fluctuations.

Each ward possesses Health Posts staffed by female volunteers without medical backgrounds. DiAv has embarked on enhancing their capabilities, rapidly transitioning from providing health and management training to supporting elderly care homes and the community, particularly the female volunteers. This effort is bolstered by the involvement of the youth, which promises to be effective in multiple ways.

    1. Volunteers will receive assistance since understanding medical terminology requires literacy, such as knowing the expiry date of medications.
    2. Young volunteers, students from grade 8 and above who are currently enrolled in school, will comprehend the health situation. It is possible, drawing from DiAv’s experiences, that these students will persist with their education. However, there is uncertainty as children may discontinue schooling at any time, especially in rural and remote urban communities where government and NGO presence is minimal. Additionally, political instability is adversely affecting people across Nepal.

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