Improving health status in new federal structure

हेल्थपोस्ट नेपाल
Gita Sapkota

As Nepal has recently entered into a new federal democratic republic system from a unitary structure, the discourse of the role and deployment of health professionals in Nepal in the new form of governance is now on the rise.
Talking about health professional and their distribution we should not undermine the role of Female Community Health Volunteers (FCHVs) as they can play a part in improving the country’s health status.
Several studies have proved that female community health volunteers have been playing a crucial role in addressing various health-related problems from their level. Although many social sectors had to go through a catastrophic situation in Nepal during the decade-long Maoist insurgency, Nepal made tremendous achievement in various aspects of making improvements in the health sector even during the conflict. In past three decades, the country could make significant improvements in child and maternal health.
Even the international community praised and rewarded Nepal in many occasions for achieving Millennium Development Goal in maternal and child health.
Resources to be provided by the government are not sufficient in addressing the demands of general people in the federal system..So, the issue of making the health service delivery effective in the new political and administrative structure should be discussed at length before making arrangements under the new system.
A concept of female community health volunteers was brought when Dr. Ram BaranYadav, who later became Nepal’s first President, was Minister for Health during 1999 to 2001. It was introduced with an aim to control several communicable diseases, and enhancing health awareness across the country, where a large section of people was unaware and out of access to even basic health facilities.
At that time, the country was witnessed by several communicable diseases like Malaria, Polio, Leprosy, Snakebite in Terai region, pregnancy-related complications and complications during delivery and to the newly born child. That scenario made the role of FCHVs more crucial in the country’s system of health delivery. They have been handling basic health services like vaccination distribution, family planning services, assisting the pregnant women to resolve their health problem before, during and after delivery and addressing the problems related to newly born child and others. Now, more than 50,000 FCHVs are being deployed across the country.
Despite the fact that the FCHVs have now become most important actors of improving the health condition of Nepali people, it is a bitter truth that they are not being able to meet the public expectations and increasing health needs.
Arranging necessary human resources from local to central level aptly has been a very tough job for the government, and it seems the problem of the government’s inability in making the balanced distribution of human resources might persist even in the new administrative structure if the issue was not addressed seriously.
Due to the disparities of human resources between rural and urban areas, poor people have low access to health facilities, which has resulted in unequal health outcomes in the people.
If the role of FCHVs was undermined, the government would be unable to address various complications to be seen in the health sector in the given context.
As the government, at present, is not being able to properly manage and distribute the FCHVs, the primary thing the government will have to do is offering golden handshake and retirement to senior FCHVs as many are still working even at the age of 70s and 80s.
What is most important is FCHVs also cannot handle the number of public expectations, and thus the government should upgrade their on health delivery system and make them aware about public health challenges by organizing close camps across the country.
There is high potentiality that FCHVs also can play a major role in controlling communicable diseases. As the studies have proven that they can make lifestyle counseling intervention, can focus on the importance of physical activity, reduce alcohol consumption and make people aware of the consumption of salt, their role should be managed well.

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