Nepali Congress leader Mohan Bahadur Basnet is currently serving as the Minister for Health and Population. Having been elected as the Member of the House of Representatives from Sindhupalchok, Basnet is known as a popular leader among people who works day and night during natural disasters and difficult times. Previously, he served as the minister of state for health and population around 22 years ago.
Two and a half months after assuming office as the health minister, he is reported to have carried out reforms in the health sector. He has announced the ambitious programme of providing free healthcare to impoverished people within two years, and to all people within five years. The programme is under implementation. The Rastriya Samachar Samiti’s Uttam Silwal and Bhishma Raj Ojha recently talked with the minister on the issues of the health sector. Excerpts:
Q. What is the Ministry of Health and Population doing for becoming prompt, efficient and people-oriented? What are the remarkable works that have taken place after you assumed office?
A. It has been two and a half months since I assumed office. I joined the ministry around 22 years ago as a state minister. As I am already accustomed to the affairs of the ministry, I commenced reforms right after assuming office. I ordered cleaning up the premises of the ministry and blacktopping the trail within 15 days.
I ordered the implementation of the allocation of 10 per cent of beds for free for the impoverished people in each hospital. So far, 3,523 such free beds have been made available in 16 hospitals in the federal and under the health science academy. In addition to this, online ticketing for OPD services has been also launched. The number of well-equipped cabins at the Bir Hospital has been increased for providing treatment to VIPs and VVIP patients after forming a team of specialist doctors. This attempt aims to stop the outflow of a large amount of money to foreign countries in the name of the treatment of VIPs and VVIPs. OPD services at Bir Hospital start at 8 am in a bid to provide effective healthcare to citizens.
We intensified the monitoring after receiving widespread complaints that there were anomalies in pharmacies. Out of 101 pharmacies in the Kathmandu Valley monitored, only one is found to have met the set standards. We did offer awards and punishment in the workplace. We have launched the monitoring across the country. We will offer free healthcare to people with low incomes and impoverished people in two years. Within five years, we will build a foundation to implement the fundamental right of people to health as guaranteed by the Constitution.
Q. How are you taking the private sector along with the government service to make health service that is directly connected with general people quality, people-oriented, accessible and credible?
A. We have enabled a mechanism to regulate and monitor all hospitals. We have increased the regulation and monitoring after forming various teams. We will create an atmosphere for all government and private health facilities to abide by the rule of law. We have been assured of assistance from the ministry to effectively implement the allocation of 10 per cent of beds for free in all hospitals. The budget ceiling has decreased. We are ready to provide free basic service by utilising the available budget. Lately, the private sector has also helped. Following complaints, we are in consultation to ensure uniformity in the fees charged by private health institutions. Citizens should not be charged high fees citing the machine has been purchased at high prices. We are monitoring the health institutions if they have charged clients high fees.
Q. While leading the ministry, what are the challenges in terms of resources, laws, organisation structure and action plan from the central to province to local levels, and how do you resolve them?
A. The ministry made a health strategy and a health financial strategy a long time ago. But they remained unendorsed. After I joined the ministry, both strategies have been passed. It has become feasible for us to work. We are also making other required laws. On the other hand, there were malpractices in the procurement of goods for the ministry. More than required goods would be purchased leading to complaints pouring in.
There was a practice of doing away with functioning hospital equipment and purchasing new ones. After being tipped off, I ordered the monitoring in a guerilla way across the country. Obviously, it was found that way. Thereafter, we called a meeting and ordered investigations. We wrote to the respective hospitals along with the report and suggestions recommended. Now, there are improvements in the purchasing process.
There were ill practices among the employees who have access to power to unnecessarily take a deputation leave for accessible cities either in the central capital of the country or the provincial capital. There were around 800 employees who stayed on deputation leave for years. No one intervened but their deputation leave was extended. There were efforts made to extend their deputation leave even after I arrived. But I refused. We started the withdrawal of the deputation leave and the deputation of doctors and health workers to rural areas. In the initial days, I faced difficulties. In the meeting of the House of Representatives, I requested to stay away from making such a recommendation. I also said so in the meeting of the Council of Ministers. The respected Prime Minister praised my work asking me to go ahead. Prime Minister and other leaders’ encouragement has motivated me to work heartily. We will depute scores of doctors and health workers to villages in 15 and 20 days.
Q. The health insurance launched by the Government of Nepal has gained popularity. What do you say about the complaints by consumers that the process is cumbersome?
A. free health insurance is an important programme in itself. But I have found some anomalies in it. In the beginning, some medical colleges and hospitals said in writing that they did not need the insurance programme. They are the ones who are now shouting about it at present. There were malpractices when it comes to providing this service and paying the amount timely. Medicines would not be available everywhere. It remained ineffective when the service was not delivered in the right way. After receiving the complaints about ill practices, we feel it requires an investigation.
We have received complaints that the service has been misused by producing fake receipts in collusion with doctors involved in the name of seeking the insurance service. Investigations are required.
In this regard, we need a mechanism. There was not a scenario wherein the private sector can be excited after the Ministry of Finance through budget made the provision of not providing this facility to private hospitals. More patients visit the hospitals not having the insurance facility. Officials in the insurance board are found not to be working impartially. We are working on it.
We are holding a discussion on monitoring doctors’ prescriptions to patients with bad intentions. My personal view on the insurance facility was that government hospitals should receive a 60 per cent share of the facility, and private ones 40 per cent.
But in the meanwhile, the budget was brought, and we are compelled to follow the provision in it. We must move ahead by establishing the system. We are doing homework on auditing unnecessary medical prescriptions to patients by doctors.
Q. How does the ministry assist in providing treatment to those injured in various disasters? And what is it doing in controlling infections including dengue that spread during monsoon?
A. First of all, we provide free treatment to every citizen injured in any disaster including floods and landslides. I personally take this responsibility of providing free treatment irrespective of whether or not there is budget for this. I have taken this responsibility and got many patients treated on my initiative.
Not only that, the persons, who were injured and have got bullets stuck in their bodies during the insurgency, have come for treatment. We have also arranged medical treatment for the people. Now, the ministry is working like a government hospital by providing free medical treatment.
In controlling dengue infection in Koshi Province, health workers along with medicines have been mobilised, and treatment is being offered. On our initiatives, the BP Koirala Institute of Health Sciences in Dharan has mobilised a team of doctors and health workers.
We have also launched an awareness programme involving the local government and all stakeholders in the infected areas after declaring them the most affected area.
Q. The constitution has guaranteed health service as a fundamental right of people and you seem to be committed to implementing it. Is it possible with the available human resources, budget and infrastructure?
A. This work is not that easy, it is an ambitious issue as well. Now, the ministry’s 40 per cent budget has been cut. Over Rs 10.1 billion has been allocated with much effort. Moreover, 20 per cent of the allocated budget is yet to arrive. But much work can be done with limited resources if you have courage and wisdom.
We did not have an additional budget for providing free healthcare. But we are doing it. We will allocate a budget to the sector that has not produced results. We will stop anomalies and leakages. We can seek assistance from donor nations and agencies for good work. Another thing is that you do not need to seek a special budget for it. At present, Rs 6 billion has been collected as taxes on tobacco products. For example, Israel has imposed an 85 per cent tax on tobacco products. The World Health Organisation has asked for the imposition of a 75 per cent tax on tobacco products.
Why should not we too increase the tax on tobacco products? No one expresses their concern over the increment of tax on tobacco products, alcohol, sweet beverages, and junk foods. The ministry can collect half of the budget presently allocated by the government for the ministry if we impose a 75 per cent tax on these products.
Much revenue will be collected by imposing high taxes on products that are harmful to the health of people. On the other hand, imposing high taxes reduces consumption of these products thus reducing their impacts on people’s health. This is a good deed, I will continue with it. I am hopeful that I will get the support and help of all for its effective implementation. This can also help a lot in the effective implementation of the insurance service. As long as I work in the ministry, I will lay the foundation for this during my tenure.
Q. You are an influential leader of the Nepali Congress. Recently, the meeting of the NC Central Working Committee has been over, how health programmes will be implemented as per the party’s election manifesto issued in the erstwhile polls?
A. I am the person who stressed the implementation of the free basic health service to people guaranteed by the constitution as mentioned in the NC’s election manifesto. I am at work on it. I also stated in the party’s meeting that healthcare should be free. How much time it will take is a different matter.
I am a person who worked a lot in the education sector too. I am the person who launched the campaign for making available free education up to School Leaving Certificate in the district (Sindhupalchok). Currently, we have launched a campaign to provide free education up to plus two in three local levels of the district. Health and education should be brought along simultaneously, and the NC should have a leading role in this effect.