Remote districts ‘missed’ out in WB’s health project

January 21, 2001
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Kathmandu, Jan 21: The first ever health project funded by the World Bank in the country may have been over but with a lopsided priority.

The Population and Family Health Project (PFHP) has recently built 225 health facilities across the country yet some remarkably backward hilly districts have no good news to rejoice about.

Billed at above US$ 20 million, the scheme has constructed only two health facilities in the remote Karnali zone while the project ended up with nearly a dozen health facilities in the more accessible Terai districts of Morang, Dhanusha and Rupandehi.

The far-reaching mountainous districts like Jumla, Mugu, Manang, Rasuwa and Dhankuta, however, are missed out in the project-checklist.

“It appears, the project has not respected the sentiment of the government plan of sustainable and overall development throughout the country,” say some officials at Department of Health Services.

“The project has missed many hilly districts where people die due to lack of medical facility when epidemics break out. It was only last year that over a hundred people died in Karnali zone in a viral influenza epidemic,” experts say.

PFHP officials, however, argue otherwise. Acting Director of the Project Implementation Unit (PIU) of the project Pushkal Bharati says that the World Bank had asked them to build health facilities keeping in mind the factors like density of the population, accessibility and so on.

Launched in 1994, the World Bank funded PFHP was designed to help improve the health conditions of the Nepalese. But with the remote areas still left out by the project, eyebrows have been raised.

And it is not only the matter of over-concentration of health facilities in easily accessible areas. There are even fears that these health infrastructures will turn into white elephants now that the government has taken over the charge of these facilities from January 2001 — one month after the project ended on Dec. 31, 2000.

Health experts are also skeptical about the proper use of these facilities which are spread in almost all the districts except in remote ones.

Then there is the problem of over-staffing in the project sites that could run into the government’s liability.

“We are mulling to trim down the size of the staff appointed by the Project and then we will run the facilities so that they can serve the people well,” Padma Prasad Pokharel, Secretary at the Ministry of Health, said at a programme organised to discuss the project’s implementation.

Even if the officialdom does that, there is already another problem awaiting to be addressed. And that is none other than the gross lack of health workers, especially in the remote areas.

The mere existence of hospitals, health centres or sub-health centres throughout the country does not necessarily mean that the country’s health sector is improving and that people have access to health care. Needless to say, the country’s health facilities are in a dire strait. They not only lack medical equipment and drugs, but also lack skilled manpower. Despite the government’s investment of billions of rupees on health sector, what ails the situation is the absence of health professionals.

Although the government has established health posts or sub-health posts in all the VDCs, most of those in the hilly ones remain unmanned due to lack of poor administration.

Of the country’s 977 doctors working in the government sector, only 46 are deputed in the mountains. “Although there are nearly 50 health posts, there are barely 10 doctors working there,” a doctor assigned to Surkhet in far west Nepal said.

Regional imbalance is equally striking. Presently, there are a total of 4,389 health facilities throughout the country but there are only 608 health facilities in the mountain and Himalayan region. And nearly 50 per cent of them are sub health posts staffed by health workers.