Health Care in MJFN's Manifesto

My Scoring: (Please see my earlier blog for the scoring system)
- Relevance: 4
- Coherence: 4
- Practical Achievability: 2

Declarations on Health Care in MJFN's Manifesto: (My translation from Nepali)
- Access to health care is a fundamental right of every citizen. Following policy will be adopted for the development of health sector: conduct primary health care under the local government; implement preventive, curative, promotive and rehabilitative policies for health care; encourage production of doctors and specialists within the country; arrange necessary mechanisms for production of quality medicines and equipment within the country; give emphasis to yoga, naturopathy and traditional treatments; promote Ayurveda, homeopathy and yunani treatment methods; make local health care facilities and maternal and child health more effective; end privatization and commercialization of health care; ensure health care access to ethnic minorities, those below poverty line, pregnant women, elderly, disabled individuals and orphans; develop a scientific mechanism to monitor quality of medicines and ban the production, import, use or distribution of quality less medications; in madhes, based on the population, upgrade or establish health facilities, determine the number of health workers, medications and equipment to be sent; ensure proportional representation of madhesi doctors and health care workers in the departments and divisions of health ministry; establish fully-equipped hospitals in each district; start a nation-wide campaign against killer diseases; ensure clean and purified water in each VDC; take appropriate measures for garbage management; start rural primary health insurance with local involvement and cooperatives.     

My Comments:
First off, they seem to have consulted someone with a knowledge in public health based on few of the terminologies used in the document. Let's look at some of the individual declarations. 

They commit to ensuring universal access to health care, which is a welcome statement. But it is an easy statement, it's hard to contest. Main question will be is there anything in their document that would give a sense of how they are going to achieve it? Nothing convincing. 

There is a consistent theme that they want to empower local government in the delivery of health care. However, they have committed to universal access. Local governments will be very widely variable in their capabilities, resources, commitment, assessment of problems, needs and priorities. So it is hard to imagine how a nation could achieve universal health coverage by asking health care to be run by local bodies. The document does not give us any idea about how they are doing to bridge the local involvement and the nation-wide goal of universal access to health care. 

They touch upon multiple aspects of health care delivery including human health resources, supply and quality of medicines and equipment, and health care facilities. This is a very appreciable thing in the document that it looks at the health care sector comprehensively. 

The statement about alternative medicine is very contentious. If the financing of health care is going to be risk-pooled, including alternative medicine becomes very tricky. For the things that have been scientifically validated within the alternative medicine practices, for example, yoga and breathing exercises in the context of psychological issues, it is easy to incorporate. But let's say you want to give "Yogaraj goggle" for rheumatoid arthritis. With no scientific evidence on effectiveness, side effects, risks and benefits, it becomes a mess. Let's say another Kabiraj claims that his concoction is far superior to "Yogaraj goggle", when the government has to purchase the remedy, which Kabiraj should they prioritize and on what basis?

I very much appreciate how they have identified vulnerable groups categorically and declared that they would prioritize ensured access to them. 

Another contentious issue in this documentation is ethnic representation in ministry of health and its branches/divisions. It is certainly a part of a larger debate. And this political party is explicitly based on ethnic identity. It should be a separate discussion. But this is where I stand in a nutshell: Madhes and madhesis have been utterly, unjustly and dehumanizingly treated by the rulers of Nepal in its larger historical context. Madhes' conscience carries that historical hurt. And it is extremely important for Nepal to right its historical wrongs. But I think it is an utter blunder if we take just one identity of madhes (ethnicity) to solve the actual problem which has many more facets to it. Reservations of positions at an institution is an example of the exercise using just one facet of ethnicity to solve the larger problems of madhes and madhesis. It might seem reasonable on the short-term but it institutionalizes the identity of madhes and its problems just based on ethnicity which, I think, on the long run would cause immense harm. Madhes and madhesis deserve much more than these populist ploys and candies. 

The document mentions about primary health insurance. For it: the devil lies in the details. We don't find those details here. 

Overall, I think it is quite a coherent document. It dreams big. Lets leave it at that because I dare not interrupt the dreaming when that has been pretty much what we have been doing for a long time.