Efforts have been started to implement the decision to establish a basic hospital with at least 10 beds in all the municipalities of the country. The government had decided to set up at least 10-bed hospitals in all the municipalities with the formation of local bodies. As per the decision to provide services from the district headquarters to the municipality level, banks and police posts have been established in almost all the municipalities so far.
There are 753 municipalities in the country. Among them, there are big hospitals in the metropolis and sub-metropolitan municipality from the past. Similarly, there are well-equipped hospitals in about 150 municipalities from the past. Because the provision of zonal hospital and district hospital is already there. During the Panchayat period, a campaign was launched to establish at least one hospital in each zone and after the establishment of a multi-party system in 2046 BS, a campaign was launched to establish at least one hospital in every district and health post in every VDC.
The foundation stone of the hospital building was laid last Monday for the construction of basic hospitals in 396 municipalities out of the remaining ones. Hospitals have been constructed in 86 municipalities in Province 1, 53 municipalities in Province 2, 51 municipalities in Bagmati, 53 municipalities in Gandaki, 57 municipalities in Lumbini, 42 municipalities in Karnali, and 54 municipalities in the Far Western Province.
Depending on the population, five to 15-bed hospitals will be constructed in these municipalities. Similarly, 50-50 bed infectious disease hospitals are being constructed in all seven states simultaneously. The government has stated that a budget of Rs. 57.95 billion has been secured for 396 basic hospitals being constructed at the municipal level. The government has also stated that a budget of Rs. 80 million per hospital has been ensured for the construction of infectious disease hospitals in all seven states.
At first glance, the government’s move is not only welcome but commendable. But on closer inspection, it looks like a fair of cheap popularity and corruption. The problem of our country so far is not the lack of hospital building, but the lack of doctors. There are no doctors in some of the existing district hospitals. According to Darawandi, most of the district hospitals in the country do not have doctors. Even some zonal hospitals do not have doctors.
The building is not a big deal. The big thing is the doctor’s arrangement. The government has gone in the opposite direction when it comes to arranging doctors. First of all, at the current rate at which doctors are being produced annually in the country and at the rate at which doctors are being recruited, if this situation continues, it will not be possible to provide doctors even in the existing hospitals for the next 30 years. Similarly, the syndicate has been implemented so that only the sons and daughters of the rich can become doctors by paying expensive fees. If this does not end, there will be a shortage of doctors in the district hospitals in remote areas for the next 30 years. Because even to raise their investment, doctors focus only on urban areas, otherwise, they migrate abroad.
On the one hand, Dr. On the other hand, a strange disease of dreaming of a hospital in every municipality has been seen in the people living in the government. If the people in the government have sincerely thought of arranging a hospital in every municipality, then, first of all, Dr. The demands put forward by Govinda KC should be met. Immediately Dr. If KC’s demand is met, it is possible to establish a hospital in every municipality within the next 15 years as announced by the government.
The concept of federalism is not only unnecessary for the country, it has come with bad intentions. But the concept of local government is welcome. The practice of local government is very old in the context of our country. From time immemorial, the practice of making decisions by the local Punch Bhaladmiddhara has been continuing.
The current concept of local government is a refined version of that. But in proportion to the size of our economy, the number of local levels has increased. Tramps had to be increased, many were made at once. For example, there were 35 districts during the Rana period and 75 districts during the Panchayat period. Now, if 150 districts were created for 30-40 years, it would be fine. The cost increased when 753 municipalities were formed at one time. The people have been forced to pay taxes. Taxes paid by the people are not being utilized well.
This decision of the government to establish basic hospitals in every municipality may prove to be a stepping stone for the positive results of the local government. But the concerned state government and the municipal government need to pay special attention. Looking at the experience so far, there is no guarantee that the work will be completed. With the construction of the building, there is no guarantee that the hospital will be operational. Hospitals need equipment, doctors are needed. And the sick are also needed.
There is still a shortage of doctors in the country. Doctors are not willing to go to the hospitals run by the district headquarters, while doctors are not easily recruited in the small hospitals run at the municipal level. Local governments should look for alternatives to the Singha Durbar when it comes to arranging doctors in their municipal hospitals.
Local governments should consider giving soft loans to poor and deserving students in their own villages to teach medicine and serve in their own village hospitals for a certain number of years.
The number of hospitals does not make much sense. The main meaning is the service and quality of the hospital. It would be counterproductive to set up a hospital on the model of other government offices to be set up in the municipality.
Just as the merger of banks and schools has started now, we have to think now so that the local basic hospitals do not have to merge tomorrow. Health post buildings were constructed in every VDC. Now the VDCs have been transformed into wards. It would be a great relief to have a pediatrician and an obstetrician at the same health post in the ward immediately.
After that, the district hospitals rush for treatment. Instead, it is necessary to provide at least one ambulance in each ward. If the hospital can be established to cater to a large population, experts in many fields can be sent. But the political parties have failed to structure the local level to suit a large population. The main thing is that the geographical location has not been adjusted while structuring the municipalities.
In 2019 BS, the structure of the municipality was flawed in itself, keeping the district structure as the border of rivers and streams. At present, bridges have been built across rivers and streams. Most of the roads are built along rivers and streams. Now the river basins have become a place to drink, but the same market is also located in different districts and different municipalities.
Rampur of Palpa, Chapakot of Syangja, Raipur of Tanahu, and Dedh village of Nawalparasi can be taken as examples. If these four urban settlements in the same place could be included in one municipality, a hospital and medical college with 200 beds could be established.
But it was divided into four districts and four municipalities. This problem exists in many places. Take Veni, Kushma, and Baglung markets for example. If these three markets were combined into one municipality, much could be done. The Arughat market of Gorkha is the same but it has been divided into different municipalities as it falls in different districts due to the river in the middle.
If the errors in the structure of the municipality had been rectified, the facilities could have been provided by constructing 300 hospitals across the country. Due to the flawed structure of the municipality, the offices set up within the municipality to provide basic services are more expensive. Therefore, a basic hospital should be established only after conducting an on-site study. There are many such places, some may need two basic hospitals, some may not.
When building a hospital in a place that caters to a small population, only limited facilities can be reached. Thematic specialists cannot be arranged. When a hospital is established in a place that caters to a large population, specialist doctors in many fields can be arranged. Better a poor horse than no horse at all. Is there going to be an abattoir in the name of the hospital? It is time that we all take an interest in that.
(Bhujel is a retired engineer in the British Army)