Binod Dangal, SP Kalaunee, Reena Lamichhane, Bharat Bahadur KC
The 2015 Constitution guarantees the right to healthcare for all Nepali citizens, however public sector healthcare systems have been insufficiently resourced to provide for this right. In this context, the public-private partnership (PPP) model offers great potential.
Following the massive earthquake on 12 May, 2015, the healthcare system of Dolakha district was devastated. More than ninty five percent of Dolakha’s health posts were damaged, and further damage was sustained by all Primary Health Centers and the district Hospital of Dolakha.
Nyaya Health Nepal (NHN) entered into a PPP with the Ministry of Health and Population (MoHP) for rebuilding damaged health facilities and strengthening health system in Dolakha district with the request of health misistry.
Under the MoU signed with the MoHP, Nyaya Health Nepal started rebuilding earthquake damaged health posts from July 2015 itself. After this, under another MoU signed with the MoHP on January 19, 2016, NHN also started managing Charikot Hospital from January 24, 2016. This PPP was historic in the country as it was the first time an NGO managed service delivery at a functioning government facility.
Prior to the PPP, emergency services at Charikot were supported by Médecins Sans Frontières (Doctors Without Borders) in initial service implementation following the earthquakes, in close partnership with DHO. Service delivery was supported by UNICEF during the same period. Among other expansions, this has included an over five-fold increase in OPD services, three-fold increase in delivery services, fully functioning surgical services and an inpatient department, as well as the first public-sector electronic health record (EHR), and communcity health program.
There has been significant improvement in health care indicators over 5 years with the introduction of the PPP’s community health care program. Increased Institutional birth rate (57% to 85%), Improved surgical complication rate (< 5%), Improved Neontal death rate ( 22% to 9%). Similarly, reconstruction of 19 health posts of Dolakha, implementation of regular continuing medical education (CME) curriculum, regular services of general and orthpedic surgeries, emergency care, collaborative care model of mental health care, introduction of digital X-Rays and digital data recording system, implementation of performance based system for employee were the major achievements of this partnership. This partnership has supported to fill the gaps of government health care system in general.
Implementation and use of Electronic health system, regularity and continuation of basic health care with CEONC services and complicated surgeries at the district setting, proper maintenance of supply chain of medicine and consumables, conduction of internal training and skill transfer by senior doctors, six monthly monitoring and yearly auditing of programs and correction with the feedback received, regular performance development opportunities for staff and implementation of the same with teaching and learning activities, implementation of team communication strategy and implementation of hospital to home care to strengthen overall health care were the major gaps addressed by this partnership.
There have been significant positive changes since NHN started working in Dolakha. Bagmati Province has declared Charikot Hospital a provincial hospital, and this provided commitment from the provincial government for additional funding to continue the services. Public sector investment in healthcare has increased due to Covid-19. In addition, federalism provided the opportunity for every municipality to have better fiscal resources and an improved health system in surrounding municipalities.
Accessibility has increased, and health status in the district has improved. NHN’s commitment to rebuild the health system post earthquake has been completed.
NHN had handed over approximately $600k worth of equipment, drugs, supplies, etc. to the local government. In this context, as per NHN’s model of design, build, operate, and transition (DBOT), local government has adopted the same program of NHN to improve the accessibility, quality, equity and affordability of healthcare. They started collective effort of all municipalities to make Charikot Hospital as a referral hospital. They have received contributions from provincial government to run it smoothly.
Yet it has also experienced challenges, initially there was issues with effective stakeholder collaboration, lack of clarity surrounding PPP policy and effective mechanisms to integrate staff. Even later, public contribution to strengthen services, monitoring and evaluation of PPP and applicable decisive regulatory framework remained unclear. Despite the challanges, the partnership has really been fruitful to improve the overall healthcare of the district.
A lesson from Charikot Hospital should guide the nation towards affordable and high-quality health care to set an example of success.
Binod Dangal is the health care director at Nyaya Health Nepal at Dolakha , SP Kalaunee is the executive director at Nyaya Health Nepal, Lamichhane is the In-charge of Charikot PHC, KC is the Mayor of Bhimeshor Municipality and the Chairperson of Charikot Hospital.