-Sailesh Kumar Mishra
The COVID-19 pandemic is having profound repercussions around the entire world. This pandemic outbreak has also toppled personal and professional lives of Nepalese people. Like other countries, Nepal has also come to a standstill and Government of Nepal is trying its best to fight this virus. Like other business and service industry, the eye health sector is facing unprecedented challenges in terms of delivering emergency services and financial sustainability.The COVID-19 outbreak is expected to have a significant impact on eye health service sector in the near term.
As soon as the Government of Nepal declared lock down, eye hospitals of Nepal eventually suspended most of its activities. All the outreach programs were suspended until further notice. All the patient care services were limited to emergency cases. The fundamental objective for the management was to make sure that patients and staff get the utmost protection against the risk of this infection. Like in other countries, ophthalmic fraternity had also a concern about the risk of infection during the work. Almost all the eye care service providers have drafted and implemented a guideline to adapt services and adjust the system and process to avoid the spread of infection in clinical setting. Right now, some eye care service providers are also providing services through text messages, Facebook messages, phone messages, telephonic consultations, or other means as available.
In Nepal most of the eye care services are delivered through non-governmental organizations, private hospitals and medical colleges. People of Nepal are receiving quality and affordable eye care services through primary, secondary, and tertiary level eye care facilities established in different parts of the country. Almost all the districts have either eye care centre or eye hospitaldelivering eye care services to the needy population.
The eye hospitals running under non-governmental organizations and private organizations are not immune to the financial struggles. Before the lock down and closure of border, there was enough arrival of Indian patients in the hospitals of border areas of Nepal. Thousands of Indian patients with cataracts and other eye disease come to Nepalese eye hospitals for treatment since many years.
Since eye hospitals in Nepal have already stopped elective and non-emergency procedures, it has reduced cash flow to almost all the eye hospitals and hospital systems, leading them to evaluate financial implications and staffing levels. Eye care in Nepal with an emphasis on cataract surgery is probably one of the few health care services that has become financially self-sustainable from users' fees while maintaining an orientation to serving the poor.Eye care centres established in remote areas across the nation were already facing financial challenges and this crisis will cause some to close their services. If we are not able to address the operating cost for these rural eye care centres, we are going to see these eye care centres close before this crisis ends. Hence these eye care centresare reeling under immense financial stress. Many eye hospitals and eye care centres are not in position to even sustaining their staff salaries.
There is a limited support from Government of Nepal for eye care program. Amid COVID-19 outbreak, in the absence of adequate resources, Nepal has been forced to divert its budget and has already withdrawn its budgeted support for eye care for this fiscal year as well. Hence, financial sustainability for high quality and large volume sustainable eye care program is going to be affected in future if there will not be increased support from Government and development partners.
For the next few months, steep decline in patient footfalls will lead to uptake less eye care services. Generating revenues sufficient to cover operating costs (“cost recovery” or “financial sustainability”) is a big challenge in future and it can adversely affect the operation of the program which is considered as a model in South Asia in terms of reducing the prevalence of blindness and eliminating trachoma from Nepal. In this scenario, eye care service providers of Nepal seek relief package from Government of Nepal and development partners for survival of the institutions in the given crisis.
-(Mishra is an Executive Director of Nepal Netra Jyoti Sangh)