The Constitution of Nepal has allocated health as a shared responsibility of local level, provincial and federal government. Among the local levels, Kathmandu Metropolitan City is the largest metropolitan city in Nepal; however, its investment in public health is disappointing. There are certain measures it should immediately take to improve the health status of the capital city.
1. Establishing an in-patient hospital with emergency services
Even small municipalities in Nepal are running their own hospitals, while KMC is lagging far behind. There are some urban health clinics run by the municipality where doctors (Medical Officers) are available, but the services are not properly advertised. Running outpatient based urban health clinics is a good initiative, but it is high time KMC established an inpatient based hospital with emergency services.
2. Partnering with existing hospitals instead of building a new hospital
I would not propose establishing a separate KMC hospital requiring billions of rupees of investment. A few years ago, I was working in the Emergency Department of Patan Hospital when I was deployed to Yala Swasthya Sewa Kendra in Patan. It was a joint initiative of Lalitpur Metropolitan City and Patan Hospital. The health centre was run by Patan Hospital and funded by Lalitpur Metropolitan City.
3. Establishing primary hospitals through partnerships
I think KMC should partner with Bir Hospital and Teaching Hospital to establish a few primary level hospitals. These hospitals could hire MDGPs and Medical Officers and provide inpatient and emergency services. They could partner with these government tertiary hospitals for specialist services and coordinate surgical services when required.
4. Improving access to doctors and regulating the sale of medicines
In Kathmandu, there are many pharmacies that sell almost every kind of medicine, including strong antibiotics, without a doctor’s prescription. As a result, people often choose pharmacies instead of visiting hospitals.
The urban health clinics run by KMC could provide a good alternative for accessing medical care if they are properly promoted. Furthermore, KMC could collaborate with the Ministry of Health to develop a specific protocol for Kathmandu’s health system. It could then work with the Nepal Medical Council and the Department of Drug Administration to strictly monitor pharmacies and clinics and control the sale of medicines without a doctor’s prescription.
5. Separating primary and specialised hospital services
It is high time we differentiated hospitals that provide primary-level services from those providing super specialty services. This would be particularly important during outbreaks such as dengue and COVID-19.
At present, our hospitals may have to manage conditions ranging from dengue to complex cardiovascular surgery within the same systems. This can affect the management of both outbreaks and complex diseases.
6. Preparing for disasters and public health emergencies
Kathmandu is an earthquake-prone region. Therefore, KMC should identify and prepare rescue shelters and emergency spaces for natural disasters and public health emergencies in partnership with hospitals.
One option could be government owned land, such as the area around Tinkune. Other options could include designated open spaces along riverbanks for temporary use during emergencies.
Given the growing population of Kathmandu, it is high time we prepared in advance for the next major crisis.
7. Urban Public Health
There is extensive unmanaged urbanization in Kathmandu which presents multiple threats to public health. Living in limited and crowded places can trigger diseases like Tuberculosis and Asthma. Similarly many residents in Kathmandu live in dark rooms with limited access to sunlight, contributing to Vitamin- D deficiency. The urban life style fueled with polluted surrounding is a major contributing factor to cardio-vascular diseases worldwide. Hence, KMC should draft a comprehensive health prevention program considering these risks and focus on timely intervention.
