Urban health centers in pathetic condition

KATHMANDU, Jan 14: Amid screeching wheels and honking horns of vehicles plying the Ring Road engulfed with dust and pollutants, two staffers at Mitra Park of Chabahil in the capital are busy writing details of patients in a two-storey building, critically damaged by the earthquake of April 2015.

CMA Rajendra Shrestha and office assistant Ganga Dhakal are accustomed to the damaged walls of the urban health clinic operated by Kathmandu Metropolitan City (KMC). The engineers assessed the condition of the building after the earthquake and warned us not to stay in the building.

Following the recommendation of the engineers, the staffers provided primary health services including immunization for children, DOTS and family planning measures to ordinary people of KMC Ward No 7 from open space on its premises for six months.

“Though we were terribly afraid of the situation, we again started working under the deadly walls after six months,” said Shrestha. “We urged the authorities to seek a safer building as an alternative but to no avail. As a result, we are obliged to continue our duty here,” he said.

Four posts of health workers, including HA, CMA, ANM and an office assistant, have been sanctioned for the urban health clinic. The post of ANM has been lying vacant for five years and the post of office in-charge for the last five months. The KMC assigned an HA to work in the clinic a few months ago but the assigned health worker declined to work there due to insecurity of the damaged building, according to Shrestha.

The clinic does not have essential medicines although the government allocates budget every year to provide essential free medicines such as antibiotics, oral rehydration solution, cetamol, vitamins, eye drops and anti-bacterial medicines through the public health institutions across the country.

“We don't have any medicine apart from medicines of DOTS, contraceptives, iron tablets and vaccinations for children,” said Shrestha. “We also don't have lab. At least 10 patients come for treatment here every day. About 100 children come for immunization every Tuesday and Friday,” he said adding, “All the patients here get free treatment and medicines available.”

The clinic building with six rooms was built by encroaching upon the road area. The building was jointly used by postal office, community police and the clinic before the devastating quake. The postal office shifted from there after the earthquake but the community police service is still on the upper floor while the clinic is on the ground floor.

Bhagwati Acharya, a volunteer at the clinic, said Health Minister Gagan Thapa had assured to provide Rs 1 million for the construction of the clinic building from the parliamentarian's fund. “But the local political leaders of Nepali Congress, CPN-UML and CPN (Maoist Center) manipulated Minister Thapa and they are planning to open another health clinic at Kumarigal of Ward No 7 by using the same fund,” she said.

The urban health center of Mitra Park in Kathmandu is just an example of chaotic situation of urban health centers across the country. The government brought a collaborative framework three years ago as per the Local Self Governance Act 1998 to open urban health centers for needy people. The government's health policy 2015 provisions to open an urban health center at each of the wards of all 217 municipalities in the country, targeting to provide health services to the urban poor, marginalized, women and children.

However, only 366 urban health clinics have been established in the municipalities of 67 districts throughout the nation, according to the Department of Health Services (DOHS).

“The program has not been effectively implemented as expected,” said Bhawani Sharma, public health inspector at the DoHS.

There are only 19 urban health centers in Kathmandu district, 8 in Bhaktapur and 6 in Lalitpur, according to the DoHS. However, the KMC claimed that there are 27 urban health clinics in the metropolitan city alone.

The government provides a grant of about Rs 350,000 to each urban health center every year, according to the DoHS. Every local body should add at least the same amount provided by the government to set up a mutual fund to operate the centers in the local bodies.