Basic Health Centers Underutilized in Rupandehi Despite Constitutional Right to Health

Devdaha (Rupandehi), 24 Magh: Nepal's Constitution of 2072 has included health service as a fundamental right. A policy has been advanced to expand access to health services through the federal, provincial, and local governments.

In line with this policy, Basic Health Service Centers have been established at the ward level in Siddharthanagar Municipality, Rupandehi. These service centers were established with the objective of providing citizens with basic treatment, immunization, maternal and child health, family planning, and other services close to their homes. However, service recipients are not utilizing these health centers as expected.

Even with Basic Health Service Centers operational at the ward level, the rush of patients at the District Hospital (Bhim Hospital) in Bhairahawa, as well as private clinics and large hospitals here, has not decreased. Instead, hundreds of patients visit Bhim Hospital and other large hospitals and clinics daily for treatment. When the patient load increases in government hospitals with limited manpower and resources, challenges multiply.

Siddharthanagar Municipality, which has 13 wards, currently has nine Basic Health Service Centers in operation. Centers are providing services in Wards No. 1, 3, 4, 5, 6, 7, 9, 10, and 11. Health centers have not yet been established in Wards No. 2, 8, 12, and 13. The operational centers serve an average of 15 to 18 service recipients daily.

According to Madhav Prasad Gyawali, Chief of the Public Health Promotion Branch of Siddharthanagar Municipality, preventive, promotional, and curative services are being provided free of cost through the Basic Health Centers. Family planning, immunization, tuberculosis, leprosy, malaria, nutrition, safe motherhood, health education, and basic treatment services are the main programs of these centers.

Each health center generally provides services with three staff members: two technical staff (AHW and ANM) and one office assistant. However, Ward No. 5 only has two staff members, an ANM and an office assistant. All these employees are working on temporary contract basis. Services are provided from 10 AM to 4-5 PM, except on public holidays.

The municipality has been conducting health education programs in mother groups, schools, and communities with the aim of increasing health awareness at the community level. Regular immunization services are provided on the 11th or 12th of every month. Family planning, tuberculosis, leprosy, and general medical services are available daily. Programs to visit homes and raise community awareness are also in operation if malaria is suspected.

Health Promotion Branch Chief Gyawali stated that there is no need to go to the hospital for basic treatment services like blood pressure testing and body weight measurement. He urged people to visit the nearest health center for general treatment services. "If general treatment services can be availed at the ward level, the patient load in hospitals will also decrease," he said.

Under the nutrition program, Vitamin 'A' and deworming medication are distributed to children under five years of age, and screening campaigns involving home visits for weight checks are being conducted. Under the safe motherhood program, pregnant women receive check-ups, and mothers and newborns receive health checks twice at home: on the third day after delivery and again between 7 to 14 days. Basic treatment services such as fever, cold, diarrhea, blood pressure checks, minor wounds, toothache, and mouth swelling are provided at the centers.

Although 89 types of medicines are listed at the health centers, 51 types of medicines, excluding those for immunization, tuberculosis, leprosy, malaria, and family planning, are available. Most wards in Siddharthanagar are market areas. As it is the district headquarters, the number of district hospitals, private hospitals, and clinics is significant. There is a tendency to go to larger hospitals for specialist services, even if it is slightly more expensive than government options. Lack of trust in government health centers and the mentality that "better treatment is available only at big hospitals" are considered the main reasons for the low utilization of health centers. Statistics confirm this. Based on data entry into the municipal health system, a total of 482,889 people received health services from Basic Health Centers, the District Hospital, and approximately 40 hospitals operating within the municipality in the last fiscal year 2081/82. Of these, only 21,696 people received services from the Basic Health Centers operated by the municipality.

If local levels increase investment in expanding health services, the rush of patients in large hospitals remains constant due to low service utilization and lack of increased public trust. Until the quality of service at health centers, manpower, medicine availability, and public trust are improved simultaneously, the concept of 'treatment near home' seems difficult to implement fully in practice.

Hospital Chief Dr. Barsha Thapa informed that up to 500 patients receive OPD services daily at Bhim Hospital. According to the hospital, more than 120,000 people received Outpatient Department (OPD) services here in the last fiscal year 2081/82. Similarly, 112,845 received services in FY 2080/81, 90,000 in FY 2079/80, and 63,000 in FY 2078/79.

The statistics from the last four years show a gradual increase in the number of service recipients. This clearly indicates that even though primary level services have expanded, the burden on the hospital has not decreased. Major hospitals here, such as Universal College of Medical Sciences and Siddharthanagar City Hospital, are experiencing a high patient load. Health Insurance started at Bhim Hospital from FY 2077/78.

The hospital stated that the crowding of service recipients is due to health insurance, specialist services, and 24-hour services. Dr. Thapa suggested that to prevent people from coming to the hospital even for minor health treatments, information about the services available at ward-level Basic Health Centers must reach the citizens, and relevant bodies must be able to convince the public to trust government hospitals. "If this can be done, patients coming to Bhim Hospital for general treatment would seek care at local health centers, and the hospital crowd would decrease," she said.

Dr. Thapa added that it would be easier for both service recipients and service providers if information on when to go to the hospital versus the health center is disseminated. Arjun Paudel, Managing Director of Siddharthanagar City Hospital Pvt. Ltd., informed that 100 people receive OPD services daily at his hospital. According to him, patients come here seeking specialist services rather than for general ailments. It is understood that the public perception still leans towards going to the hospital for specialist care.

Ward Member of Siddharthanagar Municipality-9, Basanta Bhattarai, stated that awareness programs have been conducted through the ward, and there is no truth to the claim that ward residents are unaware of the services provided by the Basic Health Service Centers. He mentioned that 12 female health volunteers, two each in six sectors (catchment areas) of Ward No. 9, are deployed for door-to-door visits. He informed that health check-up services are provided to senior citizens at their homes once a year. He also mentioned that health camps are regularly conducted at the ward level by various organizations.

Sarita Pandey, In-charge Senior ANM Inspector of the Basic Health Service Center Siddharthanagar-9, informed that an average of 35 service recipients visit the center daily. She stated that services like free medicine distribution, counseling, referrals, primary treatment, and home visit programs are frequently conducted here.

Ward Chairman of Siddharthanagar Municipality Ward No. 5, Puran Prasad Shrestha, stated that services such as child immunization, family planning, pregnancy and postnatal check-ups, monitoring of child weight gain, and senior citizen services are available at the Basic Health Service Centers. He explained that the centers were brought into operation with the objective of ending the compulsion to go to hospitals/clinics for minor health problems and counseling and providing basic health services to ward residents. He mentioned that not only ward/municipal residents but also residents of other municipalities can avail services from the health centers. He stated that all basic health-related services are arranged to be provided through the centers.

In Bhairahawa, besides hospitals, there are many private clinics. Many patients go to private health institutions due to reasons such as quick testing, access to private doctors, better facilities/convenient services, and services available on holidays. The notion of 'short time, quick treatment' has prevented the reduction of crowds in government hospitals, as private services are perceived to offer 'short time, quick treatment.'

Usha Adhikari, Deputy Mayor of Siddharthanagar Municipality, stated that Basic Health Service Centers at the ward level were established for primary and general treatment. She suggested that patients might be going to hospitals because services are only available during office hours. She mentioned that female health volunteers are providing services like immunization and counseling to new mothers door-to-door through the Basic Health Service Centers.

The reasons why the public is not visiting Basic Health Centers at the ward level as expected, leading to an increasing load on hospitals, include centers being closed on public holidays, services only being available during office hours on working days, lack of specialist services, shortage of manpower, and shortage of medicines (due to delays in medicine procurement caused by tender processes as per government regulations). Gopal Bhandari, a resident of Siddharthanagar Municipality-3, stated that all citizens in the ward should be informed about the services provided by the ward-level Basic Health Service Centers. Bhandari believes that if this is done, the patient load in hospitals will decrease.

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