Due to weak targets, insufficient implementation of health programmes, and existing barriers to seeking health care from health institutions, Nepal is still a long way from achieving Universal Health Coverage (UHC). On the one hand, the country has a high disease burden; on the other hand, citizens are heavily reliant on Out-of-Pocket (OOP) spending when seeking health care. To deliver on these two opposing realities, ambitious health goals and strong health systems are required.
The financial aspect of people’s access to health services in the country is crucial. However, the disease’s toll on the country is far too high. Non-Communicable Diseases (NCDs) are becoming a more significant contributor to the illness burden in Nepal. According to the Nepal Burden of Disease Report (2017), NCDs were responsible for 66% of fatalities in Nepal. Dr. Krishna K Aryal, one of the primary contributors to the Nepal Burden of Disease Study 2019 (which has yet to be included in the national report), recently stated at a National Health Research Council meeting that NCDs’ proportion to mortality has climbed to 71 percent in 2019. In 2019, smoking, high systolic blood pressure, household air pollution, ambient air pollution, and high fasting plasma glucose have all been identified as major risk factors for death.
While the disease burden is significant, as it is in many low- and middle-income nations, the vast majority of Nepalis lack access to excellent health care. Poverty remains a major obstacle, notwithstanding significant progress in the fight against it in Nepal. In the country, for example, 28.6 percent of individuals live in multidimensional poverty. Karnali Province has the greatest poverty rate (51%) followed by Sudurpashchim (48 percent).
People must rely largely on out-of-pocket (OOP) payments to obtain health services in this situation. In 2018, OOP expenditures for health care services and products were for 50.79 percent of overall health expenditures. Over time, the OOP has seen changes. For instance, in 2006, OOP was 42.502 percent, then 63.53 percent in 2013, and finally 57.78 percent in 2017. The trend towards reducing out-of-pocket payments for health care is not encouraging.
Nepal has committed to reaching universal health coverage, but doing so without considerably cutting out-of-pocket healthcare costs will be a mammoth undertaking. In fact, Nepal does not appear to have made cutting OOP spending a primary priority. Target 3.7 of the Sustainable Development Goals aspires to achieve universal health coverage for all people, including financial risk protection, access to quality essential health care services, and access to safe, effective, high-quality, and affordable essential medicines and vaccinations. OOP is one of a number of indications for this goal. By 2030, the government wants to reduce OPP spending to 35%. OOP has been lowered to 45 percent in 2019, however as previously said, the trajectory of OOP reduction has not been very progressive over time, and setting a target of 35 percent by 2030 is insufficient to assist attain universal health care.
The Nepal Burden of Disease Report (2017) emphasizes the importance of reducing health-care dependency on direct OOP payment. Experts in the health field share similar sentiments. Affordable health care is crucial for them to attain UHC.
The federal, provincial, and municipal governments should all share responsibilities and resources for providing health care to the large majority of individuals who cannot afford it.
Expanding the coverage of health insurance plans, according to Dr. Krishna, could be one way to improve people’s access to health care, particularly for NCDs, which are the leading cause of death. Dr Suresh Tiwari, Country Director of Oxford Policy Management in Nepal, holds a similar viewpoint, claiming that excessive OOP payments put families at risk of catastrophic health costs and hardship. Despite various legal and institutional attempts, Nepal relies heavily on out-of-pocket payments from households to fund a major portion of health-care services and supplies, posing a barrier to universal health coverage.
The Nepalese government’s Social Health Insurance Scheme can help to reduce OOP. However, participation in this program is extremely limited. As of March 2021, 75% of the population of 1,430,000 have renewed their service. This figure is not encouraging, according to Dr. Tiwari, who believes that now is the time to critically examine where and why the government has been so unsuccessful in attracting individuals to this scheme.
Nepal’s health-care system is in desperate need of improvement. The pandemic of Covid-19 has heightened the importance of providing high-quality health care. Because federalism is still being institutionalized, it is critical to have shared responsibilities and a balanced allocation of resources in order to provide health-care services to the vast majority of people who cannot afford them. To achieve this, the country should set ambitious health goals, ensure that the health system is adequately prepared, and build suitable and effective mechanisms to implement policies at all levels, from the federal to the local.