A holistic approach to redefining Nepal's health-care system
Authors: Vinita Sharma, Miguel Reina Ortiz
Journal: The Lancet Global Health (2019)

In their Comment in The Lancet Global Health (September, 2018), Jigyasa Sharma and colleagues1Sharma J Aryal A Thapa GK Envisioning a high-quality health system in Nepal: if not now, when?.Lancet Glob Health. 2018; 6: e1146-e1148Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar clearly identified the need to strengthen the Nepalese health system and articulated the opportunities that arise from the adoption of federalism in the country. Whenever quality of care is discussed, however, the conversation seems heavily focused on curative care—a common but unfortunate occurrence that does not correspond to the historical and contextual reality of Nepal's health system. Addressing quality in all aspects of health care, including preventive care, is long overdue. The integration of preventive, promotive, and rehabilitative aspects (hereafter called preventive dimensions) of health care have been largely ignored in the current model of care in Nepal and in the steps proposed by Sharma and colleagues1Sharma J Aryal A Thapa GK Envisioning a high-quality health system in Nepal: if not now, when?.Lancet Glob Health. 2018; 6: e1146-e1148Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar to achieve the goals of The Lancet Global Health Commission on High-Quality Health Systems.2Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (1007) Google Scholar Nepal cannot afford to miss the unique opportunity of this transitional period to redefine its health-care system and to effectively abandon inefficient practices focused on specific diseases and curative care only. Notably, certain existing vertical programmes, like Nepal's child health programme,3Government of NepalMinistry of HealthDepartment of Health ServicesAnnual report Department of Health Services 2072/73 (2015/2016).http://dohs.gov.np/wp-content/uploads/2017/06/DoHS_Annual_Report_2072_73.pdfDate: 2017Date accessed: September 10, 2018Google Scholar have been successful in incorporating the preventive dimensions into the delivery of health care. By contrast, the care offered for other health issues such as mental health has not yet included these dimensions but urgently needs to. Policymakers, responsible authorities, and advocates need to consider the entire continuum of care when they redesign the Nepalese health-care system. Particularly, authorities should learn from their past successes, such as Nepal's Safe Motherhood Programme which addresses the entire continuum of care, while incorporating new approaches, such as adopting an all-level affordable focus on quality, especially for preventive and curative services. This approach would also be a robust way of addressing "people-centredness",1Sharma J Aryal A Thapa GK Envisioning a high-quality health system in Nepal: if not now, when?.Lancet Glob Health. 2018; 6: e1146-e1148Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar which the authors have rightly acknowledged as an important component to ensure a high-quality health system. Additionally, bringing preventive dimensions to the forefront of discussion would help to tackle the increasing burden of non-communicable diseases, injuries, and mental health in the country.4Sharma SR Page R Matheson A Lambrick D Faulkner J Mishra SR Non-communicable disease prevention in Nepal: systemic challenges and future directions.Glob Health Promot. 2017; (published online Sept 1.)DOI:10.1177/1757975917720800Crossref PubMed Scopus (16) Google Scholar Of equal importance, Nepal needs to capitalise on its existing strengths, such as diversity and tolerance, and to positively engage traditional, indigenous, and alternative health services that, if unregulated, might endanger patients.5WHOGuidelines on developing consumer information on proper use of traditional, complementary, and alternative medicine. World Health Organization, Geneva2004Google Scholar Finally, an effort should be made to address current threats such as forged medical degrees and counterfeit medicines. Nepal is transitioning into a federal order and is trying to identify roles and functions for its Federal and Provincial governments in different competencies, including health care. Unless Nepalese society takes a comprehensive look at health care, one that includes preventive, promotive, and rehabilitative services along with curative services, it might not efficiently capitalise on the political drive for change to create a healthier and more productive Nepal. Both authors contributed equally to this work. We declare no competing interests. Envisioning a high-quality health system in Nepal: if not now, when?Nepal was one of the nine national Commissions that participated in The Lancet Global Health Commission on high-quality health systems in the Sustainable Development Goal (SDGs) era.1 which brought the widely acknowledged, yet insufficiently addressed, problem of systemic quality deficits in health systems to the forefront of the global health discourse.1 The HQSS Commission calls upon countries to make three interconnected commitments to reach the SDG goal of 'health for all by 2025'. Countries are asked to first, invest in health systems that enhance health; second, to provide services valued by people; and third, to remain accountable for delivering high-quality care. Full-Text PDF Open Access