The pandemic has pushed Nepal’s healthcare system to the edge and private hospitals are facing this enormously difficult situation with all their available resources.
--BY TAMISH GIRI
Nepal Mediciti Hospital has so far (i.e. till September end) avoided its services from getting impacted by the Covid-19 pandemic as the hospital has been continuously providing all types of medical services to patients visiting there. However, footfall of patients has remained affected even after the lifting of the restrictions by the government.
Meanwhile, Norvic International Hospital has also been providing services to patients consistently during these trying times. However, the hospital is said to be facing difficulties as some doctors, nurses, housekeeping staff, and the security personnel working there have contracted Covid-19 despite the stringent health safety measures. Dr. RB Singh, executive director of Norvic Hospital, informs that the wards at Norvic have been repeatedly sealed off affecting patient care and management. “Protecting our staff so that they can deliver services efficiently has been a challenge to us in this situation,” he says.
Likewise, footfall at Grande International Hospital has dropped by 70 percent due to the surge in Covid-19 infections. “The Covid-19 pandemic has brought economic hardship to us. Difficulties in salary payments to staff, maintaining supplies and payments to creditors have caused operational issues. Servicing bank loans is also not looking possible for a long time due to the economic slump we are in,” says Dr. Chakra Raj Pandey, managing director of Grande International Hospital. Despite the hardships, the hospital has proactively provided services to patients and has supported its staff, according to Pandey.
The problems being faced by some of the biggest private hospitals show the severity of the impact of Covid-19 on the Nepali healthcare system. According to Dr Raj Rana, medical superintendent and orthopedic surgeon of Nepal Mediciti Hospital, the global health emergency has mounted challenges for the overall healthcare system. “During this turmoil, we are also required to focus on the safety of staff, as well as patients. We are following the protocols of the World Health Organization (WHO) to better deal with the threats,” he mentions.
The surge in Covid-19 cases has promoted most private hospitals to create separate facilities for the diagnosis and treatment of Covid-19 patients by deploying a separate workforce in order to stop the contagion. “We have desks to screen Covid-19 patients. Any suspect is sent to the ‘fever clinic’. But still, some people have caught the virus in the wards,” says Singh.
According to Dr Rana, Nepal Mediciti has been calling the staff of all its departments in a rotation arrangement so as to minimise the chances of infection inside the hospital.
The Covid-19 crisis has affected the treatment of other ailments. Due to the growing fears, less patients are coming to OPD follow-ups. In case patients need medical intervention promptly, hospital authorities have to wait for Covid reports. Some interventions like emergency surgeries, cardiac catheterizations, emergency deliveries, dialysis, urological procedures as well as close contact diagnostic procedures now depend on the results of Polymerase Chain Reaction (PCR) tests.
“Also, if the report of the admitted patient comes positive in the hospital wards, the risk of contracting Covid-19 from the infected patient escalates and this adds to the treatment of other patients awaiting emergency procedures also,” Dr Singh informs.
Facing uphill challenges, healthcare institutions are doing their best to provide medical services to Covid-19 patients. According to Dr Singh, Norvic has been providing all medical, surgical, gynecological and intensive care services to patients diagnosed with Covid-19. Likewise, Grande International Hospital has been providing ward and isolation care, and ICU treatment for Covid-19 patients. “We also provide ventilator care to patients who are in a critical condition,” Dr Pandey informs.
For ensuring the safety of patients and other people, the hospitals have devised flowcharts with a clear set of instructions which has proven instrumental in providing services during these distressful times. No staff with symptoms is allowed to work. Such staff are either quarantined at home or treated in the hospitals, the expense of which is totally borne by the hospital themselves.
Nevertheless, operators and top officials of private healthcare institutions say that the government has not paid attention to resolve the problems they’ve faced at a time when their role has become more important than ever. “So far the government has not provided support of any form to private hospitals and sadly, has not even made an effort to do so,” mentions Dr Rana.
“The private healthcare institutions are also big contributors to the public health. Their services of hospitals like Norvic are known for prompt responses, efficiency, and satisfaction to the patients. We are also fighting with the pandemic in an attempt to help the government in every way possible to achieve a higher degree of public healthcare,” Dr Singh opines.
Absence of private sector friendly Covid-19 management guidelines, lack of facilities, equipment and workforce are some of the major obstructions for private healthcare institutions to ensure that they provide services without obstructions. The government is yet to take any concrete steps in providing support to private healthcare institutions in these key areas, stakeholders say. “The government should do a round table discussion with the private hospitals and build a consensus. PCR testing need to be made easy and our problems should be identified and addressed so that we face less hurdles in providing services,” says Singh.
Rana suggests the government to start a proper discussion with healthcare workers to find ways to tackle the difficulties. “An environment of trust and confidence between the government and private healthcare institutions is necessary to overcome this public health crisis. All hospital workers are ready, but proper ways to do things are lacking,” he adds.
Dr Pandey is of the view that it has become urgent for the government and private healthcare institutions to come together and find ways to minimise further problems. “I was told that the government is not able to support healthcare institutions due to the scarcity of funds. The situation is transforming into a system failure as the supply chain is broken and everything has become expensive. This is the first time in the history of healthcare in Nepal that patients are so afraid to come to the hospital. If the source of revenue is already scarce, the question is how much the government can do,” opines Dr Pandey.
According to doctors and hospital administrators, the government should come up with policies to motivate and incentivize frontline medical staff of both private and public healthcare institutions so that they are encouraged to work during this crisis. Likewise, setting up separate treatment facilities for Covid-19 patients, allowing the private sector to set up more diagnostic centres for PCR tests and making Covid-19 testing widespread will be important to fight against coronavirus, they say.
In the meantime, it has also become important to resolve the issue of PCR test pricing. Currently, the government and private healthcare institutions are at loggerheads over the rate of Covid-19 testing. The Ministry of Health has instructed private hospitals to bring down the per person charge of PCR test to Rs 2,000 from Rs 4,000, which the hospitals have rejected claiming the price will be too low to even raise the cost. “The cost of PCR should be minimal, or it should be free. If they fix a price and ask private institutions to invest, they should stick to that price. There is approximately Rs 3-4 million investments for infrastructure, the machine costs Rs 15 million, and then there are costs associated to buying reagents, consumables and staff expenses,” says Dr Pandey, adding, “I think if we become honest, everything is simple and workable. The Ministry of Health and Population should do enough homework before making decisions. The government should never think the investment part is only the problem of the private sector. Both sides need to come together to deliver sustainable healthcare to the citizens.”
Dr Singh suggests the government to gather opinions of all the stakeholders to identify the constraints in order to reach a consensus regarding the PCR test pricing.
Dr Rana of Nepal Mediciti stresses that this is no time to engage in conflicts when the country is facing a pandemic. “The government needs to understand that private hospitals are also serving the country and the people. We just need necessary support so that things can be done smoothly,” he says.