From the records of technical and community schools, colleges of CTEVT, public and private campuses of TU (Tribhuvan University), PU (Pokhara University), KU (Kathmandu University), BPKIHS (BP Koirala Institute of Health Sciences), PAHS (Patan Academy of Health Sciences), Nepal Sanskrit University and other institutions across the country, it is calculated that all these institutions are capable of producing 21 thousand one hundred and eleven health workers per annum in total. Similarly, it is recorded that around 33 thousand and eighteen health cadres are trained under different health service delivery training per annum. Are these number of health workers adequate for the country mothering 26.6 million people?
Where the 18 registered institutions of the country have the capacity of producing 1,760 MBBS doctors, 101-registered institution has the capacity of producing 4,017 nurses per annum. Similarly, 48 registered institutions hold the capacity of producing 1,910 ANM (Auxiliary Nurse Midwife) per annum. Does this number proportionate the demand of health service from 26.6 million populations living across the country?
WHO (World Health Organization) defines health workers as ‘all people whose main activities are aimed at enhancing health and who provide health services such as doctors, nurses, laboratory technicians, pharmacists and the people who are managing and playing a supportive role for health service providers such as health managers, financial officers, cooks, drivers, cleaners etc’. The World Health Organization has identified Nepal as one of 57 nations with a critical shortage of health workers that creates a huge deficit in the requirements to meet the health related Millennium Development Goals.
Experts from different government bodies, diplomatic missions, I/NGOs, CBOs and media concentrated, shared the findings of their research works and discussed in all the aspects surrounding the concern of HRH production and its skill mixed distribution, and participation of civil society for the improvement of the situation during the national conference on HRH (Human Resources for Health) which was organized at Regal Hall, Hotel Yak and Yeti on 13th and 14th June. The event was supported by partners including Save the Children, The Britian Nepal Medical Trust, Merlin Nepal, AIN, Family Planning Association of Nepal and others.
Since 1991, the population of the country has recorded an increase by 35 per cent compared to the increase in public workforce that has increased only by 3 per cent during the same period. According to the Nepal Health Sector Programme-Implementation Plan II (NHSP-IP, 2010-2015), approximately 25 per cent of the total health workforce is unskilled. Dr Mingmar Sherpa, Director General at Department of Health Services said, ‘the number of health institutions have increased but the production is low and we cannot remain like this because the demand has now increased’. He added, ‘the need of experienced doctors is important in rural areas than in urban because the urban population now has many alternatives than their rural counterparts.’
The motivation level of the health workers are low due to low remuneration, lack of institutional recognition, limited opportunity for career development, dominance from political parties, poor working environment, poor infrastructure, lack of security and frequent transfer. Dr. Alexander Spachis, Ambassador of European Union Delegation to Nepal said, ‘being optimistic, Nepal is going in the right direction as shown by the achievement in bringing the maternal mortality rate from 539 deaths per 100,000 live births in 1996 A.D. to 281 but the country has to concentrate on retaining its health workforce by increasing their salaries and searching other ways to motivate them to achieve further health related goals.’
Health Secretary at MoHP (Ministry of Health and Population), Dr Praveen Mishra said, ‘the country has 25% of population under the poverty line and if their demand is not addressed intelligently, their out of pocket expenses will increase resulting in increasing the poor population.’ He added, ‘the current disease pattern is different than that of 20 years ago and to address this, the government alone cannot function well and thus, partnership with private sector is important to improve HRH situation which is the major pillar of health strengthening system.’