सिंहदरबार संवाददाता
Kathmandu. A free health insurance campaign program has been launched for Dalits and the underprivileged in Ajirkot Rural Municipality of Gorkha. With the aim of bringing the entire Dalit and underprivileged community within the rural municipality under the ambit of health insurance, the necessary budget has been allocated through the municipality’s approved annual policy and program for the current fiscal year 2081/082.
“The municipality has launched a program to provide free health insurance to about seven hundred people to provide easy health care services to Dalit and underprivileged households who are far from access to health services,” said Deepak Devkota, chairman of the rural municipality. “So far, free health insurance has been completed in wards 1 and 2. We have focused more on the economically disadvantaged and those who do not have money for health care.” The rural municipality has launched the free health program in partnership with the Mutu Foundation and the Manoj Association France.
Like Ajirkot Rural Municipality, Roshi Rural Municipality of Kavrepalanchok has also provided free health insurance to 1,780 families. The rural municipality has provided free health insurance to local families aged 60 to 70 years. According to the rural municipality chairman Dinesh Lama, out of the 3,079 local families, 2,648 households have been provided free health insurance. Out of these, 54 completely disabled citizens have also been provided free insurance, while the government has provided 50 percent of the insurance to female volunteers from three families.
There is a legal and policy provision to provide free health to senior citizens, Dalits, poor and marginalized communities. As per the same policy provision, health programs have been implemented at local levels across the country, but the program has not yet been effectively operated at many local levels. Dalit rights activist Durga Sob feels that the health program has benefited only a few and that the poor, Dalit and marginalized communities have not been able to take advantage of it.
“There is no body to explain that the health program is like this, the target group has not received it,” he said, “The economic situation is not a priority for the weak, health is made for the poor.” According to the Health Insurance Board’s statistics as of Asoj 22, 2081, 667,965 individuals from the Dalit community and 218,234 families have taken out health insurance.
However, if we look at the renewal aspect, only 209,760 individuals have renewed, while 114,462 families have done so. According to the statistics, only 269,696 people have used health insurance. Dalit rights activist Bhakta Bishwakarma has found that health care is free for those with poverty identification cards, but Dalits, even though they are poor, are not getting it.
“The poor have received health care for those with identity cards, but the poor Dalits have not received that opportunity,” he said. “Although the law provides it to the target group, some states lack provisions and show it to one or two percent of the rich Dalits, Dalits have been deprived of that opportunity.”
In his experience, public awareness about health is very weak and even if they get health insurance in a fiscal year at the local level, the number of people who do not renew it due to lack of awareness is large. Bishwakarma informed that the Asia Dalit Rights Forum and Equal Justice Society Nepal are working on the situation of health insurance for Dalits and marginalized communities. He said that the service delivery by hospitals in the health program is not smooth, and the service is not available from health hospitals across the country, so the health insurance beneficiaries are not able to benefit as expected. The benefits of health insurance are not available from hospitals across the country, they have to be taken only from specific hospitals, and due to lack of education, the beneficiaries have not been able to benefit as per the provisions made by the law.
Manoj Poudel, Bagmati Province Coordinator of the Health Board, believes that the insurance program is effective in bringing the cost of health services to a level that families can afford and reducing financial risks. “Health insurance increases access to quality health services through risk management, direct involvement of individuals, communities and the government, advocacy for quality health services,” he said. “On the basis of social health insurance, ensuring health services for all, and providing additional financial protection for the general public by arranging for risk reduction.” Dr. Senendra Raj Upreti, former chairman of the Health Board, feels that a clear system should be implemented in the provision of health insurance that does not charge premiums or provides discounts to the poor and needy.
“The local level has also made arrangements to provide discounts or concessions in health insurance to the marginalized, Dalits, and some ethnic groups. Health has been provided to Dalits and marginalized in a legal and policy way,” he said. “For that, the government has not identified poverty in all districts. Until it is identified, implementation is difficult.” Poverty should be identified across the country for the target group to benefit from health.
“There is a legal system to provide relief according to the economic situation, there is also a system for the government to pay the entire amount to the very poor, poverty identification has not been done in all districts”, Dr. Upreti added, “For the first time, poor citizens were identified in 26 districts, and in those districts, poor citizens have been provided with full or half exemption from premium as per the rules.” The then Ministry of Poverty Alleviation had previously identified poverty in 26 districts. They have taken facilities based on that. “The target groups who come to benefit from health also say that they are poor and come with their identity cards knowing that they will get exemptions”, he said, recounting his experience, “They have received facilities on the basis of coming on their own, the study of the target groups has not been done effectively, the state needs to identify the economically weak.”
The government has not identified poverty and provided identity cards across the country. The wards have not even been able to provide poverty identity cards. Health insurance eliminates the need to seek loans for immediate treatment and also makes health treatment easier. The Health Act, 2074 has made very convenient arrangements. Under the prevailing law, individuals considered to be civil servants and families of workers going for foreign employment must be affiliated with the health program, and it will be the duty of their guardians and guardians to include newborns, children, senior citizens, disabled people and the infirm in the health program.
It is the duty of the manager of such institutions to include dependents in health programs. Article 35 of the Constitution of Nepal, under the Fundamental Rights, provides for the right to health. “Every citizen shall have the right to receive basic health services free of charge from the state and no one shall be deprived of emergency health services,” it states,
“Every person shall have the right to receive information regarding his or her health treatment, every citizen shall have the right to equal access to health services, every citizen shall have the right to access clean drinking water and sanitation.”
Article 42 In the field of social justice, citizens of economically disadvantaged and endangered communities shall have the right to special opportunities and benefits in education, health, housing, employment, food and social security for the protection, upliftment, empowerment and development.
Similarly, Article 43 states that under the right to social security, citizens of economically disadvantaged, disabled and helpless, helpless single women, people with disabilities, children, citizens who cannot take care of themselves and citizens of endangered races shall have the right to social security in accordance with the law. The National Health Policy, 2071 BS, states that a nationwide plan will be implemented by making financial management sustainable and ensuring the provision of accessible health services.
In addition, there is a provision to provide discounts to the incapacitated and economically disadvantaged. Citizens will be ensured access to quality health services as a fundamental right, and a program will be formulated and implemented on the basis of equity and social justice to ensure access to health services provided by the state for the poor, marginalized and at-risk communities. There is a provision to receive outpatient and emergency services, diagnostic services and 1,181 medicines during health care. Of these, 70 medicines and 25 Ayurvedic medicines are available. Glasses up to Rs. 1,000 and health-related assistive devices up to Rs. 5,000 are available.
According to the Health Board’s statistics, 482 health institutions have currently implemented the program across the country. The program is being operated in most government institutions. Mainly, issues such as the insured not receiving medicines and health services on time, being forced to wait in long lines to receive services, discrimination in services for patients who have and have not, and the lack of necessary documents when referring to large hospitals for further treatment from the first service point have not increased the trust of citizens in the program.
Looking at international practice, Germany implemented the social health program in 1883, and the national health insurance program was started in Britain in 1948. Initially, free health services were started for workers. In 1977, it was done in South Korea, focusing on industrial workers.
The Government of Nepal had implemented the health program in all 77 districts since Chaitra 16, 2077. The health program was implemented in all 77 districts through the Health Board formed in 2072 BS. The health program was launched in Taplejung, Dolakha, Bara, Sarlahi, Manang and Mustang on Chaitra 25, 2077 BS and was later implemented in Kathmandu and Lalitpur districts. According to the Health Board, 8.732 million 912 people have been enrolled in health insurance so far.
Minister for Health and Population Pradeep Poudel has presented the action plan related to health insurance reform to the Prime Minister. Based on the issues mentioned in the report of the Health Insurance Reform Suggestion Task Force, the action plan was prepared under the leadership of Additional Secretary of the Ministry, Dr. Dipendra Raman Singh. After receiving the report including the action plan prepared by the committee, Minister Poudel submitted the report to the Prime Minister on Tuesday.
## Minister Poudel’s secretariat has stated that a decision will be taken regarding health insurance reforms through a meeting of the Council of Ministers based on the action plan. Minister Poudel had said that preparations are being made to improve health insurance and increase it to 500,000. The report includes content that can reach the target of 500,000. If the Council of Ministers decides, Minister Poudel has prepared to move forward the process of amending the Health Insurance Act through the session of Parliament.
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