There’s a reason the Sudurpaschim Province is called the “far-west” – it’s really far. It’s hilly districts, especially beyond Dadeldhura are remote, and disconnected from the centre. Villages en route the highway to Chainpur, Bajhang till date retain their age-old charm and evoke a sense of timelessness. That was probably why I was surprised to see a modern building after a twelve-hour long journey from Dhangadi. That building, one of the biggest in the district was none other than the District Hospital.
In big, bold letters, it said, Bajhang District Hospital, Provincial Government, Sudurpaschim Province – Ministry of Social Development – Health Directorate.
Bajhang District Hospital, upgraded in 2021, boasts a wide range of services from a blood bank, a maternity unit to a Neonatal Intensive Care Unit and a 24-hour Emergency Services wing. According to Ganga Prasad Joshi, Information Officer at the district hospital, the hospital is supported by three specialized doctors (a gynecologist, an orthopedic surgeon, and a general surgeon) along with five medical officers. In the last fiscal year, more than 27,000 people visited the facility to seek healthcare, and the hospital also delivered 639 babies safely in the same time period.
The hospital’s upgradation has come as a respite for the residents of Bajhang, who would otherwise have to make long and expensive journeys to Dadeldhura (or beyond) in pursuit of healthcare. A few challenges remain, for example, the community eye centre which is operated by Geta Eye Hospital is serviced by a single ophthalmic assistant. According to Khadak Bhatta (OA), an estimated 300 people arrive at the centre complaining of eye-health related problems every month. The number one problem pertains to refractive errors which the eye centre is able to correct through prescription glasses. The second one is cataract blindness. Due to the lack of an ophthalmic surgeon, or equipment, Bhatta sadly has to either suggest the patient go to Dhangadi for surgery or wait for a scheduled outreach camp.
Improvements in healthcare services could also be seen beyond the district headquarter. For example, Masta Rural Municipality boasts of a health post in four of its wards, and community health centres in the remaining three. The health posts focus on providing basic healthcare while concentrating on child and maternal health. They also conduct regular screenings for tuberculosis and leprosy.
According to Devi Chandra Thapa, Health Coordinator at the Masta Rural Municipality, home births, and its associated risks have significantly reduced in the region in the past ten years. Most health posts are equipped with birthing facilities, and in the last fiscal year, the seven basic facilities delivered 198 babies. When asked of the challenges, he states that road access is a major challenge as the municipality’s ambulance is unable to connect mothers or other patients with the health posts.
Seeing such improvements in the forgotten, far-western region of Nepal, I am reminded of a circulating narrative – that the provincial government is an added expense to state coffers. More so today, as the central government yet again hangs by a thread, and could topple anytime, while provincial and local governments have shown more political stability than the central government. The narrative has been further compounded by emerging leaders such as KMC Mayor Balen Shah or Rabi Lamichhane of the new party Rastriya Swatantra Party who boycotted the provincial elections because they believe a federal and local government is sufficient for Nepal – which is worrisome because the new generation of leaders seem urban-centric. The subsequent lack of focus on rural development could thwart development progress in the country unless emerging leaders also stress developing rural communities.
Sitting in Bajhang, I also wondered if a municipality such as Jaya Prithvi Municipality would ever have the budget to upgrade or operate a hospital of this magnitude, therefore the local government making such changes is out of the question. I further wondered if the need for a hospital in Bajhang would ever cross the minds of the officials at the central government’s Ministry of Health.
According to a report by Nepal Check, Nepal adopted federalism as a solution to reducing regional inequality and development disparities. The same report also suggests that federalism has aided service delivery in the country, particularly in education and healthcare. “Provincial and local governments have created innovative programs to serve people – something the federal government has failed to do,” the report reads.
This has been proven true in Bajhang as well. During Covid-19, Bajhang District Hospital ran an 85-bed facility, including an isolation ward. In the past fiscal year, 27,000 people received quality healthcare at the hospital. Then, how can we say that the provincial government is not working, or defunct?
Surely data of 27,000 people from a population of 189,097 people, who received quality healthcare without having to embark on long journeys states otherwise.