‘Role of Ministry of Health should be clear’: Dr Sushil Baral’s views on forthcoming Public Health Act in Nepal

This is the translated version of the article published recently in Swasthya Khabar Patrika – the most read health magazine in Nepal.

The Public Health Act needs to be explicit in some areas. The devolution of authority needs to be well described in the Act. It should also clearly draw the specific roles of the government, non-government and public health actors. If their roles and scope are not clearly defined, the Act is deemed to be incomplete. Acts are required to institutionalise good practices and ensure effective monitoring and supervision mechanisms to regulate the health bodies. Many good Acts have been introduced in Nepal. However, due to unclear institutional structures, roles and scope, many such Acts have been ineffective. Proper distribution of responsibilities along with provisions for punishment – penalties for failing to fulfill the responsibilities should be included in our Acts.

The Ministry of Health (MoH) should also be well aware of its roles. MoH cannot mobilise the police and perform the functions like that of the Home Ministry nor can mobilise the army as does the Defense Ministry. The scope of MoH is to identify the individuals/groups who are not sensible on public health related matters. However, it cannot punish such individuals/groups. MoH was involved in developing the Tobacco Control Act and in raising awareness about the Act. Conversely, if this Act is violated, then MoH has no jurisdiction on punishing the violators. Other agencies have the authority to penalise the violators. Currently, the District Administration Office and the Police is authorised to oversee if there is any violation of the Act. The responsibility to oversee the effective implementation of the Tobacco Control Act needs to fall under MoH, which should be stated in the Act.

The MoH is also a service provider by itself as hospitals and other health facilities operate under it. The service provider cannot itself monitor and assure the quality of the services it provides. That should be carried out by an autonomous body. That autonomous body needs to define the standards and technical criteria for providing any services of quality. Therefore, the roles of the MoH bodies should not be overlapped.

Snapshot of the article published in Swasthya Khabar Patrika.

In many countries, after development of the Act, the provisions under the Act are described in two ways. Firstly, the content within the Act is defined and then the structures provisioned by the Act are elaborated.  What is written in the Act is one aspect while what sorts of structures and mechanisms are in place for its effective implementation is another aspect. In our context, we seem to have more debates on the content rather than building structures and mechanisms for effective implementation. In this sense, in the forthcoming Public Health Act, structures and mechanisms should be in place for the provisions made in the Act so as to showcase a good example of its effective implementation.