The Oli family had already borrowed a hundred thousand Nepalese rupees (around 800 Pounds) for the treatment of their daughter with epilepsy. They needed more to continue the treatment. Unable to get this money, the parents and the epileptic daughter committed suicide.

Health care has to be paid for by patients or their family in Nepal. Health insurance or government funding of free health care is virtually non-existent. Hence, health care is one of the prime reasons for indebtedness here.  We have all been reading about these statistics here in Nepal since our medical school days. But when once in a while, a family commits suicide or makes it into the news, the numbers and figures suddenly seem to have a different meaning.

I could not help thinking about how many times as doctors we have been told by patients that they cannot afford a particular test or treatment. It was almost an everyday experience during my training in a government owned teaching hospital. There was really not much most of us could do. There were funds for the poor but the administrative process to get these were often complicated and many a times, this would not be enough either.

I am sure cost considerations are a part of healthcare service delivery even in developed countries. But the gap in health services available for the rich and the poor in developed countries is not as big as in developing countries, is it? How often does a doctor in a developed country have to cancel an essential test because the patient cannot afford it? How often does he or she have to change the prescription because the patient cannot buy the drug of choice?

I have always liked the UK’s NHS for one simple reason: It covers all irrespective of their financial capabilities. The US is trying to establish a universal health care system as well. For us, living in developing countries, this still seems to be a farfetched idea. I cannot think of this happening during my lifetime. It is said that every country in the world has now signed at least one convention that recognizes right to health as a part of human rights. Where does the right to health stand in terms of an individual’s ability to afford healthcare? 

I always try to end my blogs on a positive note. But right now, I cannot think of anything optimistic to say for the Nepalese healthcare in this regard. No doubt, everyone in Nepal or elsewhere agrees in principle that healthcare should be available to all irrespective of their financial status. However, the economics of healthcare seems to strongly dominate the value of human ideologies.

Siddhartha Yadav is a former BMJ Clegg scholar.