Medicosnext
Dr. Sudha Sharma, MBBS, DGO, FRCOG, MPH, former Secretary of the Ministry of Health and Population, Nepal, is an obstetrician gynecologist and public health expert with major experiences in policy, governance, health systems, and quality of healthcare.
She is a Fellow of the Royal College of Obstetricians and Gynecologists, UK, and holds a master’s degree in Public Health. She is also past presidents of Nepal Medical Association, Nepal Society of Obstetricians and Gynecologists, South Asian Federation of Obstetricians and Gynecologists, and Chair of Education Committee of the Asia Oceana Federation of Obstetrics and Gynecology.
She has served as an advisor to various UN agencies, WHO, and international NGOs, and held important positions, including professor and director of Paropakar Maternity and Women’s Hospital, Kathmandu.
More recently, she served as Chief of Health and Nutrition at UNICEF Tanzania and Chair of the Development Partners Group and contributed in developing the health sector strategic plan, national nutrition strategy, “Big Results Now” initiative, and “Investment case for GFF”, among many others.
She is currently co-director of CIWEC Hospital and Travel Medicine Center and consultant for health policy and program areas.
You have a wealth of experience in the medical sector here, as a medical officer, as an educator, and as an administrator. Which role gave you the most satisfaction, and why?
To be honest, I have enjoyed each of these roles. As a medical officer, when I could save lives, the satisfaction was immediate. Many a times, I have choked with happy emotions, with a lump forming in my throat, or with watering in my eyes. As an educator, I have felt very proud when my students did well in the exams, and even now I feel rewarded when I see them doing good work. As an administrator, I could contribute on a much bigger scale and make a meaningful difference in the lives of people. For example, the Ama program scale-up in its current form, or the free treatment of uterine prolapse, or the one-stop crisis management center for gender-based violence, etc. are special areas where I feel very proud of my role as an administrative leader in the Ministry of Health and Population. Each of these is a very different role, but each comes with unique opportunities.
Keeping in mind your long tenure in this field, what do you think are the three major changes that have helped to enrich medicine in the country?
First, our strong foundation of public health continues to bring successes, second, the expansion of medical education in the country, and third, expansion of the private sector, with most super-specialty services and diagnostics. All of these are very important, but we have to be mindful of the quality of our programs, monitoring role of the government, and access to the poor and marginalized people. I see an urgent need to strengthen our efforts in these areas.
Likewise, where have we lagged or failed?
I think prioritization and lack of cost benefit analysis have been our weakest points in the public sector. Most decisions are made for the sake of popularity, without really considering whether they are serving the needs of the target population. For example, the social health insurance program is not attractive to the people because of many challenges, such as access, quality of services, unavailability of medicines, etc. Out of pocket spending in healthcare is reaching almost 60 percent. This puts poor and middle class households into great difficulties and creates long standing adverse consequences for them. Instead of each local, provincial, and federal government looking critically at what exists currently and tailoring responses to making services easily accessible to the local people through small reforms, we have chosen to build primary hospital at each local level with a blanket decision. I do not think that is a good approach, because it will divert scarce resources to constructing buildings, while the existing buildings remain non-functional due to lack of health workers, medicines, water, sanitation, and the like. This is just an example, but there are many more.
Do you believe that there is good coordination between the concerned government bodies and health professionals and organizations?
Unfortunately, no! So many demands of the health professionals are not taken seriously by the government. The health professionals are under-paid and over-worked. Due consideration has not been given to creating more positions in health facilities to serve the increasing population size. Again, some health professionals are not doing ethical practices. Government’s role to ensure checks and balances is not visible.
Likewise, do you think there is unnecessary interference from the government’s side?
I think, rather than interference, there is insufficient supportive supervision. Sometimes, multiple delays that happen at the administrative level cause problems to the health facilities and the private sector, which could be avoided.
Can you give your candid opinion on the prevalent situation concerning medical education in Nepal?
I am very happy to see the expansion of medical education in the country. But, I sincerely believe that we should be doing more in terms of enhancing its quality. I feel the ethics of medical practice is gradually eroding, most likely, because of the high cost of medical education. The government should have a holistic vision of the human resources (number and type) needed for the country and plan accordingly. The quality of medical education must continue to receive priority. I mean, on paper, our requirements for ensuring quality seem to be adequate, but in practice, there are huge shortfalls. Various bodies/ institutions have been established to oversee these issues, but I see huge gaps in the way they function.
Given the shortage of doctors in rural areas, how can we attract and retain new generation of doctors to these places which they think have poor working and living conditions and fewer opportunities?
When I was in MOHP, we had done a study to see what incentives health workers find attractive to serve in rural and remote areas. The first and foremost was scholarships for post graduate studies, then, the need for good schools for children, third was access to adequate equipment, diagnostic facilities, and teams. Others, but in lower priority, were financial rewards, internet and communication, improvement in living conditions, and security. The government needs to continue enhancing its efforts in these areas. I was actually pointing to such issues when I said I do not approve of the blanket decision to invest in new health buildings everywhere, rather, we should be tailoring our responses to improve the current working condition. We need to establish proper referral linkages, provide telemedicine, and opportunities for professional growth, so that young doctors can serve with full dedication, without having to worry for their safety and for their future.
Regarding the current COVID-19 pandemic, why do you think the death number is so high in a highly developed country like the United States, whereas in a least developing country like ours, there are very few deaths?
I think our population is much younger compared to the country that you have highlighted, and others. It is well known that deaths due to COVID -19 are higher in people with advanced age and having other health problems. We are seeing increasing number of deaths in older population in Nepal, too. In fact, we have already lost five doctors of advanced age. Therefore, we should not be complacent in our fight against COVID-19.
What, in your opinion, is the right way to look at the pandemic, and what do you think should be the future action concerning it?
“Safety first” should be our motto. Improving the current working conditions in public institutions, where a large number of people attend, must receive continued priority. Hospitals and health facilities also must ensure better and more rigorous infection prevention practices and avoid over- crowding. As citizens, we must continue to follow the practice of using masks, physical distancing, and hand sanitization. When vaccination becomes available, we must ensure that our vulnerable population gets adequate protection.
Finally, your first book has been released, who do you think will benefit the most from reading it?
The book is named Singha Darbarko Ghumne Mech. It has my experiences of a lifetime, from my childhood to the present. I hope all young health professionals and medical students will benefit from reading these experiences. In addition, I think anyone interested in the issues of gender and reforms in public administration will find it useful. This is my first attempt at writing a book. Many of my friends and a few other readers have given very positive feedback. I know medical professionals are very busy, but I do hope that more and more people will read it. Who knows, it might even inspire young people to tell their own stories?
