Emergency units at all hospitals in South Korea except for one, on Thursday (Feb 22) were on red alert as more than 8,000 trainee doctors continued their protest against the government’s proposed reforms to boost the country’s healthcare sector. The doctors have argued that Seoul needs to address existing issues before increasing the number of physicians.&nbsp;

<h2>‘Red alert’ in South Korea’s hospitals</h2>

As of Thursday, more than 8,400 doctors have joined the walkout – about 64 per cent of the entire resident and intern doctors in the country, reported Reuters citing the health ministry.&nbsp;

Around 300 doctors also took to the streets in the capital city of Seoul near the presidential office to call on the government to scrap its plan.&nbsp;

WATCH |&nbsp;Why are South Korean trainee doctors on strike?

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The protests continued a day after South Korea’s government officially ordered thousands of striking doctors to get back to work immediately or face legal action. The walkouts left general hospitals, which heavily rely on trainees for emergency operations and surgeries, paralysed.&nbsp;

Around two-thirds of the country’s young doctors have joined the protests since they began earlier this week, raising fears of further disruptions to the medical system if the dispute over the reforms drags on.&nbsp;

<h2>About the proposed reforms</h2>

The government citing the low number of doctors and the country’s rapidly ageing society proposed several reforms in one of the largest shake-ups to South Korea’s medical training system.

The proposed reforms, announced earlier this month, would raise the number of students admitted to medical schools by 2,000 in the academic year 2025.&nbsp;

The government has sought to fill an expected shortfall of 15,000 doctors projected by 2035, said the health ministry, given that the ageing population would raise the demand for medical services in the future.&nbsp;

Since the medical community is also ageing, more doctors are expected to retire in the upcoming years, said the health ministry.

South Korea, with 2.6 doctors per 1,000 people, is ranked among the lowest in developed countries for its doctor-to-patient ratio, according to data from the Organisation of Economic Cooperation and Development (OECD).

The government’s plan has also sought to increase investment and lift pay for doctors in regional and rural areas to maintain healthcare in those regions.&nbsp;

Also Read |&nbsp;<a href="https://www.wionews.com/world/south-korean-trainee-doctors-stop-work-to-protest-medical-reforms-692126">South Korean trainee doctors stop work to protest medical reforms</a>

The government has raised the fees for doctors in paediatrics, obstetrics and emergency medicine since last year, said South Korea’s Prime Minister Han Duck-soo. Seoul also plans to inject over $7.48 billion to further boost these fees.&nbsp;

Specialist doctors in South Korea, as per OECD, are some of the highest paid among developed countries, as opposed to the general practitioners who are comparatively paid less.&nbsp;

South Korea faces a shortage of specialists in certain key areas, such as paediatrics and cardiology, which has been attributed to misplaced financial incentives, national health insurance, and the risk of medical lawsuits.

Seoul has acknowledged that doctors in essential services are often subject to malpractice suits and prosecution and plans to introduce new legislation to expand legal protection for doctors.&nbsp;

<h2>What have the doctors said?</h2>

The doctors have said that universities aren’t ready to offer quality education to that many students, as the government has sought to bring the total to 5,000 students, as per its plan.&nbsp;

The 2,000 additional admissions “is a nonsensical figure,” said the Korea Interns and Residents Association, the body leading the strike, and called the plan a political ploy ahead of a general election in April.&nbsp;

The Korea Medical Association, which represents 140,000 doctors, said it supports the trainee doctors’ walkouts, but is yet to decide if they will join them.&nbsp;

As of Tuesday night, about 8,820 out of the country’s 13,000 trainee doctors have submitted resignations to their hospitals, but none of them have been accepted. Around 7,813 of the doctors have walked off, Vice Health Minister Park Min-soo told reporters&nbsp;on Wednesday.&nbsp;

South Korea’s medical community argues that there are already sufficient numbers of doctors saying that the real issue is the pay and working conditions.

The medical interns and resident doctors say they are underpaid and overworked and their protests show the flaws in the system. Trainee doctors typically work 80 to 100 hours, five days a week, supporting senior doctors during surgeries and dealing with inpatients.&nbsp;

They say more senior staff needs to be hired to address this issue and not increase the number of trainees.&nbsp;

Young doctors are also concerned that increasing the number of medical students would lead to more competition in the already cut-throat sector,&nbsp;a view which is not particularly popular.&nbsp;

“Opposing the expansion of medical school admissions to ensure greater profitability by reducing competition when they establish their own practices in the future is unlikely to garner public support,” Kim Jae-heon, head of an NGO advocating free medical care told AFP.&nbsp;

<h2>Government issues back-to-work order</h2>

The government, on Wednesday (Feb 21) issued the back-to-work and accused trainee doctors of putting their rights before the lives of patients. “A collective action taking the lives and safety of the people hostage cannot be justified for whatever reason,” said Safety Minister Lee Sang-min.&nbsp;

Also Read |&nbsp;<a href="https://www.wionews.com/world/south-korea-orders-striking-doctors-back-to-work-as-emergency-units-turn-away-patients-692497">South Korea orders striking doctors back to work as emergency units turn away patients</a>

Seoul’s medical law allows the government to issue such back-to-work orders if there are grave concerns about public health. If not abided by, striking doctors can face up to three years in prison, $22,480 in fines, and punishment that could lead to them losing their medical licence.&nbsp;

“Everyone is angry and frustrated, so we are all leaving hospitals,” said Park Dan, head of the Korea Interns and Residents Association, adding that he was willing to be arrested if their demands were not heard.

<h2>Impact on hospitals and patients</h2>

The biggest hospitals across South Korea were forced to cancel operations and turn away patients who sought emergency care.&nbsp;

Five major hospitals in the country have cut surgeries by up to 50 per cent to deal with the stoppage of operations, reported news agency Yonhap citing industry sources.&nbsp;

Cancer patients and pregnant women needing C-sections have seen procedures cancelled or delayed, as per local media reports.

Social media and online communities were flooded with posts about people receiving phone calls about delays and cancellations.&nbsp;

“I’m really angry at both the government and the hospital,” wrote a patient with breast cancer whose operation was postponed indefinitely, as per AFP.&nbsp;

She added, “I hate both the government that created this situation and the doctors who pretend not to know that no cause is more important than their patients.”

A poll by Gallup Korea showed that most South Koreans (76 per cent) are in favour of the reforms&nbsp;amid concerns about an acute shortage of doctors for paediatrics, emergency units and clinics outside the greater Seoul area.&nbsp;

(With inputs from agencies) 
&nbsp;

Emergency units at all hospitals in South Korea except for one, on Thursday (Feb 22) were on red alert as more than 8,000 trainee doctors continued their protest against the government’s proposed reforms to boost the country’s healthcare sector.

Emergency units at all hospitals in South Korea except for one, on Thursday (Feb 22) were on red alert as more than 8,000 trainee doctors continued their protest against the government’s proposed reforms to boost the country’s healthcare sector. The doctors have argued that Seoul needs to address existing issues before increasing the number of physicians. ‘Red alert’ in South Korea’s hospitals As of Thursday, more than 8,400 doctors have joined the walkout – about 64 per cent of the entire resident and intern doctors in the country, reported Reuters citing the health ministry. Around 300 doctors also took to the streets in the capital city of Seoul near the presidential office to call on the government to scrap its plan. WATCH | Why are South Korean trainee doctors on strike? The protests continued a day after South Korea’s government officially ordered thousands of striking doctors to get back to work immediately or face legal action. The walkouts left general hospitals, which heavily rely on trainees for emergency operations and surgeries, paralysed. Around two-thirds of the country’s young doctors have joined the protests since they began earlier this week, raising fears of further disruptions to the medical system if the dispute over the reforms drags on. About the proposed reforms The government citing the low number of doctors and the country’s rapidly ageing society proposed several reforms in one of the largest shake-ups to South Korea’s medical training system. The proposed reforms, announced earlier this month, would raise the number of students admitted to medical schools by 2,000 in the academic year 2025. The government has sought to fill an expected shortfall of 15,000 doctors projected by 2035, said the health ministry, given that the ageing population would raise the demand for medical services in the future. Since the medical community is also ageing, more doctors are expected to retire in the upcoming years, said the health ministry. South Korea, with 2.6 doctors per 1,000 people, is ranked among the lowest in developed countries for its doctor-to-patient ratio, according to data from the Organisation of Economic Cooperation and Development (OECD). The government’s plan has also sought to increase investment and lift pay for doctors in regional and rural areas to maintain healthcare in those regions. Also Read | South Korean trainee doctors stop work to protest medical reforms The government has raised the fees for doctors in paediatrics, obstetrics and emergency medicine since last year, said South Korea’s Prime Minister Han Duck-soo. Seoul also plans to inject over $7.48 billion to further boost these fees. Specialist doctors in South Korea, as per OECD, are some of the highest paid among developed countries, as opposed to the general practitioners who are comparatively paid less. South Korea faces a shortage of specialists in certain key areas, such as paediatrics and cardiology, which has been attributed to misplaced financial incentives, national health insurance, and the risk of medical lawsuits. Seoul has acknowledged that doctors in essential services are often subject to malpractice suits and prosecution and plans to introduce new legislation to expand legal protection for doctors. What have the doctors said? The doctors have said that universities aren’t ready to offer quality education to that many students, as the government has sought to bring the total to 5,000 students, as per its plan. The 2,000 additional admissions “is a nonsensical figure,” said the Korea Interns and Residents Association, the body leading the strike, and called the plan a political ploy ahead of a general election in April. The Korea Medical Association, which represents 140,000 doctors, said it supports the trainee doctors’ walkouts, but is yet to decide if they will join them. As of Tuesday night, about 8,820 out of the country’s 13,000 trainee doctors have submitted resignations to their hospitals, but none of them have been accepted. Around 7,813 of the doctors have walked off, Vice Health Minister Park Min-soo told reporters on Wednesday. South Korea’s medical community argues that there are already sufficient numbers of doctors saying that the real issue is the pay and working conditions. The medical interns and resident doctors say they are underpaid and overworked and their protests show the flaws in the system. Trainee doctors typically work 80 to 100 hours, five days a week, supporting senior doctors during surgeries and dealing with inpatients. They say more senior staff needs to be hired to address this issue and not increase the number of trainees. Young doctors are also concerned that increasing the number of medical students would lead to more competition in the already cut-throat sector, a view which is not particularly popular. “Opposing the expansion of medical school admissions to ensure greater profitability by reducing competition when they establish their own practices in the future is unlikely to garner public support,” Kim Jae-heon, head of an NGO advocating free medical care told AFP. Government issues back-to-work order The government, on Wednesday (Feb 21) issued the back-to-work and accused trainee doctors of putting their rights before the lives of patients. “A collective action taking the lives and safety of the people hostage cannot be justified for whatever reason,” said Safety Minister Lee Sang-min. Also Read | South Korea orders striking doctors back to work as emergency units turn away patients Seoul’s medical law allows the government to issue such back-to-work orders if there are grave concerns about public health. If not abided by, striking doctors can face up to three years in prison, $22,480 in fines, and punishment that could lead to them losing their medical licence. “Everyone is angry and frustrated, so we are all leaving hospitals,” said Park Dan, head of the Korea Interns and Residents Association, adding that he was willing to be arrested if their demands were not heard. Impact on hospitals and patients The biggest hospitals across South Korea were forced to cancel operations and turn away patients who sought emergency care. Five major hospitals in the country have cut surgeries by up to 50 per cent to deal with the stoppage of operations, reported news agency Yonhap citing industry sources. Cancer patients and pregnant women needing C-sections have seen procedures cancelled or delayed, as per local media reports. Social media and online communities were flooded with posts about people receiving phone calls about delays and cancellations. “I’m really angry at both the government and the hospital,” wrote a patient with breast cancer whose operation was postponed indefinitely, as per AFP. She added, “I hate both the government that created this situation and the doctors who pretend not to know that no cause is more important than their patients.” A poll by Gallup Korea showed that most South Koreans (76 per cent) are in favour of the reforms amid concerns about an acute shortage of doctors for paediatrics, emergency units and clinics outside the greater Seoul area. (With inputs from agencies)

Explained: Proposed reforms that have led South Korea’s doctors to walk out

According to health and human services, at least 15 million Americans could lose access to their health care coverage as various states in America start checking everyone's eligibility for the first time in three years.

Who is eligible for Medicaid? | 83 million Americans on Medicaid program

As India is just a few days away from the Union Budget, one question that is doing rounds is if the health sector will receive a boost after being tampered by the ongoing pandemic.&nbsp;

An Assocham survey states that the healthcare sector is likely to receive the highest priority in the upcoming budget. Apart from this, MSMEs, energy and infrastructure and technology were also on the priority list.&nbsp;

While health workers played a significant role in fighting the pandemic, the consequences have not been so good as it brought gaps in the public healthcare system.&nbsp;

<a href="https://www.wionews.com/business-economy/indias-budget-2022-important-terms-you-should-know-448628">Also read |&nbsp;India's Budget 2022: Important terms you should know</a>

Nearly 40 per cent of respondents of the survey also noted that Finance Minister Nirmala Sitharaman should reduce the income tax. This will help in boosting private demand and consumption, they believe.&nbsp;

The Finance Minister will be submitting the country's annual financial statement for the year 2022 on February 1. Article 112 of the Indian Constitution states that the Union Budget is a declaration of the government's expected receipts and expenditures for that particular year. It is presented in two parts: the railway budget and the main budget.

The budget session of Parliament will be held in two parts. The first part will be held from January 31 to February 11 and the second part will be held from March 14 to April 8.

(With inputs from agencies)

As India is just a few days away from the Union Budget, one question that is doing rounds is if the health sector will receive a boost after being tampered by the ongoing pandemic.

As India is just a few days away from the Union Budget, one question that is doing rounds is if the health sector will receive a boost after being tampered by the ongoing pandemic. An Assocham survey states that the healthcare sector is likely to receive the highest priority in the upcoming budget. Apart from this, MSMEs, energy and infrastructure and technology were also on the priority list. While health workers played a significant role in fighting the pandemic, the consequences have not been so good as it brought gaps in the public healthcare system. Also read | India's Budget 2022: Important terms you should know Nearly 40 per cent of respondents of the survey also noted that Finance Minister Nirmala Sitharaman should reduce the income tax. This will help in boosting private demand and consumption, they believe. The Finance Minister will be submitting the country's annual financial statement for the year 2022 on February 1. Article 112 of the Indian Constitution states that the Union Budget is a declaration of the government's expected receipts and expenditures for that particular year. It is presented in two parts: the railway budget and the main budget. The budget session of Parliament will be held in two parts. The first part will be held from January 31 to February 11 and the second part will be held from March 14 to April 8. (With inputs from agencies)

Union Budget 2022: Will the healthcare sector see a boost after being tampered by the pandemic?

The ongoing Covid-19 pandemic has had a series of consequences for the entire world, one of them being, extreme poverty. New research compiled by the World Health Organisation and the World Bank shows how this pandemic is going to put a pause on two decades of global progress towards Universal Health Coverage. Both the organisations have further revealed that the pandemic has pushed over half a billion people into extreme poverty. This is because they have to spend hefty amounts on health services.

Launched on Universal Health Coverage Day, the report further highlights how the pandemic has also triggered the worst economic crisis since the 1930s.&nbsp;

Dr Tedros Adhanom Ghebreyesus, WHO Director-General said, “There is no time to spare."

“All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.”

The report further talks about how in 2020, the pandemic completely disrupted health services. As a result of this, immunisation coverage dropped for the first time in ten years.&nbsp;

<a href="https://www.wionews.com/world/omicron-south-african-president-cyril-ramaphosa-tests-positive-for-covid-19-isolates-himself-436376">Also read |&nbsp;Omicron: South African President Cyril Ramaphosa tests positive for COVID-19, isolates himself</a>

There was also a surge in deaths from TB and malaria.

“Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage," says Tedros in an official press release by WHO.&nbsp;

Prior to the pandemic, in 2019, 68 per cent of the world’s population was covered by essential health services - treatment for diseases like HIV, TB and malaria, services to diagnose and treat noncommunicable diseases including cancer, heart conditions, and diabetes. However, there was no progress made in ensuring affordability.&nbsp;

This is why people living in the poorest areas are the last ones to obtain health care services.&nbsp;

Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank, in an official release by WHO said, "Even before the Covid-19 pandemic struck, almost 1 billion people were spending more than 10 per cent of their household budget on health."

He further highlighted how this is completely unacceptable. He said, "This is not acceptable, especially since the poorest people are hit hardest. Within a constrained fiscal space, governments will have to make tough choices to protect and increase health budgets."&nbsp;

(With inputs from agencies)

The ongoing Covid-19 pandemic has had a series of consequences for the entire world, one of them being, extreme poverty. New research compiled by the World Health Organisation and the World Bank shows how this pandemic is going to put a pause on two decades of global progress towards Universal Health Coverage.

The ongoing Covid-19 pandemic has had a series of consequences for the entire world, one of them being, extreme poverty. New research compiled by the World Health Organisation and the World Bank shows how this pandemic is going to put a pause on two decades of global progress towards Universal Health Coverage. Both the organisations have further revealed that the pandemic has pushed over half a billion people into extreme poverty. This is because they have to spend hefty amounts on health services. Launched on Universal Health Coverage Day, the report further highlights how the pandemic has also triggered the worst economic crisis since the 1930s. Dr Tedros Adhanom Ghebreyesus, WHO Director-General said, “There is no time to spare." “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.” The report further talks about how in 2020, the pandemic completely disrupted health services. As a result of this, immunisation coverage dropped for the first time in ten years. Also read | Omicron: South African President Cyril Ramaphosa tests positive for COVID-19, isolates himself There was also a surge in deaths from TB and malaria. “Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage," says Tedros in an official press release by WHO. Prior to the pandemic, in 2019, 68 per cent of the world’s population was covered by essential health services - treatment for diseases like HIV, TB and malaria, services to diagnose and treat noncommunicable diseases including cancer, heart conditions, and diabetes. However, there was no progress made in ensuring affordability. This is why people living in the poorest areas are the last ones to obtain health care services. Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank, in an official release by WHO said, "Even before the Covid-19 pandemic struck, almost 1 billion people were spending more than 10 per cent of their household budget on health." He further highlighted how this is completely unacceptable. He said, "This is not acceptable, especially since the poorest people are hit hardest. Within a constrained fiscal space, governments will have to make tough choices to protect and increase health budgets." (With inputs from agencies)

Inflated health care costs have forced over half billion people into poverty amid pandemic

New Orleans in the city of Louisiana is helping those who have laid off during COVID-19 shut down and this is being done to try and help improve their work skills. Watch report.

COVID-19 Pandemic: Retraining the jobless to work in healthcare

The Maccoux family receive visitors to their beautiful home in a Minneapolis suburb with an infectious warmth that belies the fact their youngest daughter Olivia has had more than 140 brain surgeries, all by the age of 24.

Also read:&nbsp;<a href="https://www.wionews.com/world/trump-unveils-middle-east-peace-plan-jerusalem-to-be-undivided-capital-277163" hreflang="en">Trump unveils Middle East peace plan; Jerusalem to be undivided capital</a>

Mom Cathy smiles tenderly as she scrolls through photos of Olivia on hospital beds at various ages, from a baby to toddler to a teen.

Also read:&nbsp;<a href="http://13.235.153.162/world/trump-administration-files-lawsuits-against-overseas-call-centers-for-making-fake-robocalls-277174" hreflang="en">Trump administration files lawsuits against overseas call centers for making fake robocalls</a>

"That's just a hole in her skull from one of the shunts, isn't that crazy?" she says.

And dad, Dan, is close to laughing as he reads from bills sprawled out on a table cataloguing medical costs going back to 1996 including parking tickets and hospital meals.

"Very surprisingly, very few people have a love of records," says the 57-year-old independent consultant in the semiconductor industry.

The family's case is a telling illustration of the flaws of the US health care system, which Democratic candidates for the White House have promised to overhaul or scrap ahead of their first primary contests in February.

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Despite spending the most on health care in the world, 27.5 million Americans are without any health insurance.

And for the "lucky" insured, sky-high costs can lead many to bankruptcy, or as in the case of the Maccoux, indebted for life.

Olivia was born three months early, which is at the root of her misfortunes.

She has a rare condition called hydrocephalus, meaning fluids build up in the cavities of her brain that require valves and catheters to drain down toward the abdomen.

But the devices have needed to be changed dozens of times -- not to say anything of epilepsy she experiences, among several other neurological conditions.

"I grew up with no hair," she says of her childhood.

But the Maccoux family are fortunate in one respect: Dan has a six-figure income and has always had health insurance.

When he worked for a company, his insurance coverage was "gold," he says.

The problem is that in the US, coverage rarely covers 100 per cent of people's needs. The system is largely privatized, and reimbursements to patients depend on negotiations between a hospital or pharmacy and the insurer.

The level of reimbursement varies from case to case. There are different levels of "deductibles" -- the amount paid by the patient before the insurance kicks in, as well as "copays," the fixed amount of out-of-pocket costs for doctor visits or drugs once the deductible has been met.

"It was the copays I think that killed us because we had so many appointments," said Cathy. "We were drowning for a while because it was just constant, constant."

- Advised to divorce -

Dan sat with an AFP team and added up the columns on spreadsheets he has used to calculate costs since 2005, the year he began documenting expenses in detail (before that, he has estimates).

Across a total of 15 years, it came to $100,000 for out-of-pocket costs, $22,000 for prescription co-pays, $15,000 for meals during hospitalization...with provider co-pays and parking threw in, totalling $192,000.

From 1996 to 2004, he estimates the costs were around $130,000 with the two figures combining to around $322,000.

"Considering the catastrophe, we did relatively good," said Dan. "We probably had a couple of dozen times where a provider turned it over to a debt collector and those situations were probably the hardest to deal with."

The house in which they live has served as a piggy bank for their debts: the family has borrowed money by remortgaging it, a permanent financial juggle.

In 2001, their woes multiplied when their second youngest, Traci was diagnosed at the age of 11 with complex regional pain syndrome, a rare affliction that started in her leg and spread to her arms (their eldest, Amanda, is fine).

The family has on occasion turned to GoFundMe to raise money for the two; the platform has become indispensable for Americans trapped in medical debt.

"We've had people tell us you should get a divorce," said Cathy, as a financial strategy. Under this plan, she would have taken custody of the children and, without being employed, would have benefited from public coverage.

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The couple never considered it.

Obamacare, the insurance reforms enacted by former President Barack Obama in 2010, helped the family by removing lifetime caps previously imposed by insurance companies on their payouts.

It also prevented insurers from refusing patients coverage on the basis of having pre-existing conditions&nbsp;something that would have made the family pariahs when Dan left his company and went freelance.

In the last few years, things have improved markedly, said Dan. Olivia and Traci are still sick but have successfully moved to state health insurance, a more comprehensive package that reduces the burden of out-of-pocket costs on the family.

Olivia finished college last year. "Neurologically I'm doing a lot better," she said.

But the system isn't finished yet with the parents. While Obamacare helped the family in some ways, it also sent their insurance premiums soaring. For this year, Dan and Cathy are paying $1,261 a month. Any reimbursements won't kick in until they reach their annual deductible of $6,400 each.

"We all have to laugh," said Dan. While his friends are discussing their retirement plans, "I'm like, I'll never be able to retire!"

The Maccoux family receive visitors to their beautiful home in a Minneapolis suburb with an infectious warmth that belies the fact their youngest daughter Olivia has had more than 140 brain surgeries, all by the age of 24.

The Maccoux family receive visitors to their beautiful home in a Minneapolis suburb with an infectious warmth that belies the fact their youngest daughter Olivia has had more than 140 brain surgeries, all by the age of 24. Also read: Trump unveils Middle East peace plan; Jerusalem to be undivided capital Mom Cathy smiles tenderly as she scrolls through photos of Olivia on hospital beds at various ages, from a baby to toddler to a teen. Also read: Trump administration files lawsuits against overseas call centers for making fake robocalls "That's just a hole in her skull from one of the shunts, isn't that crazy?" she says. And dad, Dan, is close to laughing as he reads from bills sprawled out on a table cataloguing medical costs going back to 1996 including parking tickets and hospital meals. "Very surprisingly, very few people have a love of records," says the 57-year-old independent consultant in the semiconductor industry. The family's case is a telling illustration of the flaws of the US health care system, which Democratic candidates for the White House have promised to overhaul or scrap ahead of their first primary contests in February. × Despite spending the most on health care in the world, 27.5 million Americans are without any health insurance. And for the "lucky" insured, sky-high costs can lead many to bankruptcy, or as in the case of the Maccoux, indebted for life. Olivia was born three months early, which is at the root of her misfortunes. She has a rare condition called hydrocephalus, meaning fluids build up in the cavities of her brain that require valves and catheters to drain down toward the abdomen. But the devices have needed to be changed dozens of times -- not to say anything of epilepsy she experiences, among several other neurological conditions. "I grew up with no hair," she says of her childhood. But the Maccoux family are fortunate in one respect: Dan has a six-figure income and has always had health insurance. When he worked for a company, his insurance coverage was "gold," he says. The problem is that in the US, coverage rarely covers 100 per cent of people's needs. The system is largely privatized, and reimbursements to patients depend on negotiations between a hospital or pharmacy and the insurer. The level of reimbursement varies from case to case. There are different levels of "deductibles" -- the amount paid by the patient before the insurance kicks in, as well as "copays," the fixed amount of out-of-pocket costs for doctor visits or drugs once the deductible has been met. "It was the copays I think that killed us because we had so many appointments," said Cathy. "We were drowning for a while because it was just constant, constant." - Advised to divorce - Dan sat with an AFP team and added up the columns on spreadsheets he has used to calculate costs since 2005, the year he began documenting expenses in detail (before that, he has estimates). Across a total of 15 years, it came to $100,000 for out-of-pocket costs, $22,000 for prescription co-pays, $15,000 for meals during hospitalization...with provider co-pays and parking threw in, totalling $192,000. From 1996 to 2004, he estimates the costs were around $130,000 with the two figures combining to around $322,000. "Considering the catastrophe, we did relatively good," said Dan. "We probably had a couple of dozen times where a provider turned it over to a debt collector and those situations were probably the hardest to deal with." The house in which they live has served as a piggy bank for their debts: the family has borrowed money by remortgaging it, a permanent financial juggle. In 2001, their woes multiplied when their second youngest, Traci was diagnosed at the age of 11 with complex regional pain syndrome, a rare affliction that started in her leg and spread to her arms (their eldest, Amanda, is fine). The family has on occasion turned to GoFundMe to raise money for the two; the platform has become indispensable for Americans trapped in medical debt. "We've had people tell us you should get a divorce," said Cathy, as a financial strategy. Under this plan, she would have taken custody of the children and, without being employed, would have benefited from public coverage. × The couple never considered it. Obamacare, the insurance reforms enacted by former President Barack Obama in 2010, helped the family by removing lifetime caps previously imposed by insurance companies on their payouts. It also prevented insurers from refusing patients coverage on the basis of having pre-existing conditions something that would have made the family pariahs when Dan left his company and went freelance. In the last few years, things have improved markedly, said Dan. Olivia and Traci are still sick but have successfully moved to state health insurance, a more comprehensive package that reduces the burden of out-of-pocket costs on the family. Olivia finished college last year. "Neurologically I'm doing a lot better," she said. But the system isn't finished yet with the parents. While Obamacare helped the family in some ways, it also sent their insurance premiums soaring. For this year, Dan and Cathy are paying $1,261 a month. Any reimbursements won't kick in until they reach their annual deductible of $6,400 each. "We all have to laugh," said Dan. While his friends are discussing their retirement plans, "I'm like, I'll never be able to retire!"

Health care in America: For one family, a $300,000 debt nightmare

After defeat Jeremy Corbyn defends Labour party policies, some of the leftist policies like health care polled well.

Jeremy Corbyn under pressure to step down

In a significant achievement, the world's largest fully government-funded health insurance scheme Pradhan Mantri Jan Arogya Yojana (PMJAY)&nbsp;has given benefit to over 50 lakh patients in their treatment so far.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which is the flagship health assurance scheme of the central government, has now given half a crore hospital treatments in just a year.

According to the government, so far free secondary and tertiary treatment worth nearly Rs&nbsp;7,901 crores have been availed and states such as Gujarat, Tamil Nadu, Chhattisgarh, Kerala and Andhra Pradesh have emerged as the top-beneficiary states.

Lauding the progress of the scheme, <a href="https://www.wionews.com/india-news/harsh-vardhan-launches-digital-platform-for-oral-health-information-254297">Union Health Minister Dr Harsh Vardhan</a> said: "The Ayushman Bharat family is growing by leaps and bounds. In just over one year, under PM-JAY more than 50 lakh treatments have been availed by beneficiaries across the country. But, this is just the beginning for this path-breaking scheme."

"The successful implementation of this scheme will help us take forward Pandit Deen Dayal Upadhyay's vision of "Antyodaya" - the upliftment of the last man, such that this deprived man gets the benefits of development. The aim of our government is to make Bharat 'Rog mukt and Ayushmaan!'," Vardhan said.

National Health Authority (NHA) chief executive officer (CEO) Dr Indu Bhushan also termed the development as a significant milestone.

"The scheme will continue to focus on reducing catastrophic out-of-pocket health expenditure, improving access to quality health care and meeting the unmet need of the population for hospitalization care so that we move towards the vision of Universal Health Coverage," he said.

Bhushan also said that empowering the poorest people in the country with the assurance of scheme is a major area of focus.

There were nine hospital admissions every minute across the country in the first year, said the government data.

More than 60 per cent of the amount spent has been on tertiary care. Cardiology, Orthopaedics, Radiation Oncology, Cardio-thoracic and Vascular Surgery, and Urology have emerged as the top tertiary specialities.

The scheme was launched by Prime Minister Narendra Modi on September 23 last year.

In a significant achievement, the world's largest fully government-funded health insurance scheme Pradhan Mantri Jan Arogya Yojana (PMJAY) has given benefit to over 50 lakh patients in their treatment so far.

In a significant achievement, the world's largest fully government-funded health insurance scheme Pradhan Mantri Jan Arogya Yojana (PMJAY) has given benefit to over 50 lakh patients in their treatment so far. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which is the flagship health assurance scheme of the central government, has now given half a crore hospital treatments in just a year. According to the government, so far free secondary and tertiary treatment worth nearly Rs 7,901 crores have been availed and states such as Gujarat, Tamil Nadu, Chhattisgarh, Kerala and Andhra Pradesh have emerged as the top-beneficiary states. Lauding the progress of the scheme, Union Health Minister Dr Harsh Vardhan said: "The Ayushman Bharat family is growing by leaps and bounds. In just over one year, under PM-JAY more than 50 lakh treatments have been availed by beneficiaries across the country. But, this is just the beginning for this path-breaking scheme." "The successful implementation of this scheme will help us take forward Pandit Deen Dayal Upadhyay's vision of "Antyodaya" - the upliftment of the last man, such that this deprived man gets the benefits of development. The aim of our government is to make Bharat 'Rog mukt and Ayushmaan!'," Vardhan said. National Health Authority (NHA) chief executive officer (CEO) Dr Indu Bhushan also termed the development as a significant milestone. "The scheme will continue to focus on reducing catastrophic out-of-pocket health expenditure, improving access to quality health care and meeting the unmet need of the population for hospitalization care so that we move towards the vision of Universal Health Coverage," he said. Bhushan also said that empowering the poorest people in the country with the assurance of scheme is a major area of focus. There were nine hospital admissions every minute across the country in the first year, said the government data. More than 60 per cent of the amount spent has been on tertiary care. Cardiology, Orthopaedics, Radiation Oncology, Cardio-thoracic and Vascular Surgery, and Urology have emerged as the top tertiary specialities. The scheme was launched by Prime Minister Narendra Modi on September 23 last year.

Pradhan Mantri Jan Arogya Yojana has benefited 50 lakh patients across country, says Dr Harsh Vardhan

Four minority US congresswomen known as the "the squad" accused President Donald Trump of trying to sow division and distract attention from what they characterized as failed policies on immigration, health care and taxation on Monday.

Congresswomen call Trump's attack an attempt to distract from his policies

In this segment, we brings to a survey report that suggests Jobs, health care are the top priorities for voters. Watch full video to know more.

India Election Watch: Jobs, health care top priorities for reveals survey

Before my AIF Clinton Fellowship position at Bempu Health, a public health start-up based in Bangalore that uses technological solutions to save newborn lives, my public health experiences had occurred in more “typical” settings. I’d held internships at the state health department in Wisconsin and at the Public Health Foundation of India in Gurgaon, where I worked mostly with individuals with public health or clinical degrees.&nbsp;

After college, in my role with AmeriCorps, which is a US government-funded civil service programme, I was surrounded by doctors, nurses and other clinical staff as I worked with patients on health education regarding specific risk factors. Most of my classmates and former colleagues working in public health have undergraduate or Master’s degrees in public health, so I saw the path to working in public health as largely defined by this specific type of background or degree programme.&nbsp;

However, my last year as an AIF Clinton Fellow in the field changed this perception. From my first few weeks at Bempu Health, my notion of what a career in public health looked like was radically shaken up. The Bempu team includes engineers, designers, and finance and production specialists in addition to people with public health-specific backgrounds. On the various projects, I’ve worked on, including launching clinical studies through the Bempu research award, working on clinical study publication, writing grant applications, managing social media, and more, I’ve engaged with colleagues who work on all sides of the company.&nbsp;

This has offered me perspective on just how diverse and interdisciplinary the public work we’re doing, all centred around improving maternal and child health really is. I’ve also come to understand why this so important.&nbsp;

I’ve observed that it has been absolutely necessary, for my projects to be effective, to work with individuals from every team. To design a clinical protocol for a study on a new Bempu product that works to detect and resolve neonatal apneas, I met with the engineering team to better understand how the device works and what modifications can be made for the purposes of a study. I worked extensively with our clinical advisor, a neonatologist, to ensure the study was designed appropriately to be able to obtain clinically relevant information. I spoke with our on-the-ground research coordinator, who best understands the day-to-day workings of the study hospital and what is feasible in that particular setting with the available resources.&nbsp;

I reviewed the draft with my colleagues on the public health team, who were able to provide suggestions and input based on their own experiences with clinical research. To make sure there was a prototype ready to bring to the hospital when meeting with the study investigator about the proposal, I coordinated with members of Bempu’s production team. Through this project and others, I’ve worked here, I’ve witnessed how essential inputs from team members with different backgrounds and expertise are in making public health interventions as effective as possible.&nbsp;

For a public health start-up, where creative minds are working every day to come up with ways to address the maternal and child health challenges that exist in India and other low- and middle-income countries, having a well-rounded, interdisciplinary team is crucial for understanding all aspects of the problem and how to develop a solution that works.&nbsp;

My conversations with members of Bempu’s engineering, design, and production teams - fields I previously wouldn’t have typically seen as particularly related or relevant to public health - have offered some of the most meaningful insight I’ve gained this past year on India’s public health challenges and how a wide range of work can contribute to solving them. Understanding more about these fields has been tremendously helpful, as I hadn’t previously been exposed much to engineering, design, and production.&nbsp;

Seeing the value of interdisciplinary work in public health has been one of my most important takeaways from my time in India, and I will strive to continue to approach public health through an interdisciplinary lens moving forward.&nbsp;

(A previous version of <a href="https://aif.org/how-interdisciplinary-teams-can-tackle-public-health-challenges/">this article </a>was originally published by the American India Foundation)

(Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Before my AIF Clinton Fellowship position at Bempu Health, a public health start-up based in Bangalore that uses technological solutions to save newborn lives, my public health experiences had occurred in more “typical” settings.

Before my AIF Clinton Fellowship position at Bempu Health, a public health start-up based in Bangalore that uses technological solutions to save newborn lives, my public health experiences had occurred in more “typical” settings. I’d held internships at the state health department in Wisconsin and at the Public Health Foundation of India in Gurgaon, where I worked mostly with individuals with public health or clinical degrees. After college, in my role with AmeriCorps, which is a US government-funded civil service programme, I was surrounded by doctors, nurses and other clinical staff as I worked with patients on health education regarding specific risk factors. Most of my classmates and former colleagues working in public health have undergraduate or Master’s degrees in public health, so I saw the path to working in public health as largely defined by this specific type of background or degree programme. However, my last year as an AIF Clinton Fellow in the field changed this perception. From my first few weeks at Bempu Health, my notion of what a career in public health looked like was radically shaken up. The Bempu team includes engineers, designers, and finance and production specialists in addition to people with public health-specific backgrounds. On the various projects, I’ve worked on, including launching clinical studies through the Bempu research award, working on clinical study publication, writing grant applications, managing social media, and more, I’ve engaged with colleagues who work on all sides of the company. This has offered me perspective on just how diverse and interdisciplinary the public work we’re doing, all centred around improving maternal and child health really is. I’ve also come to understand why this so important. I’ve observed that it has been absolutely necessary, for my projects to be effective, to work with individuals from every team. To design a clinical protocol for a study on a new Bempu product that works to detect and resolve neonatal apneas, I met with the engineering team to better understand how the device works and what modifications can be made for the purposes of a study. I worked extensively with our clinical advisor, a neonatologist, to ensure the study was designed appropriately to be able to obtain clinically relevant information. I spoke with our on-the-ground research coordinator, who best understands the day-to-day workings of the study hospital and what is feasible in that particular setting with the available resources. I reviewed the draft with my colleagues on the public health team, who were able to provide suggestions and input based on their own experiences with clinical research. To make sure there was a prototype ready to bring to the hospital when meeting with the study investigator about the proposal, I coordinated with members of Bempu’s production team. Through this project and others, I’ve worked here, I’ve witnessed how essential inputs from team members with different backgrounds and expertise are in making public health interventions as effective as possible. For a public health start-up, where creative minds are working every day to come up with ways to address the maternal and child health challenges that exist in India and other low- and middle-income countries, having a well-rounded, interdisciplinary team is crucial for understanding all aspects of the problem and how to develop a solution that works. My conversations with members of Bempu’s engineering, design, and production teams - fields I previously wouldn’t have typically seen as particularly related or relevant to public health - have offered some of the most meaningful insight I’ve gained this past year on India’s public health challenges and how a wide range of work can contribute to solving them. Understanding more about these fields has been tremendously helpful, as I hadn’t previously been exposed much to engineering, design, and production. Seeing the value of interdisciplinary work in public health has been one of my most important takeaways from my time in India, and I will strive to continue to approach public health through an interdisciplinary lens moving forward. (A previous version of this article was originally published by the American India Foundation) (Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Blog: How to tackle public health challenges

By Maisam Najafizada and Jill Allison

Women health-care volunteers in low-income countries such as Afghanistan, Nepal and Ethiopia play a vital role in the health-care system, yet they are undervalued and undertrained. Many community health programs use volunteer Community Health Workers (CHW) to provide basic health-related services to rural and remote populations.

Most of these thousands of volunteers, trained for a short period and supported by the health system to provide basic health services to rural and remote communities, are women. The irony is that many of these settings are strictly patriarchal where women’s participation in the public sphere is restricted.

In rural Afghanistan, there are around 26,000 volunteer CHWs working, half of whom are women. They dispense drugs for prevalent diseases such as pneumonia and diarrhoea, provide information on family planning, antenatal, delivery and postnatal care, as well as basic hygiene and nutrition. They also refer patients to larger health centres.

In Nepal, the network of Female Community Health Volunteers (FCHVs) created in 1988 provides support for maternal and child health through the sharing of information and collaboration with local health services. The FCHVs treat basic illnesses, promote the government immunisation schedule and handle contraception, antenatal and postnatal care. They also co-ordinate a government-supported initiative to create mother’s groups in every community.

There are currently more than 52,000 FCHVs in Nepal. The FCHVs are a conduit between the community and the formal health sector. With the exception of a very brief period of time at the inception of the program, there has been no remuneration offered to the FCHVs. Government policy-makers believe that volunteerism is critical to the sustainability of the programme.

New but limited opportunities for women 
 
The communities where women volunteers work are mostly patriarchal with limited opportunities for education and paid work for women. Generally, women are considered to be operating at a subordinate level compared to men. By becoming volunteer health workers, some women create opportunities for themselves: they learn and gain new skills outside the formal education system from which they are marginalized.

They become eligible to participate in community activities through community health councils and decision-making committees from which they are usually excluded. This allows them to gain small forms of respect that they don’t otherwise have.

Although communities have learned to accept the presence of female health workers in social spheres, especially in health and education, they have also developed ways to maintain women’s second-grade status.

Our observations regarding recruitment of Community Health Workers (CHWs) show that communities choose women to volunteer, whereas men choose to volunteer for the community, indicating a greater agency for men in their choices. The services of male volunteers are valued as “acts of selflessness,” where the services of female volunteers are considered “natural tasks” for women.

In Nepal, volunteerism is considered an asset, with links to moral and religious ideals, and a sense of duty to one’s community. Communities assume that women should undertake their volunteer duties in their spare time and should not give up other responsibilities.

This is in contrast to the lack of respect and trust that is associated with paid employees in the Nepal health system.

The idea that volunteerism is as an act of selflessness is often used as an argument against paying female volunteers. Administrators argue there would be no “moral” reward if female workers were paid.

Therefore, promotion of female volunteerism is often a form of detaching material and monetary value for women’s work, while doubling their community and family responsibilities.

Free labour with no advancement 
 
The volunteer works also play a paradoxical role for weak health systems, both as part of the workforce and the scapegoat for failures. First, the range of activities CHWs undertake are vast and they are the first workforce to be assigned and trained for any new task for the formal health system.

On the other hand, FCHVs are not truly accountable for the quality of services they provide because they are volunteers. As well, they have no control over the kinds of programs, the priorities or the types of services they deliver. And yet all the primary health care and community programs depend on them.

Lack of success or failures to improve metrics in a given service are often blamed on the fact that volunteers cannot be expected to undertake the work. Because all or most active volunteers are women, sexist attitudes contribute to the ease of using them as much as possible for basic services and blaming them for the failures of the system.

What’s more, volunteer workers are viewed as less valuable because they lack training and professional skills. They are the glue that binds the primary health- care system yet they are not acknowledged as part of the professional health-care team even though they are often dispensing basic medicines such as anthelmintic vitamins and treatment for diarrhoea and pneumonia.

Prioritise education 
 
This paradox in relations between female workers and the patriarchy is not new. Historically, women’s participation in the workforce has been concomitant with poor working conditions, lower wages, exploitation and abuse, yet women have used their work as a tool to resist patriarchy and its societal manifestations.

At the same time, upstream interventions in the forms of international declarations, national regulations and local policies have often been helpful. Whereas international attention on development is focused on the United Nations’ Agenda 2030, which includes gender equality, we suggest practical recommendations for gender equitable and inclusive strengthening of the health workforce, especially female volunteers, in low-income countries.

Female volunteer CHWs are unique workers who require a true acknowledgement for their services and better support from the health systems in the following ways:

1.Education and training for CHWs so they can gain opportunities to become midwives, nurses, supervisors and health managers.

2. Designing formal processes to make sure their community voices at village health councils are heard in the boardrooms of decision-makers at provincial and national levels.

3. Socialising and promoting culturally appropriate and systemically sustainable remuneration mechanisms through the health system and the community.

4.Extending their scope of practice beyond reproductive, maternal and child health while reducing their workload. 
 
(Maisam Najafizada is Assistant Professor of Population Health Policy, Memorial University of Newfoundland; &nbsp;Jill Allison is Clinical Assistant Professor., Memorial University of Newfoundland)

(This article was originally published on The Conversation. Read the <a href="https://theconversation.com/women-health-care-volunteers-have-no-upward-mobility-101781">original article</a>)

(Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

 
&nbsp;

By Maisam Najafizada and Jill Allison Women health-care volunteers in low-income countries such as Afghanistan, Nepal and Ethiopia play a vital role in the health-care system, yet they are undervalued and undertrained.

By Maisam Najafizada and Jill Allison Women health-care volunteers in low-income countries such as Afghanistan, Nepal and Ethiopia play a vital role in the health-care system, yet they are undervalued and undertrained. Many community health programs use volunteer Community Health Workers (CHW) to provide basic health-related services to rural and remote populations. Most of these thousands of volunteers, trained for a short period and supported by the health system to provide basic health services to rural and remote communities, are women. The irony is that many of these settings are strictly patriarchal where women’s participation in the public sphere is restricted. In rural Afghanistan, there are around 26,000 volunteer CHWs working, half of whom are women. They dispense drugs for prevalent diseases such as pneumonia and diarrhoea, provide information on family planning, antenatal, delivery and postnatal care, as well as basic hygiene and nutrition. They also refer patients to larger health centres. In Nepal, the network of Female Community Health Volunteers (FCHVs) created in 1988 provides support for maternal and child health through the sharing of information and collaboration with local health services. The FCHVs treat basic illnesses, promote the government immunisation schedule and handle contraception, antenatal and postnatal care. They also co-ordinate a government-supported initiative to create mother’s groups in every community. There are currently more than 52,000 FCHVs in Nepal. The FCHVs are a conduit between the community and the formal health sector. With the exception of a very brief period of time at the inception of the program, there has been no remuneration offered to the FCHVs. Government policy-makers believe that volunteerism is critical to the sustainability of the programme. New but limited opportunities for women The communities where women volunteers work are mostly patriarchal with limited opportunities for education and paid work for women. Generally, women are considered to be operating at a subordinate level compared to men. By becoming volunteer health workers, some women create opportunities for themselves: they learn and gain new skills outside the formal education system from which they are marginalized. They become eligible to participate in community activities through community health councils and decision-making committees from which they are usually excluded. This allows them to gain small forms of respect that they don’t otherwise have. Although communities have learned to accept the presence of female health workers in social spheres, especially in health and education, they have also developed ways to maintain women’s second-grade status. Our observations regarding recruitment of Community Health Workers (CHWs) show that communities choose women to volunteer, whereas men choose to volunteer for the community, indicating a greater agency for men in their choices. The services of male volunteers are valued as “acts of selflessness,” where the services of female volunteers are considered “natural tasks” for women. In Nepal, volunteerism is considered an asset, with links to moral and religious ideals, and a sense of duty to one’s community. Communities assume that women should undertake their volunteer duties in their spare time and should not give up other responsibilities. This is in contrast to the lack of respect and trust that is associated with paid employees in the Nepal health system. The idea that volunteerism is as an act of selflessness is often used as an argument against paying female volunteers. Administrators argue there would be no “moral” reward if female workers were paid. Therefore, promotion of female volunteerism is often a form of detaching material and monetary value for women’s work, while doubling their community and family responsibilities. Free labour with no advancement The volunteer works also play a paradoxical role for weak health systems, both as part of the workforce and the scapegoat for failures. First, the range of activities CHWs undertake are vast and they are the first workforce to be assigned and trained for any new task for the formal health system. On the other hand, FCHVs are not truly accountable for the quality of services they provide because they are volunteers. As well, they have no control over the kinds of programs, the priorities or the types of services they deliver. And yet all the primary health care and community programs depend on them. Lack of success or failures to improve metrics in a given service are often blamed on the fact that volunteers cannot be expected to undertake the work. Because all or most active volunteers are women, sexist attitudes contribute to the ease of using them as much as possible for basic services and blaming them for the failures of the system. What’s more, volunteer workers are viewed as less valuable because they lack training and professional skills. They are the glue that binds the primary health- care system yet they are not acknowledged as part of the professional health-care team even though they are often dispensing basic medicines such as anthelmintic vitamins and treatment for diarrhoea and pneumonia. Prioritise education This paradox in relations between female workers and the patriarchy is not new. Historically, women’s participation in the workforce has been concomitant with poor working conditions, lower wages, exploitation and abuse, yet women have used their work as a tool to resist patriarchy and its societal manifestations. At the same time, upstream interventions in the forms of international declarations, national regulations and local policies have often been helpful. Whereas international attention on development is focused on the United Nations’ Agenda 2030, which includes gender equality, we suggest practical recommendations for gender equitable and inclusive strengthening of the health workforce, especially female volunteers, in low-income countries. Female volunteer CHWs are unique workers who require a true acknowledgement for their services and better support from the health systems in the following ways: 1.Education and training for CHWs so they can gain opportunities to become midwives, nurses, supervisors and health managers. 2. Designing formal processes to make sure their community voices at village health councils are heard in the boardrooms of decision-makers at provincial and national levels. 3. Socialising and promoting culturally appropriate and systemically sustainable remuneration mechanisms through the health system and the community. 4.Extending their scope of practice beyond reproductive, maternal and child health while reducing their workload. (Maisam Najafizada is Assistant Professor of Population Health Policy, Memorial University of Newfoundland; Jill Allison is Clinical Assistant Professor., Memorial University of Newfoundland) (This article was originally published on The Conversation. Read the original article) (Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Women healthcare volunteers have no upward mobility

More than 70 years have passed since India&#39;s independence. However, the world&rsquo;s largest democracy is still far from its goals of providing accessible and affordable healthcare to its population. Moving between smart cities and a digitally equipped nation, one sector, which the government seems to have turned a blind eye to, is healthcare.

&nbsp;

Most glaring example of the terrible condition of healthcare in India came late last year in August. Nestled in a remote corner, the tragedy in the town of Gorakhpur serves as a blot on India&rsquo;s rich progressive fabric of 70. Over a span of five days, over 60 young children died in the local government-run hospital in Gorakhpur, dozens of them on a particular night. As oxygen supplies ran out, bills remain unpaid and authorities passed the buck &ndash; a pitiful state of one of the essential commodities of life glared in every Indian&rsquo;s eyes. The government should study the lessons of Thailand&rsquo;s rollout, in the early part of this century, of universal healthcare. Thailand spends 4.4% of its GDP on health, compared to 4.1% in India (when private spending is included) and has far better outcomes.

&nbsp;

The Indian healthcare system is plagued with numerous problems and is in a dilapidated state. India spends less than 1.2%GDP and as per World Bank estimates, the per capita healthcare expenditure in India is around USD 60.&nbsp;

&nbsp;

Additionally, unequal distribution of limited health facilities poses a larger problem at hand. Though a majority of India&rsquo;s population lives in rural areas (72% or 716 Million), 75% of the health infrastructure in India is concentrated in urban areas where only 28% of India&rsquo;s population lives. To put the deplorable state in perspective &ndash; 60% of health expenditure is out of pocket; 21% of the global disease burden is represented by India and around 85% of the healthcare needs can be managed at the primary level.

&nbsp;

Let&rsquo;s look at the last statistic in close detail now. A cost you can afford, a distance you can travel and the dignity you deserve &ndash; three ingredients of all that the people in India, especially the poor want out of the healthcare system. Since 85% of the needs can be managed at the primary level, it&rsquo;s important to strengthen effectiveness, reach and quality of such healthcare.&nbsp;

&nbsp;

From the evidence across the world, it appears that the countries that have a strong primary health care system have better health outcomes, lower inequalities in these outcomes, and lower costs of care. So what is the issue? Currently, primary health care services in India are located too far from the populations they serve, provide too little services, and have too little resources. Adding to this, the problem of healthcare professionals, adequate investment, population coverage and certifications make the entire primary healthcare system riddled with problems.

&nbsp;

However, we saw this as an opportunity.

&nbsp;

We at Enactus SRCC, decided to work at the primary level in the healthcare sector to bring about a turnaround in healthcare delivery and ensure last-mile connectivity for every Indian. Focusing on affordability and accessibility as two cornerstones of our health intervention, we aim to leverage existing communities and healthcare providers to revolutionize the healthcare system.&nbsp;

&nbsp;

We understand the pivotal role that communities play, and so, develop medical entrepreneurs to disburse health-related services and information at a community level. &ldquo;Our community health workers are the most integral part of our model. They&rsquo;re the real health change agents in the communities we work in. Through constant engagement, we believe our health workers can drive the idea of the importance of healthcare to each and every household&rdquo;, said Rutwik Shah. Our aim is to improve the health-seeking behaviour of consumers and bring about a behavioral change in the mindset of people towards health.

&nbsp;

As economist Amartya Sen has pointed out, no country can become rich&mdash;or even middle-class&mdash;with an unhealthy workforce. Now is the time to act, and to change. &nbsp;

&nbsp;

(Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)&nbsp;&nbsp;

Affordability and accessibility need to be two cornerstones of Indian healthcare reform.

More than 70 years have passed since India's independence. However, the world’s largest democracy is still far from its goals of providing accessible and affordable healthcare to its population. Moving between smart cities and a digitally equipped nation, one sector, which the government seems to have turned a blind eye to, is healthcare. Most glaring example of the terrible condition of healthcare in India came late last year in August. Nestled in a remote corner, the tragedy in the town of Gorakhpur serves as a blot on India’s rich progressive fabric of 70. Over a span of five days, over 60 young children died in the local government-run hospital in Gorakhpur, dozens of them on a particular night. As oxygen supplies ran out, bills remain unpaid and authorities passed the buck – a pitiful state of one of the essential commodities of life glared in every Indian’s eyes. The government should study the lessons of Thailand’s rollout, in the early part of this century, of universal healthcare. Thailand spends 4.4% of its GDP on health, compared to 4.1% in India (when private spending is included) and has far better outcomes. The Indian healthcare system is plagued with numerous problems and is in a dilapidated state. India spends less than 1.2%GDP and as per World Bank estimates, the per capita healthcare expenditure in India is around USD 60. Additionally, unequal distribution of limited health facilities poses a larger problem at hand. Though a majority of India’s population lives in rural areas (72% or 716 Million), 75% of the health infrastructure in India is concentrated in urban areas where only 28% of India’s population lives. To put the deplorable state in perspective – 60% of health expenditure is out of pocket; 21% of the global disease burden is represented by India and around 85% of the healthcare needs can be managed at the primary level. Let’s look at the last statistic in close detail now. A cost you can afford, a distance you can travel and the dignity you deserve – three ingredients of all that the people in India, especially the poor want out of the healthcare system. Since 85% of the needs can be managed at the primary level, it’s important to strengthen effectiveness, reach and quality of such healthcare. From the evidence across the world, it appears that the countries that have a strong primary health care system have better health outcomes, lower inequalities in these outcomes, and lower costs of care. So what is the issue? Currently, primary health care services in India are located too far from the populations they serve, provide too little services, and have too little resources. Adding to this, the problem of healthcare professionals, adequate investment, population coverage and certifications make the entire primary healthcare system riddled with problems. However, we saw this as an opportunity. We at Enactus SRCC, decided to work at the primary level in the healthcare sector to bring about a turnaround in healthcare delivery and ensure last-mile connectivity for every Indian. Focusing on affordability and accessibility as two cornerstones of our health intervention, we aim to leverage existing communities and healthcare providers to revolutionize the healthcare system. We understand the pivotal role that communities play, and so, develop medical entrepreneurs to disburse health-related services and information at a community level. “Our community health workers are the most integral part of our model. They’re the real health change agents in the communities we work in. Through constant engagement, we believe our health workers can drive the idea of the importance of healthcare to each and every household”, said Rutwik Shah. Our aim is to improve the health-seeking behaviour of consumers and bring about a behavioral change in the mindset of people towards health. As economist Amartya Sen has pointed out, no country can become rich—or even middle-class—with an unhealthy workforce. Now is the time to act, and to change. (Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Opinion: Heath tourism flourishes but Indian healthcare in bad shape

By: Claire Snell-Rood and Cathleen Willging

Much has been made of the distress and discontent in rural areas during the 2016 U.S. presidential election. Few realise, however, this is also felt through unequal health.

Researchers call it the &ldquo;rural mortality&nbsp;penalty.&rdquo; While rates of mortality have steadily fallen in the nation&rsquo;s <a href="http://www.pnas.org/content/113/7/E815.full">urban areas</a>, they have actually climbed for rural Americans. And the picture is even bleaker for specific groups, such as rural white women and people of colour, who face persistent disparities in health outcomes. In every category, from suicide to unintentional injury to heart disease, rural residents&rsquo; health has been declining since the 1990s.

While some have blamed these gaping disparities on &ldquo;culture&rdquo; or &ldquo;lifestyle&rdquo; factors &ndash; such as a supposed fatalism or overconsumption of unhealthy products like Mountain Dew &ndash; the truth is that the biggest culprit is limited access to health care and challenging economic circumstances.

The passage of the Affordable Care Act (ACA) in 2010 began to change this as more rural Americans gained insurance coverage and the government invested more money into regional health facilities and training.

This progress is now at risk, however, as the Republican Congress inches closer to repealing Obamacare and replacing it with a feeble alternative that greatly weakens rural health care access. As researchers who study the mental and physical health of rural Americans, we believe this would have disastrous consequences.

The travails of rural America

Even as <a href="https://theconversation.com/where-is-rural-america-and-what-does-it-look-like-72045?sr=1">rural America</a> feeds the country, <a href="http://www.npr.org/sections/thesalt/2017/05/22/529493413/in-some-rural-counties-hunger-is-rising-but-food-donations-arent">hunger is on the rise</a> in rural areas.

Some <a href="https://www.iatp.org/files/258_2_98043.pdf">98 percent of rural residents</a> live in food deserts &ndash; defined as counties in which one must drive more than 10 miles to get to the nearest supermarket. This makes it challenging to maintain healthy and nutritious diets, leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481194/">higher rates of obesity in rural areas</a> that greatly increase the risk for diabetes, heart disease and certain cancers.

As rural workers struggle to <a href="https://www.wsj.com/articles/rural-america-struggles-as-young-people-chase-jobs-in-cities-1395890099">sustain employment</a> in a <a href="https://www.washingtonpost.com/news/wonk/wp/2016/05/22/a-very-bad-sign-for-all-but-americas-biggest-cities/?utm_term=.174ccab19701">shifting economy</a>, the increasing poverty is contributing to mental distress and <a href="http://journals.sagepub.com/doi/abs/10.1177/002204260703700302">substance use</a>. On a larger scale, the economic changes that have hit rural areas have resulted in a declining tax base, lower incomes and strained educational institutions. Together, they challenge rural residents&rsquo; health not just in the immediate term but cumulatively over their lives.

<figure class="align-center "><img alt="" src="https://cdn.theconversation.com/files/175505/width754/file-20170625-13475-1udmu6z.jpg" />
<figcaption>
&nbsp;

Like many other rural hospitals in the U.S., Evans Memorial in Claxton, Georgia, has struggled to keep its doors open while treating patients who tend to be older, poorer and often uninsured. AP Photo/Russ Bynum
</figcaption>
</figure>

Barriers to accessing health care

Yet, despite all these medical issues, rural residents have a tough time getting the health care they need.

The nature of rural employment, for example, is characterised by <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1748-0361.2005.tb00058.x/epdf">self-employment, seasonal work and lower-than-average pay</a>. This means rural workers are <a href="https://www.ruralhealthinfo.org/pdf/research_compendium.pdf">less likely to get insurance through their jobs and thus face higher premiums</a> when buying their own policies.

The lack of public transportation in most rural areas is also a major hurdle to seeing a doctor, particularly as residents <a href="https://www.ncbi.nlm.nih.gov/pubmed/16606425">have to travel much farther</a> than those in urban areas to reach health care providers.

Rural residents get most of their services through primary care providers, who take on the work of other practitioners, like behavioural health clinicians, due to longstanding specialist shortages. When handling numerous complaints during a single medical encounter, primary care providers may concentrate on the acutest health concerns of their patients, undermining the ability to diagnose all their conditions and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609543/">meaningfully discuss their larger health risks</a>, such as exercise, weight and substance use. When providers are rushed or deliver sub-par care, rural residents may wonder if seeking it out is worth the challenge, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27322157">opting to struggle on their own</a>.

These and other constraints make it tougher for rural Americans to get the screenings necessary to spot serious diseases such as <a href="http://www.tandfonline.com/doi/abs/10.1300/J013v42n02_06">cancer</a> early or to maintain adequate follow-up on conditions like <a href="https://www.ncbi.nlm.nih.gov/pubmed/24183213">hearing loss</a>. Finding the regular medical care necessary to manage chronic conditions, such as diabetes, depression or opioid disorders, is even more challenging.

Rural health care has at times been <a href="https://www.ncbi.nlm.nih.gov/pubmed/18709749">characterised as patchwork</a>. In part, that&rsquo;s because the costs of sustaining health care infrastructure in rural areas<a href="https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/30/10/36/rural-health-goals-guaranteeing-a-future"> are higher</a> thanks to the large service areas, the inability to negotiate bulk pricing and lack of financial incentives to fill in provider gaps.

The ACA and the AHCA

The ACA, intended to turn this around, has in fact led to dramatic gains in insurance coverage among rural Americans.

Broadly speaking, insurance rates in rural areas <a href="http://hrms.urban.org/quicktakes/Substantial-Gains-in-Health-Insurance-Coverage-Occurring-for-Adults-in-Both-Rural-and-Urban-Areas.html">reached almost 86 percent</a> in early 2015, up from an estimated 78 percent in 2013.

In Kentucky &ndash; a state with high poverty, a large rural population (42 percent of residents) and a successful <a href="https://theconversation.com/love-it-or-hate-it-obamacare-has-expanded-coverage-for-millions-66472?sr=2">Medicaid expansion</a> initiative &ndash; <a href="http://www.cbpp.org/blog/medicaid-at-50-kentuckys-experience-highlights-benefits-of-medicaid-expansion">tens of thousands of newly insured low-income adults</a> began using preventative services after previously being unable to afford it. The state&rsquo;s uninsured fell by half and, as a result, <a href="http://content.healthaffairs.org/content/35/1/96.abstract">fewer people skipped taking their medications</a> due to financial hardships relative to other states that didn&rsquo;t expand Medicaid.

The ACA also <a href="http://www.scholarsstrategynetwork.org/brief/how-obamacare-repeal-would-harm-rural-america">strengthened rural health care institutions</a> by investing in upgrades to hospitals and clinics, preventative health programs and support for providers to stay in rural areas. While rural hospitals are often laden with the expense of providing extensive care without payment to indigent patients, rural hospitals in states that expanded Medicaid under the ACA <a href="http://www.cbpp.org/research/health/house-passed-bill-would-devastate-health-care-in-rural-america?utm_source=CBPP+Email+Updates&amp;utm_campaign=d303d5c441-EMAIL_CAMPAIGN_2017_05_16&amp;utm_medium=email&amp;utm_term=0_ee3f6da374-d303d5c441-110964945">finally was able to better balance their books when caring for this vulnerable group</a>. At the same time, the ACA supported innovative models ideal for rural areas that prioritised <a href="https://www.ncbi.nlm.nih.gov/pubmed/18709749">outreach</a>, <a href="http://content.healthaffairs.org/content/29/5/852.abstract">integration of services</a> and <a href="http://nashp.org/wp-content/uploads/2016/09/Rural-Opioid-Primer.pdf">collaboration between safety-net players</a>.

Both the <a href="https://www.washingtonpost.com/graphics/2017/politics/obamacare-senate-bill-compare/">House and Senate</a> bills to repeal and replace Obamacare would <a href="http://www.scholarsstrategynetwork.org/brief/how-obamacare-repeal-would-harm-rural-america">drastically reduce rural Americans&rsquo; insurance coverage</a> and significantly threaten the ability of <a href="http://www.npr.org/sections/health-shots/2017/06/22/533680909/republicans-proposed-medicaid-cuts-would-hit-rural-patients-hard">many rural hospitals and clinics to keep their doors open</a>. <a href="http://www.cbpp.org/research/health/house-passed-bill-would-devastate-health-care-in-rural-america">Analysts show</a> that the bill would provide insufficient tax credits to pay for rural premium costs, drastically increase the price of rural premiums and increase uncompensated care in rural hospitals.

What rural areas need from health care reform

Previous efforts at health care reform show us that rural areas are uniquely vulnerable. Efforts need to take account not only of coverage and access &ndash; as has been the focus of the current debate &ndash; but also how reform affects rural health care institutions and the larger social factors shaping overall health.

The particular economic factors affecting rural health care institutions <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415203/">make rural areas particularly vulnerable to political shifts</a> that disrupt services for existing patients and for those newly insured, creating immense challenges for rural providers. Steps that fail to account for the impact of financial hardship on these institutions not only hurt their bottom line but contribute to <a href="https://www.ncbi.nlm.nih.gov/pubmed/22229021">poor morale and workforce turnover</a> and larger-scale decisions to reduce services, which decrease their ability to address patient needs.

At the same time, commitment to improving the health of rural Americans requires attention to the so-called upstream factors shaping rural health. That means <a href="http://www.prnewswire.com/news-releases/medicaid-plays-a-more-significant-role-in-small-towns-and-rural-communities-than-in-metro-areas-300469734.html">preserving the safety net programs so vital in rural areas</a> with underemployment and low-paying jobs, <a href="http://www.soar-ky.org/about-us">strengthening rural economies</a> and investing in <a href="https://www.brookings.edu/blog/brown-center-chalkboard/2017/01/04/a-better-future-for-rural-communities-starts-at-the-schoolhouse/">high-quality education</a>.

<img alt="The Conversation" height="1" src="https://counter.theconversation.edu.au/content/78018/count.gif?distributor=republish-lightbox-basic" width="1" />If our leaders are serious about reform that will lessen the rural-urban mortality gap, they should recognise the unique needs of rural America and ensure health care policy reflects how vital access to quality care is to their financial success &ndash; not to mention their well-being.

<a href="https://theconversation.com/profiles/claire-snell-rood-378593">Claire Snell-Rood</a>, Assistant Professor of Public Health, University of California, Berkeley and Cathleen Willging, Adjunct Associate Professor of Anthropology, University of New Mexico

This article was originally published on <a href="http://theconversation.com">The Conversation</a>. Read the <a href="https://theconversation.com/ahca-would-make-rural-americas-already-distressed-health-care-worse-78018">original article</a>.

Researchers who study the mental and physical health of rural Americans, believe this repealing Obamacare would have disastrous consequences

By: Claire Snell-Rood and Cathleen Willging Much has been made of the distress and discontent in rural areas during the 2016 U.S. presidential election. Few realise, however, this is also felt through unequal health. Researchers call it the “rural mortality penalty.” While rates of mortality have steadily fallen in the nation’s urban areas, they have actually climbed for rural Americans. And the picture is even bleaker for specific groups, such as rural white women and people of colour, who face persistent disparities in health outcomes. In every category, from suicide to unintentional injury to heart disease, rural residents’ health has been declining since the 1990s. While some have blamed these gaping disparities on “culture” or “lifestyle” factors – such as a supposed fatalism or overconsumption of unhealthy products like Mountain Dew – the truth is that the biggest culprit is limited access to health care and challenging economic circumstances. The passage of the Affordable Care Act (ACA) in 2010 began to change this as more rural Americans gained insurance coverage and the government invested more money into regional health facilities and training. This progress is now at risk, however, as the Republican Congress inches closer to repealing Obamacare and replacing it with a feeble alternative that greatly weakens rural health care access. As researchers who study the mental and physical health of rural Americans, we believe this would have disastrous consequences. The travails of rural America Even as rural America feeds the country, hunger is on the rise in rural areas. Some 98 percent of rural residents live in food deserts – defined as counties in which one must drive more than 10 miles to get to the nearest supermarket. This makes it challenging to maintain healthy and nutritious diets, leading to higher rates of obesity in rural areas that greatly increase the risk for diabetes, heart disease and certain cancers. As rural workers struggle to sustain employment in a shifting economy, the increasing poverty is contributing to mental distress and substance use. On a larger scale, the economic changes that have hit rural areas have resulted in a declining tax base, lower incomes and strained educational institutions. Together, they challenge rural residents’ health not just in the immediate term but cumulatively over their lives. Like many other rural hospitals in the U.S., Evans Memorial in Claxton, Georgia, has struggled to keep its doors open while treating patients who tend to be older, poorer and often uninsured. AP Photo/Russ Bynum Barriers to accessing health care Yet, despite all these medical issues, rural residents have a tough time getting the health care they need. The nature of rural employment, for example, is characterised by self-employment, seasonal work and lower-than-average pay. This means rural workers are less likely to get insurance through their jobs and thus face higher premiums when buying their own policies. The lack of public transportation in most rural areas is also a major hurdle to seeing a doctor, particularly as residents have to travel much farther than those in urban areas to reach health care providers. Rural residents get most of their services through primary care providers, who take on the work of other practitioners, like behavioural health clinicians, due to longstanding specialist shortages. When handling numerous complaints during a single medical encounter, primary care providers may concentrate on the acutest health concerns of their patients, undermining the ability to diagnose all their conditions and meaningfully discuss their larger health risks, such as exercise, weight and substance use. When providers are rushed or deliver sub-par care, rural residents may wonder if seeking it out is worth the challenge, opting to struggle on their own. These and other constraints make it tougher for rural Americans to get the screenings necessary to spot serious diseases such as cancer early or to maintain adequate follow-up on conditions like hearing loss. Finding the regular medical care necessary to manage chronic conditions, such as diabetes, depression or opioid disorders, is even more challenging. Rural health care has at times been characterised as patchwork. In part, that’s because the costs of sustaining health care infrastructure in rural areas are higher thanks to the large service areas, the inability to negotiate bulk pricing and lack of financial incentives to fill in provider gaps. The ACA and the AHCA The ACA, intended to turn this around, has in fact led to dramatic gains in insurance coverage among rural Americans. Broadly speaking, insurance rates in rural areas reached almost 86 percent in early 2015, up from an estimated 78 percent in 2013. In Kentucky – a state with high poverty, a large rural population (42 percent of residents) and a successful Medicaid expansion initiative – tens of thousands of newly insured low-income adults began using preventative services after previously being unable to afford it. The state’s uninsured fell by half and, as a result, fewer people skipped taking their medications due to financial hardships relative to other states that didn’t expand Medicaid. The ACA also strengthened rural health care institutions by investing in upgrades to hospitals and clinics, preventative health programs and support for providers to stay in rural areas. While rural hospitals are often laden with the expense of providing extensive care without payment to indigent patients, rural hospitals in states that expanded Medicaid under the ACA finally was able to better balance their books when caring for this vulnerable group. At the same time, the ACA supported innovative models ideal for rural areas that prioritised outreach, integration of services and collaboration between safety-net players. Both the House and Senate bills to repeal and replace Obamacare would drastically reduce rural Americans’ insurance coverage and significantly threaten the ability of many rural hospitals and clinics to keep their doors open. Analysts show that the bill would provide insufficient tax credits to pay for rural premium costs, drastically increase the price of rural premiums and increase uncompensated care in rural hospitals. What rural areas need from health care reform Previous efforts at health care reform show us that rural areas are uniquely vulnerable. Efforts need to take account not only of coverage and access – as has been the focus of the current debate – but also how reform affects rural health care institutions and the larger social factors shaping overall health. The particular economic factors affecting rural health care institutions make rural areas particularly vulnerable to political shifts that disrupt services for existing patients and for those newly insured, creating immense challenges for rural providers. Steps that fail to account for the impact of financial hardship on these institutions not only hurt their bottom line but contribute to poor morale and workforce turnover and larger-scale decisions to reduce services, which decrease their ability to address patient needs. At the same time, commitment to improving the health of rural Americans requires attention to the so-called upstream factors shaping rural health. That means preserving the safety net programs so vital in rural areas with underemployment and low-paying jobs, strengthening rural economies and investing in high-quality education. If our leaders are serious about reform that will lessen the rural-urban mortality gap, they should recognise the unique needs of rural America and ensure health care policy reflects how vital access to quality care is to their financial success – not to mention their well-being. Claire Snell-Rood, Assistant Professor of Public Health, University of California, Berkeley and Cathleen Willging, Adjunct Associate Professor of Anthropology, University of New Mexico This article was originally published on The Conversation. Read the original article.

Trump's health care policy is disastrous for rural America

Dr Govinda KC spent 22 days lying on a gurney in a hospital in Nepal&#39;s capital Kathmandu, but he was not a patient. The orthopaedic surgeon was on hunger strike.

Dr KC has gone on hunger strike 10 times over the past four years in an attempt to pressure the government to improve healthcare in the impoverished Himalayan nation -- and he is sure he will have to strike again.

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<h5>Nepal&#39;s limited health sector was further strained after the devastating 2015 earthquake, which damaged nearly a third of public clinics and hospitals</h5>
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&quot;The hospitals and medical institutions, they don&#39;t have proper infrastructure. They don&#39;t have adequate manpower, adequate equipment,&quot; said Dr KC from a hospital bed where he is recovering from his latest fast.

Nepal -- a country of 28 million people -- has only seven doctors, nurses and midwives, and 50 hospital beds, for every 10,000 people, according to the World Health Organization.&nbsp;

The WHO recommends at least 34.5 skilled healthcare professionals per 10,000 people.

The limited health sector was further strained after the devastating 2015 earthquake, which damaged nearly a third of public clinics and hospitals.

More than 80 percent of the population live in rural areas, reliant on rudimentary state-run clinics, while hospitals are concentrated in cities -- and are mostly private.

&quot;Private health care is linked to higher out-of-pocket payments, which leads to more people being impoverished as a result of health care,&quot; said Jos Vandelaer, country director for the WHO in Nepal.

Health Minister Gagan Thapa said that while Nepal has made improvements, reducing child and maternal mortality, health care remained limited -- and expensive.&nbsp;

&quot;You have one liver problem and you are back into poverty,&quot; he said.

Something of a medical Robin Hood, Dr KC, 60, is well known in Nepal for his philanthropic work, travelling to some of the country&#39;s most remote communities to provide medical care and train local health workers.

He lives in doctors&#39; quarters at the back of the hospitals where he works and spends less than a third of his salary on himself, using most of it to buy drugs and basic equipment for his clinics. His only luxury is a 20-year-old television.

He has travelled alone to help out in disaster zones around the world, offering his services to local hospitals in Haiti following the 2010 earthquake and the Philippines after Typhoon Haiyan.

Broken promises

Nepal has been plagued by political instability since it transformed from a Hindu monarchy to a federal state in 2008, two years after the end of the bloody decade-long Maoist insurgency.

The revolving door politics has seen competing parties seek to retain influence by stacking loyalists within the bureaucratic structures -- including in the health sector.

A new constitution agreed last year included a pledge for universal healthcare, but the charter is yet to be implemented.

Private hospitals and medical colleges have mushroomed, filling a hole left by the limited government-run health sector, and often owned by the politically well-connected.

&quot;It is supposed to be a service-orientated sector, but it has turned to be [a] profit making sector for the political parties, for the politicians themselves,&quot; said Dr KC.

Top of Dr KC&#39;s demands is an end to the political meddling that he says is putting business interests ahead of developing public health services.

Training is particularly contentious, dominated by fee-based medical schools which critics say lack basic facilities and enrol too many students each year.

&quot;There is no commercialization of the medical education sector in the big developed countries, whereas in our country it is so rampantly commercialised,&quot; said Dr KC, who trained in Bangladesh with residencies in Britain and Switzerland.

Health minister Thapa said at least six members of the government&#39;s advisory health committee, which has consistently blocked the passing of a medical education bill to regulate doctor training, had links to private medical colleges.

The bill was one of the main demands Dr KC made in his latest strike, his longest yet, which ended in early December after he reached an agreement with the government.

But the surgeon and his supporters have little confidence things will change quickly.

&quot;This is the tenth time that Dr Govinda KC has been in hunger strike, that means there has been nine times the agreement has been broken,&quot; said Dr Lijan Maharjan, part of his negotiating team.

Lying on a hospital bed, a woollen hat pulled down low against the cold, Dr KC appeared resigned to another strike.&nbsp;

&quot;They won&#39;t let it happen if I don&#39;t,&quot; he said.

(AFP)

Dr Govinda KC has gone on hunger strike 10 times over the past four years in an attempt to pressure the government to improve healthcare

Dr Govinda KC spent 22 days lying on a gurney in a hospital in Nepal's capital Kathmandu, but he was not a patient. The orthopaedic surgeon was on hunger strike. Dr KC has gone on hunger strike 10 times over the past four years in an attempt to pressure the government to improve healthcare in the impoverished Himalayan nation -- and he is sure he will have to strike again. Nepal's limited health sector was further strained after the devastating 2015 earthquake, which damaged nearly a third of public clinics and hospitals × "The hospitals and medical institutions, they don't have proper infrastructure. They don't have adequate manpower, adequate equipment," said Dr KC from a hospital bed where he is recovering from his latest fast. Nepal -- a country of 28 million people -- has only seven doctors, nurses and midwives, and 50 hospital beds, for every 10,000 people, according to the World Health Organization. The WHO recommends at least 34.5 skilled healthcare professionals per 10,000 people. The limited health sector was further strained after the devastating 2015 earthquake, which damaged nearly a third of public clinics and hospitals. More than 80 percent of the population live in rural areas, reliant on rudimentary state-run clinics, while hospitals are concentrated in cities -- and are mostly private. "Private health care is linked to higher out-of-pocket payments, which leads to more people being impoverished as a result of health care," said Jos Vandelaer, country director for the WHO in Nepal. Health Minister Gagan Thapa said that while Nepal has made improvements, reducing child and maternal mortality, health care remained limited -- and expensive. "You have one liver problem and you are back into poverty," he said. Something of a medical Robin Hood, Dr KC, 60, is well known in Nepal for his philanthropic work, travelling to some of the country's most remote communities to provide medical care and train local health workers. He lives in doctors' quarters at the back of the hospitals where he works and spends less than a third of his salary on himself, using most of it to buy drugs and basic equipment for his clinics. His only luxury is a 20-year-old television. He has travelled alone to help out in disaster zones around the world, offering his services to local hospitals in Haiti following the 2010 earthquake and the Philippines after Typhoon Haiyan. Broken promises Nepal has been plagued by political instability since it transformed from a Hindu monarchy to a federal state in 2008, two years after the end of the bloody decade-long Maoist insurgency. The revolving door politics has seen competing parties seek to retain influence by stacking loyalists within the bureaucratic structures -- including in the health sector. A new constitution agreed last year included a pledge for universal healthcare, but the charter is yet to be implemented. Private hospitals and medical colleges have mushroomed, filling a hole left by the limited government-run health sector, and often owned by the politically well-connected. "It is supposed to be a service-orientated sector, but it has turned to be [a] profit making sector for the political parties, for the politicians themselves," said Dr KC. Top of Dr KC's demands is an end to the political meddling that he says is putting business interests ahead of developing public health services. Training is particularly contentious, dominated by fee-based medical schools which critics say lack basic facilities and enrol too many students each year. "There is no commercialization of the medical education sector in the big developed countries, whereas in our country it is so rampantly commercialised," said Dr KC, who trained in Bangladesh with residencies in Britain and Switzerland. Health minister Thapa said at least six members of the government's advisory health committee, which has consistently blocked the passing of a medical education bill to regulate doctor training, had links to private medical colleges. The bill was one of the main demands Dr KC made in his latest strike, his longest yet, which ended in early December after he reached an agreement with the government. But the surgeon and his supporters have little confidence things will change quickly. "This is the tenth time that Dr Govinda KC has been in hunger strike, that means there has been nine times the agreement has been broken," said Dr Lijan Maharjan, part of his negotiating team. Lying on a hospital bed, a woollen hat pulled down low against the cold, Dr KC appeared resigned to another strike. "They won't let it happen if I don't," he said. (AFP)

Hunger-striking doctor demands better healthcare in Nepal

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