PHYSICIANS AND PRINCIPLE CENTERED DELIVERY OF HEALTH SERVICES

Abstract

ABSTRACT Health is the fundamental right of human beings and the constitution of Nepal also envisages that the state will follow the policy of developing health of the people to improve their living standards. The national health policy and the evolution of health services in Nepal reveal that there have been attempts to reach all the citizens with quality services. Health is defined and understood in different ways by different people. However, health of the population is determined by situation and services outside the purview of health services. The extent to which health services can influence health of the people is limited and there are groups of people who advocate that the physicians be active outside the area of health services and medical care to promote health. Ideally the principles that guide the health services are equity, quality, relevance and cost- effectiveness, efficiency and compassion. The values of beneficence, non-malfeasance and autonomy also form the cornerstone of the health services. Review of the current health services in Nepal show that further efforts are needed for our health services to achieve those principles. The health services are yet to reach all the population, there is a variation in the quality of services available at different places of the country. There is not much information on the cost-effectiveness of the services. A perusal of the health literature from the developed countries recognize that medical harm is one of the important cause of illness but the similar studies is lacking in our country. The issue of autonomy is still in infancy in Nepal. There is not much evidence of efforts for quality assurance of the services available. A functional collaboration between medical education, health services and medical practitioners is expected to achieve ideal values in the health services. There have been a number of international and national efforts to bring changes in medical education, medical practices and health care system to make the health services more equitable, relevant, and cost-effective and of high quality. The competences and attitudes the physicians must have in order to provide principle-centered health services have been identified by a number of studies. Similarly the ways to achieve those goals through better collaboration among the principal stakeholders as well as what physicians themselves can do with assistance from these stakeholders have been suggested. Key Words: medical education, medical practices, professional councils, health services, and principles of health services, equality and heath.