In Sri Lanka, health and education programs are intact despite conflict. Why can’t it be the same in Nepal?
From Issue #283 (27 January 06 - 02 February 06) |
TABLE OF CONTENTS
 Here in eastern Sri Lanka, one year after the tsunami and amidst a fraying ceasefire, thoughts turn to a return to war in Nepal. Inevitably, one is inclined to make comparisons and the paradox is that despite a separatist civil war that is much more virulent than Nepal’s, the health care system on this island is still intact.
Tensions are rising again in Sri Lanka’s northeast, too, after four years of ceasefire. But the rebels have a man in charge of their health service. There are no guns about as we go to see him and he speaks fluent English. Even more surprising, he had all the public health issues in the area at his fingertips or if he didn’t remember he would pull out a file and find the information which include assessments, research and programs.
Having visited the war-torn far western regions of Nepal many times over the past 10 years of conflict I never came across a single Nepali Maoist leader who had even a fraction of the health information about the local population as this man had. No Maoist I met in Nepal ever kept any records or had reports.
And while Nepal’s conflict has made an already horrific public health situation, especially maternal health, much worse, here in Sri Lanka health and education are so important that in the past, both sides have stopped fighting at exam time or during vaccination campaigns.
The Sri Lankan government still pays for schools and teachers, hospitals and doctors. The Tamil Tigers allow health workers access to their territory whenever there is an inoculation drive or health survey. Except in some remote parts of northeastern Sri Lanka, the immunisation coverage in Sri Lanka is much higher by far than anywhere else in South Asia.
There are some areas where health personnel lie about the success of their vaccination campaigns and in these places it is very reminiscent of Nepal. In one village in the Tiger-controlled northeast we asked the women if all the children were given polio doses. They said sometimes children were given only one dose and the health worker would fill out the card to make it look like all the doses were given so he wouldn’t have to come back.
Even before the ceasefire, the midwives of Sri Lanka’s public health service were doing a good job. The result is that despite the war, Sri Lanka’s maternal mortality rate is at par with middle-income countries and much lower than other nations in the region. In Sri Lanka, less than 40 mothers die for every 100,000 live births while Nepal’s national rate is 600 and in parts of Rolpa and Jumla it is at least 1,000.
The reason is Sri Lanka’s heavy investment in health and education since independence. The momentum of this success has kept public health systems intact despite disruptions caused by conflict.
It is just the opposite in Nepal: health and education have suffered directly as a result of the conflict. In fact, there is a deliberate policy in Nepal to target education as a part of the conflict strategy.
Sri Lanka’s emphasis on health and education are self-enforcing. Higher literacy of women (95 percent of women here are literate compared to 35 percent in Nepal) has helped reduce infant and maternal mortality.
The other reason is that most Sri Lankan women give birth in hospitals where complications can be treated. In Nepal, only 10 percent of deliveries take place in hospitals. But in far and midwestern Nepal, nearly 100 percent of deliveries are at home.
No two wars are alike. There are things Nepal shouldn’t learn from Sri Lanka, especially about allowing ethnic tensions to boil over into full-scale civil war. But there are things we should learn how despite the conflict there is still a strong emphasis on female literacy and public health.
Dr Aruna Uprety is working for an international aid agency in Sri Lanka. |
|
GO TO TOP
