Financial burden of kidney disease in Nepal
In Nepal, the GDP per capita is 1200 USD (estimated for 2010), which is in nepali rupees 8000 NRs per month per person. The average household income is estimated to be 15 000 NRs per month, and the average consumption is also estimated to be about 15 000 NRs per month.
The cost of twice weekly regular hemodialysis is min. 40-50 000 Nrs per month, if there is no complication. It includes not only the cost of treatment, but also the medicines, injections, transportation, etc. The cost of peritoneal dialysis is 30 000 NRs, and additional costs are the medications. Transplantation if it is done in Nepal, then 4-5 lakh NRs is the cost of operation, and the cost can rise in case of complication. If transplantation is done in India, the costs can be 2-3 times higher.
How can people afford such treatments? The sources can be the following: family savings, taking loans or borrowing, selling property or jewelry, family members working abroad sending money home, collecting donation, pension or health welfare service eg. ex-army persons. The government contributes to the expenses by providing 50 000 Nrs once for dialysis patients, and 1 lakh NRs for transplantation. Besides in government hospitals dialysis facility service charges are less, than in private hospitals. Chronic kidney disease is huge burden, in terms of finance, time, quality of life. Poor people will become even poorer. Loans, consumptions of savings, etc. often cannot be recovered over the lifetime of the surviving family.
Prevention is the best intervention, with the possible lowest costs, possible greatest savings can be earned, in terms of years of quality life. Prevention means, to stop behaviours which are harmful for the kidneys, encourage behaviuor that protects the kidneys. For early stages of kidney disease, medicines and controlling disease conditions can help in slowing down the progression of the disease, for example, high blood pressure, diabetes.
In many countries there is a government support program for kidney diseases, for dialysis and transplantation. In those programs the dialysis and some medicines are provided for free to the patients. This kind of support system would be appreciated for the nepali population too, as at the present situation, bigger proportion of patients needing dialysis are sentenced to early death and huge financial burden on the family. We should try to work out a mechanism, which supports these needy patients in many ways. For example, alleviating import tax on the dialysis consumables and equipment could reduce the costs of treatment. An agreement with transportation companies could give discounted or free transportation for these patients when they go to their dialysis session. Drug companies in Nepal should offer 10 percent of their profit in the form of free medicines, and that could be used to support the kidney patients too.
If someone has a fever, high blood pressure or diabetes, usually, the monthly cost of treatment is bearable. If someone need an operation, the money can be arranged in some way, and then patient will recover. But in chronic kidney disease, it does not matter how much someone spends on dialysis, he will still not be cured, in fact, he will live until and unless his money lasts. And this is not fair to anybody. For this reason we should take kidney disease as a separate entity and help those who suffer from it with the common effort.
2068 Falgun 22nd
Dr Klara Paudel
Gandaki Medical College Teaching Hospital
Department of Medicine