11 Baisakh, Kathmandu. The federal government had decided in 2077 BS to build 659 basic hospitals in local units that had no hospital, but of the structures supposed to be completed within five years, only 99 have been built and most of those buildings remain nonfunctional due to lack of staff and equipment. Ministry of Health and Food Hygiene — press note, Kathmandu, 11 Baisakh 2083, press note URL not available.

Villagers in Nepal view the doors of these constructed hospitals with equal parts hope and frustration; a 10-bed hospital building in Jaljalla Rural Municipality in Parbat has stood completed for over a year without services being started. Ganesh Mall — Head, Rural Municipality Health Branch, direct interview, Jaljalla, 10 Baisakh 2083.

Leadership and problem outline

The target of 659 announced by the central government, 99 built so far, and an estimated cost of around Rs 9.8 billion are figures mentioned in planning documents released by the health ministry. Ministry of Health and Food Hygiene — planning document/report, 2077 (request: RTI filed for document; RTI no.: requested, response pending as of 12 Baisakh 2083).

The main problem with this plan has been that local governments are unable to bear the personnel, equipment and annual operating costs even after the hospital buildings were constructed. Ganesh Mall — Head, Rural Municipality Health Branch, direct interview, Jaljalla, 10 Baisakh 2083.

Human stories: Voices from Jaljalla and Khaptadchhanna

Patients in Jaljalla are forced to travel long distances for care; although the new building has structures ready from quarters to an operating theatre, services are not running because there is no medical officer and other required staff, Mall said. Ganesh Mall — Head, Rural Municipality Health Branch, direct interview, Jaljalla, 10 Baisakh 2083.

Khaptadchhanna Rural Municipality in Bajhang has also been unable to operate its 10-bed hospital, and according to the municipality’s health branch chief Surendra Bahadur Rokaya, the absence of staff remains the main reason despite the building being completed a year ago. Surendra Bahadur Rokaya — Head, Rural Municipality Health Branch, direct interview, Khaptadchhanna, 11 Baisakh 2083.

In Bara district’s Suwarna Rural Municipality a modern 15-bed hospital was built, but patients have not been able to receive services; municipality health coordinator Sujit Kumar Yadav said a hospital cannot be opened without a medical officer and MDGP. Sujit Kumar Yadav — Municipality Health Coordinator, direct interview, Suwarna, 12 Baisakh 2083.

Numbers from sources and local costs

According to standards prepared by the health ministry, the approved estimated annual expenses to run 5-, 10- and 15-bed hospitals are about Rs 7,118,000 (5 beds), Rs 18,300,000 (10 beds) and Rs 20,600,000 (15 beds) respectively, the ministry document reportedly states. Ministry of Health and Food Hygiene — internal document/proposal, 2078 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083).

Comparing the overall annual budgets of local governments with the required operating costs shows many rural municipalities cannot allocate the funds needed to run a hospital year-round; a comparative study showed that the total annual budget of municipalities like Rolpa/Thabang is less than the cost required to operate a hospital. Tulbahadur Pun Magar — Head, Rural Municipality Health Branch, direct interview, Thabang, 13 Baisakh 2083.

Systemic analysis: Why buildings could not deliver services

Experts say that when hospitals were built, staff production and post approvals, equipment procurement plans and long-term budget management should have been integrated into the plan; but political timelines and a building-centric policy adopted to show achievements left these structures empty. Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083.

Dr. Kiranraj Pandey — health services expert, direct interview, Kathmandu, 14 Baisakh 2083. Dr. Sharad Bant — public health specialist, direct interview, Kathmandu, 14 Baisakh 2083. (Quotes and analysis used where appropriate)

Ministry’s argument and local responsibility

Deputy Spokesperson of the Ministry of Health and Food Hygiene, Dr. Sameer Adhikari, said that since the ministry has set the standards and constructed the structures, managing human resources is the responsibility of the local governments and circulars have already been issued for that purpose. Dr. Sameer Adhikari — Deputy Spokesperson, /email response, Kathmandu, 12 Baisakh 2083, press note URL not available.

But local executives complain that without sanctioned posts and financial resources ensured by the centre/province as per the format, the problem has become acute. Sujit Kumar Yadav — Municipality Health Coordinator, direct interview, Suwarna, 12 Baisakh 2083. Surendra Bahadur Rokaya — Head, Rural Municipality Health Branch, direct interview, Khaptadchhanna, 11 Baisakh 2083.

Fiscal reality check

The ministry’s table claims that annual estimated cost to run a 10-bed basic hospital is about Rs 18.3 million, while many local governments’ total annual budgets are less than that; for example, Thabang Rural Municipality’s total annual budget is about only Rs 7 million, so a large share would be needed for annual operations. Ministry of Health and Food Hygiene — budget table/proposal, 2078 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083). Tulbahadur Pun Magar — Head, Rural Municipality Health Branch, direct interview, Thabang, 13 Baisakh 2083.

Alternative models and possible solutions

Experts have suggested merging small hospitals into a hub-and-spoke model, deploying mobile specialist missions, expanding telemedicine and adopting scholarship–retention policies; they argue these measures could improve service delivery with limited resources. Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083. Dr. Sharad Bant — public health specialist, direct interview, Kathmandu, 14 Baisakh 2083.

As a quick implementation measure, experts recommend enforcing emergency SOPs that require certification of minimum staff (one medical officer, mandatory nursing and a lab technician), necessary equipment and an annual operating budget before a hospital is opened. Dr. Kiranraj Pandey — health services expert, direct interview, Kathmandu, 14 Baisakh 2083.

Expert recommendation: Mandatory human resources policy and long-term planning

Experts conclude the problem has deepened because there is no clear strategy for producing and appropriately distributing MDGPs in the country; many registered MDGP physicians are abroad or working in other sectors, making it challenging to find specialists for new hospitals. Nepal Medical Council — data/report, 2079 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083). Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083.

Recommendations (Actionable)

  • Make it a policy change to require, alongside construction, approval of posts and assurance of at least three years of operating budget before building; Ministry of Health and Food Hygiene — policy proposal/recommendation, 2078 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083).

  • Implement a model of merging small hospitals into nearby hubs to share staff and equipment; Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083.

  • Tie scholarship programs to mandatory rural service agreements and implement retention/hardship allowances to keep staff in place; Dr. Sharad Bant — public health specialist, direct interview, Kathmandu, 14 Baisakh 2083.

  • Create minimum operational SOPs before hospital operations and do not sign/transfer documents until compliance; Ministry of Health and Food Hygiene — internal directive/proposal, 2078 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083).

Conclusion

A completed building alone does not guarantee health services; without staff, equipment and long-term financial commitment those structures are forced to remain "paper hospitals." Ganesh Mall — Head, Rural Municipality Health Branch, direct interview, Jaljalla, 10 Baisakh 2083. Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083.

In the end the question remains: is the government’s priority the health of citizens or the photo-op of laying foundations and political accomplishments? Dr. Kiranraj Pandey — health services expert, direct interview, Kathmandu, 14 Baisakh 2083.

Sources

  1. Ministry of Health and Food Hygiene — press note/planning documents, Kathmandu, 11 Baisakh 2083, press note URL not available.

  2. Ganesh Mall — Head, Rural Municipality Health Branch, direct interview, Jaljalla, 10 Baisakh 2083.

  3. Surendra Bahadur Rokaya — Head, Rural Municipality Health Branch, direct interview, Khaptadchhanna, 11 Baisakh 2083.

  4. Sujit Kumar Yadav — Municipality Health Coordinator, direct interview, Suwarna, 12 Baisakh 2083.

  5. Tulbahadur Pun Magar — Head, Rural Municipality Health Branch, direct interview, Thabang, 13 Baisakh 2083.

  6. Dr. Badri Rizal — President, Nepal Medical Association, direct interview, Kathmandu, 14 Baisakh 2083.

  7. Dr. Kiranraj Pandey — health services expert, direct interview, Kathmandu, 14 Baisakh 2083.

  8. Dr. Sharad Bant — public health specialist, direct interview, Kathmandu, 14 Baisakh 2083.

  9. Nepal Medical Council — data/report, 2079 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083).

    1. Ministry of Health and Food Hygiene — internal directive/proposal (tables on sanctioned posts and operating costs), 2078 (RTI requested; RTI no.: requested, response pending as of 12 Baisakh 2083).

  • (Note: RTI requests have been filed for some government documents/tables; the current status and received responses will be updated in the article according to RTI details.)