KATHMANDU, July 23: Five years after then Prime Minister KP Sharma Oli virtually laid the foundation stones for 396 basic hospitals from his official residence in Baluwatar, only a small fraction of the promised facilities have been completed.
The government later expanded the programme by adding 261 more hospitals, raising the total number of proposed local-level hospitals to 657. Although all the hospitals were expected to be completed within two years, only 109 have been built so far.
The Public Health Service Act, 2018, enacted two years before the announcement, mandated the establishment of five-, 10-, or 15-bed basic hospitals at the local level based on need to provide essential healthcare services. However, seven years after the law came into force and five years after the foundation stones were laid, the nationwide hospital construction programme has fallen far behind schedule.
According to the Ministry of Health and Population, 109 hospitals have been completed, while 326 are under construction. Work has yet to begin on the remaining projects.
Ministry spokesperson Dr Samir Kumar Adhikari said the completed hospitals were part of the first phase of the programme, while construction of second-phase hospitals is underway. He added that work under the third phase has also begun. However, official data show that many of the 396 hospitals whose foundation stones were laid by former Prime Minister Oli are still incomplete.
Municipalities without facilities
Adhikari attributed the delays to land acquisition and project preparation, saying such a large-scale infrastructure programme could not realistically be completed within two to four years.
Until the hospitals become operational, he said local governments have continued to strengthen healthcare services through existing primary healthcare centres and health posts. According to him, the basic hospitals are intended to bridge the gap between health posts and district hospitals by providing a wider range of essential healthcare services closer to communities.
Former additional secretary at the ministry Dr Mahendra Shrestha, however, said primary healthcare centres cannot substitute for basic hospitals. He said the objective of establishing the hospitals is to provide all essential healthcare services free of charge under one roof.
The services are intended to include vaccination, integrated neonatal and child healthcare, family planning, nutrition, maternal and reproductive health, mental healthcare, treatment of communicable and non-communicable diseases, elderly care, emergency services, health promotion, Ayurveda, and other government-approved health services.
To provide these services effectively, the hospitals also need basic laboratories, X-ray and ultrasound facilities, mental health services, and diagnostic services for communicable and non-communicable diseases. They must also be staffed with adequate healthcare personnel, including medical officers, general practitioners, nurses, and other trained health workers. With most of the hospitals still under construction, stakeholders say the country's healthcare delivery system continues to face significant challenges.
"The biggest challenge is the shortage of skilled manpower and approved positions needed to provide basic services. Hospitals cannot function with MBBS doctors alone," said Dr Shrestha.
He said general practitioners and other trained healthcare professionals are essential for treating a wide range of illnesses. In their absence, many patients are referred to larger hospitals for conditions that could otherwise be managed at the local level.
Dr Shrestha also said many basic hospitals still lack the 98 categories of free medicines and essential diagnostic services guaranteed under the Public Health Service Act, leaving patients without the care they are entitled to receive. He added that public confidence in basic hospitals remains low because the quality of services has yet to improve.
Although Kathmandu Metropolitan City operates Urban Health Promotion Centres in all 32 wards, Deepesh KC, chief of the metropolitan city's Health Department, said the facilities are attracting fewer patients than expected.
Dr Prakash Budhathoki, information officer at Bir Hospital, said the growing patient burden at major hospitals is a direct consequence of delays in completing and fully operationalizing basic hospitals.
"Health services have not been strengthened in many parts of the country," he said. "Because many people are unaware of the services available at local health facilities, they go directly to Bir Hospital, Tribhuvan University Teaching Hospital or Patan Hospital even for minor illnesses. As a result, patients with serious conditions have to wait longer for treatment because specialist hospitals are overwhelmed with common ailments such as coughs, colds and stomach problems.
