Overview of Health Service in Nepal

    Nepal, a landlocked country, situated in South Asia sandwiched between India and China. It is a geographically diverse country consisting of a variety of landscapes ranging from the flat terai plains of the south, the central mid-hills region to the foothills and up in to the majestic Himalayan mountain range which occupies 0.03 % and 0.3% land area of the World and the Asia respectively. The HDI of the country is 0.491 (NHDR, 2014) whereas Kalikot, as a district lies at last 3 of 77 districts in HDI with just 0.374 (NHDR, 2014) in country. The per capita income of the country is $1160 (NHDR, 2014) per year, among the lowest in the world and per capita income of Kalikot is $578 (NHDR, 2014). Similarly, the average life expectancy rates of Nepalese people is 68.8 (as per CBS, 2014) and there are various reason behind this of which major are low literacy rate, low living standard, high poverty (25.16% people living below poverty line; CBS 2011) and above all unavailability of adequate health service. Accessibility of human being to health facilities is one of the basic human needs. Health is wealth, sound physical and mental state is essential for all and without which nothing can be done properly. The national health policy 2076’s main thrust is to increase accessibility of the rural population to health services. This has been envisaged through the series of health facilities including sub-health post, health post, primary health care center, hospitals etc. But many people reside in rural area (83% population living in rural areas; CBS 2011) do not have the access to health service because the services available at these levels are inadequate and they cannot afford private clinic and nursing home.

    Heading Nepal Kathmandu Kalikot
    Human Development Index(Geometrical Mean method) 0.491 0.632 0.374
    Human Poverty Index 31.12 22.45 45.2
    Percentage of people not expected to survive to age 40 7.52 4.39 13.38
    Adult illiteracy rate 40.43 15.96 54.7
    Adult Literacy 59.57 84.04 45.3
    Percentage of children under age five who are malnourished 40.5 32 54.1
    Life expectancy 68.8 68.55 63.64
    Per capita income (PPP $) 1160 2764 578

    Source: NHDR, 2014

    Nepal is regarded as one of the poorest and least developed countries in the world with the population is more than 27 million. It can be divided into two main ecological regions, the mountainous/hilly part and the plains. 55% of the populations live in the hills and mountains and

    45% live on the plains. The total numbers of allopathic doctors are 21000 and majority of them are staying in capital and other major cities. The public and doctors ratio is approximately 1500:1. Health workers in rural health care, who serve most of the population, are isolated from specialist support and up to date information. The advent of ICTs has unleashed new opportunities to the delivery of health services. Telemedicine may in fact have a more profound impact on developing countries than on developed countries.

    In Nepal, top ten OPD diseases are related to communicable and infectious diseases. These types of diseases can be diagnosed and managed with the help of images and physical examination to patients is not necessity. Further, simple change in health habits can help to reduce the burden of these diseases, which can be provided through Telemedicine.

    HealthCare is a vital need in the rural Nepal. Primary health care facilities for rural population are highly inadequate, despite several initiatives by Government & private sector the rural and remote areas continue to suffer from absence of quality healthcare. Though there have been efforts by the Government to address the needs of rural Nepal through Primary Healthcare Centers, it has been observed that this network is inadequate due to the problems of access and availability of good doctors in rural areas.

    In the absence of healthcare facilities in the villages of Kalikot, the rural people tend to visit the nearest towns (Manma, Jumla, Nepalgunj, Surkhet and finally to Kathmandu) for their healthcare needs. Since a visit to a doctor in town has financial implications for the villagers in terms of transportation, accommodation cost and consulting costs, not to mention loss of work/pay, the villagers tend to use this as a last resort. This usually means that either they tend to self-medication or that they approach a doctor at a late stage. More dangerous is to use remedies prepared by unauthenticated practitioners in their ownership.

    At present, primary health care level services are available in the health post (HP) and primary health care centers (PHC), these provide basic integrated promotive, preventive and curative primary health care services and the PHCs provide both preventive and curative services including emergency cases. The secondary and tertiary level health services are available at district, regional/provincial and central hospitals. The district hospital with 15-25 beds is considered the main health institution at district level that serves as first referral center. The regional and provincial hospitals serves as secondary referral centers where specialist services are available and the hospitals at center level are tertiary referral center having better facilities and experts. The infrastructure, facilities, human resources and services in HP, PHC, district and provincial hospital are inadequate to deal with many health problems. People are unable to get proper services from those health institutions. Therefore, many private sector health institutions established as a substitute of existing government supported health institution to provide service to the people. But most of the private sector health institutions are concentrated in urban area like Kathmandu, Pokhara, Biratnagar etc. and the service is highly expensive and inaccessible for those reside in remote places.

    Access to proper healthcare is a fundamental right of people across the globe and it becomes the duty of the respective government agencies to deliver this right to its citizen. Also, it becomes the task of the respective Government to ensure all the basic health services and deliver all the

    emergency services to the people. Despite being established as a Fundamental Rights in the Constitution of 2015; the access to healthcare still remains a distant dream of many people, especially those who reside in the remote parts of Nepal. However, the cases of the urban areas of the country are not same, thus making the gap wider between the rural and the urban area in the access of such facilities. Are all the services limited only to the urban areas of the country? Is an important question that arises here. The ever-changing government too has been a reason as no concrete policy-making decisions could be taken amidst the turmoil. With the formation of a stable government, access to healthcare still doesn’t appear on the priority list of the government.

    Access to healthcare in the remote area has always been poorly planned and people do not have a proper access to an emergency care, having instances of people walking for hours or even days to access healthcare services. In such cases, because of the time taken to avail medical services, the severity of the matter increases, resulting delay in seeking care, delay in reaching care and delay in providing health care making the health status of rural area a disastrous.

    To ensure access to health as a fundamental right, the Government of Nepal has to establish 15- bed hospital in each local governing unit, as per Nepal Health policy, 2019.This is where the role of Raskot hospital comes in hoping to be the messiah of people, who have been long deprived of such healthcare services due to the inaccessibility and deprivation. The fundamental purpose of this is to bridge the gap between the service providers and its beneficiaries. Although this is the premier one of its kind, there is a need of more than 500 such hospitals throughout the country.

    Situation Analysis

    Raskot is regarded as an urban municipality located in Kalikot District of Karnali Province of Nepal with the total area of the municipality is 59.73 square kilometers (23.06 sq mi) and the total population is 18636 individuals. The municipality is divided into total 9 wards. The municipality was established on 10 March 2017, when Government of Nepal restricted all old administrative structure and announced new local level units as per the new constitution of Nepal 2015. Sipkhana, Siyuna and Phurkot Village development committees were incorporated to form this new municipality. The headquarters of the municipality is situated at Siyuna.

    Karnali Province lies to the Western part of Nepal and it is bordered with province number 5 at the south, Gandaki province at the East and China to the north and province Sudurpaschim to the west. In this province, only a limited private health institution provides health services, and those are inadequate for population of Karnali province, which is 1743006 (HIMS 2074/75). Within Karnali province, Kalikot is one such district which is geographically remote and physically difficult. This area further comprises of Humla, Jumla, Mugu, Kalikot, Dolpa, Surkhet, Jajarkot, Dailekh, Salyan and Rukum. To get medical service people need to travel to nearby traditional healer. As an alternative to the traditional healer, they need to travel to Manma, Jumla, Surkhet or Nepalgunj but such alternative sources become expensive and challenging as well. All in all, one is in the position to say that the health situation of district is in bad condition and that district hospitals are rarely equipped with medical doctor, tools and equipment etc. Along with that even other health institution are in poor situation and mostly operated by non-medical practitioner.

    Number of health facilities


    Type of Health Facility National Karnali Kalikot Raskot
    Public Hospital 125 12 1 0
    PHCC 198 13 2 0
    HP 3808 336 28 3

    Source: HIMS 2974/75

    Observing at the data of above table (table 1) and health profile of region (annexure 1) , one can clearly infer that there is a great need of well-equipped Community hospital in Kalikot to provide quality health service to the people of the area. Going parallel to Sustainable Development Goals 2030, that was adopted by the country, goal 3 is directly related to improving health and providing quality healthcare, it is clear that progressive initiatives must be undertaken in reaching these goals, and innovative solutions recognized and utilized. By facilitating the rapid dissemination of information to remote and underdeveloped regions, by acting as a free multiplier for existing healthcare professionals and infrastructures, and by increasing access to qualified healthcare, telemedicine initiatives contribute to the fulfillment of these development goals.


    The region is geographically isolated, as the region is not connected to Karnali highway and Central Electric Transmission line. The region with nearly 100000 population has to travel nearly 8 hours (which is around 50 km) for nearest district hospital. The nearest hospital at district headquarter Manma, itself is a 15 bedded hospital, which is overcrowded most of the time. Following points further describe the rationale for need of the hospital.

    • Out of 77 districts, the privileged district itself is at last 5 in district health status of
    • Access to affordable health care services far exceeds the income of the majority of the population Nepal. More than 50% of total population is under
    • The total district of population 153316 (HIMS 2074/75) has only 4 doctors (observed) in district hospital
    • Lack of any emergency care in the vicinity deteriorates the life of the The poor maternal and infant mortality so lack of emergency caesarian operations.
    • Nearly 55% are illiterate in Kalikot
    • Nearly 83% are Agriculture based (2011 CBS).
    • Life expectancy is around 63
    • Human development index is just 37.
    • Around 40 km away from nearest national high way i.e., Karnali
    • Major Clinical conditions that need
      • Acute gastroenteritis (AGE),
      • Fever of unknown origin (FUO),
      • Fractures and trauma,
      • Chronic obstructive pulmonary disease (COPD),
      • Upper and lower respiratory tract infections (U and RTIs),
      • Abdominal pain (acute abdomen, biliary colic, renal colic, acid peptic disorder, and so on),
      • Obstetric (and gynecologic) emergencies
    • Currently three health posts, lead by health assistant, are serving the need of the locals which is not sufficient to treat the above clinical The existing health post lacks sufficient trained health professionals, proper cold chain center for vaccines and injections, well established labs for proper diagnosis, Health supplies, Health information system.

    A community hospital will provide and ensure affordable access to healthcare services for the poor communities in the surrounding hills of Raskot municipality. Based on vision of 15 bedded hospital of new health policy of Nepal government, hospital will:

    • Provide emergency services, treatment of common diseases and injuries, maternal and peri- natal healthcare, a 24 hour/day delivery service, emergency obstetric care, child health services (including oral health services, accident prevention and rehabilitation, post trauma problems, operation services, chronic disease – diagnosis, control and referral, counseling and school health program and preventive services) and outreach support such as seasonal camps at a community
    • Complete smart hospital with Digitalization, Telemedicine
    • A specialized doctor (MD GP), and additional nurses and health professionals in will lead the hospital after
    • Have a operating theatre to the capacity for surgery, specifically for emergency obstetrics and gynecology and other emergencies surgery; as well as a full range of simple
    • Ambulance service to carry the emergency and incapable patients from remote part of the
    • Provide support and outreach services to the surrounding
    • Remain as a health supporting organization for local governing
    • Universal Health Coverage as per National Health Policy
    • Community Health Awareness and Interventions programs for health promotion, awareness, attitude and behavioral practices towards maintaining