Health Sector Stagnates Under Minister Nisha Mehta's Six-Month Tenure

Kathmandu. With the formation of the government led by Prime Minister Balendra Shah, significant changes and efficient service delivery were expected in the public health sector. However, even after six months since Nisha Mehta took charge as the Minister of Health and Food Hygiene, the health sector has failed to gain momentum. The ambitious reform programs announced by the government at the time of assuming office have not been implemented, leaving citizens struggling to access even basic healthcare services. Mehta assumed office at the Ministry of Health on March 26, 2025 (2082 Chaitra 13). Upon assuming office, she thought, 'The Health Minister, with a nursing background, will surely do something; reforms will come to the health sector.' However, four months after she became minister, nursing activist Jyoti Ranabhat was forced to go on a hunger strike. Ranabhat, demanding the immediate implementation of basic issues such as minimum wages, an end to contract/temporary employment, creation of positions, and improvement in the quality of study and teaching, drew attention to the Ministry of Health with various 15-point demands. Although the government broke Ranabhat's fast through an agreement, most points remain stuck on paper. In August, doctors went on strike after an attack on a doctor at Narayani Hospital. The strike was called off after the government pledged to advance legal reforms for doctor safety. However, incidents of attacks on doctors have not stopped, and doctor safety has not been established as a national policy agenda. The government's decision to provide two days of public holiday per week without prior infrastructure has directly impacted the health sector and patients. Due to the lack of concrete plans for holiday management, rotation systems, additional manpower, or incentives, government hospitals experience an unusual rush of patients on the first working day of the week (Monday). Patients suffer from long queues, and patients have to wait for up to seven months for surgery. The announcement under the Prime Minister's 100-day agenda to provide 10% of total hospital beds free of charge and monitor through a 'Free Health Portal' remains mere propaganda. According to portal data, out of 3,580 free beds, 2,590 beds remain vacant. Due to a lack of information, weak coordination, and limited access, ordinary patients are forced to wander without treatment. The plan to implement digitalization and an integrated health information system within three months is still incomplete. Similarly, the 100-day commitment to operate 'Sulah Pharmacy' (accessible pharmacy) in government hospitals across the country and provide medicines at minimum prices under generic names is stalled due to a lack of clear guidelines. Health administrators say, 'Hospitals already had pharmacies, but the idea was to rename them as Sulah Pharmacies and proceed accordingly, with a clear directive (guideline) and a start like 'this is how it's done in X and Y places as a model,' but that situation has not arisen.' Now, even the municipalities that started from one or two places are facing a situation where medicines are not available, and directives have to be issued from the Prime Minister and Council of Ministers' Office and the Ministry of Health. Those administrators say, 'This is also not operating very well. The related issue was to prescribe under generic names, but that has also not been implemented.' Although some initial efforts have been made to establish burn wards at the provincial level and operate air ambulance services in hilly areas, their effective operation has not been achieved. Despite a commitment to allocate 8% of the total budget to the health sector, the actual budget has not exceeded 5%. Due to a lack of budget and policy clarity, plans to form a National Accreditation Authority are gathering dust. The government has not yet come up with concrete plans for the formation and operation of important structures like the Food and Drug Administration, Center for Disease Control (CDC), and Accreditation Authorities. Although a policy has been adopted to promote Nepal Drug Limited and Singha Durbar Vaidyakhana, the proper management of existing medicines and equipment in emergency situations (e.g., floods/landslides) has not been achieved, leading to a scarcity of medicines in various parts of the country during disasters. Within the ministry, a climate of fear has been created due to political or other biases dominating transfers, appointments, and responsibility allocation over criteria and competence. Section chiefs and high-ranking officials are shirking responsibilities, leading to a 'you stay quiet, I stay quiet' situation. As Minister Mehta herself cannot make clear decisions, every file from the ministry has to be sent to the Prime Minister's Office secretariat, raising questions about the ministry's autonomy and efficiency. In some sections of the Ministry of Health and its subordinate departments, heads who do not have expertise are in charge. Minister Mehta has been transferring and reassigning employees against the criteria. It appears that clinical and junior employees have been given administrative leadership based on political connections. For example, the position of Chief of the Family Welfare Division under the Department of Health Services currently has a sanctioned post for the Public Health Administration group. However, orthopedic specialist Dr. Om Aryal has been appointed to this post. Employees selected from the Public Health Administration group by the Public Service Commission are prepared for the policy, planning, management, and administration of the public health sector. Similarly, forensic physician Dr. Birendra Mandal has been brought into the Management Division of the Department of Health Services. The policy arrangement is to place a Public Health Administrator (Health Inspection) in the Management Division. Not only the division but the Department of Health Services has appointed an acting director-general for the second time. Anuj Bhattachan of the 11th level has been removed from the responsibility of acting director-general and replaced by pediatrician Dr. Krishna Prasad Poudel. In remote areas (like Jumla, Bajhang), pregnant women are still forced to lose their lives on the way due to not receiving timely treatment. The ministry has proven completely unsuccessful in rectifying the errors seen in the construction and operation of 396 basic hospitals under construction for years. Due to the inability to present a concrete reform roadmap in a six-month period, Mehta's performance is facing widespread criticism. Former Deputy Director-General of the Department of Health Services, Chudamani Bhandari, stated that the lack of government priority for health in the budget has become a major issue, requiring additional budget and increased initiative. He said, 'The restructuring of the Ministry of Health included in the policy and programs and budget – especially the formation of the Food and Drug Administration, CDC, and National Health Accreditation Authority – has not progressed yet.' He stated that there has been insufficient progress in making the food and drug regulatory body autonomous and in starting at least some work. Former Additional Secretary of the Ministry of Health, Mahendra Shrestha, said that effective public health programs from the center have not been able to come for the necessary reforms in health services, strengthening of health insurance, and upgrading of health posts. Shrestha stated that even the existing services are not operating as effectively and result-orientedly as expected. Expectations were high for concrete progress from the current government in the expansion of basic hospitals, promotion of public health, and prevention of communicable and non-communicable diseases. However, concrete achievements have not been made as per those expectations. Uncertainty prevails among health workers and employees working in ministries, departments, and hospitals, and a lack of enthusiasm and motivation for work is clearly visible. He said, 'The Ministry of Health has not been able to move at the pace expected by the health workers.' With the absence of new plans and programs, neither doctors, health workers, nor the general public have been able to feel any positive change. Health officials say that the transformation and tangible activities that should be happening in the health sector are still almost stagnant.