Intended for healthcare professionals


Nepal’s scramble to piece together a health budget amid rumoured cuts

BMJ 2023; 382 doi: (Published 18 September 2023) Cite this as: BMJ 2023;382:p1824
  1. Marty Logan, freelance journalist
  1. Kathmandu, Nepal
  1. martydlogan{at}

Heads spun after warnings of budget cuts of up to 40% reached Nepal’s health ministry. Attempts to balance the books reveal the fragile nature of healthcare funding in lower income countries, reports Marty Logan

Mandeep Pathak’s mind is on full alert. A tractor carrying local people to a funeral crashed near his rural hospital in Nepal, leaving one dead and 16 injured, and he is busy in the operating theatre. But the orthopaedic surgeon and medical director at Bayalpata Hospital has a second emergency on his mind: funding.

After Nepal adopted a federal system, the 70 bed hospital had its governance moved to a new province created by the change. In 2022, Nyaya Health Nepal, the non-governmental organisation that runs the hospital, signed a five year deal in which the Far West province paid 40% of its operating costs.

But when the province’s annual budget was released in June there was no money for Bayalpata Hospital, which provides services free of charge. “Both the chief minister and the minister of finance said ‘it must be a mistake,’” says Pathak.

Bureaucrats told him that they have money but it has been earmarked for spending only on buildings and equipment, which Pathak says he doesn’t need. Bureaucratic reasons mean there is currently no way for such funds to be legally used for day-to-day operations.

The province has set up a special committee, which seems sympathetic, but the surgeon thinks the chances of getting the money are, at best, 60-40. Meanwhile, hospital management is delaying signing new contracts with staff. “We have money for about seven or eight months. After that we’d have to think about retrenchment,” he says.

Pathak is not the only health official to be wrong footed by Nepal’s budget process. On 28 May, one day before the central government …

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