In a planning meeting held a few days ago, officials from the National Centre for AIDS and STD Control complained that the budget ceiling for the upcoming fiscal year is too low to continue even basic services, including antiretroviral treatment and HIV testing programmes.

They also warned that they would have to trim the programmes in line with the allocated budget, and that the relevant agencies would be responsible for any negative outcomes.

“They said the budget cut will affect most services, and they also warned that the agencies concerned would be responsible if infected people are deprived of basic services and medications,” an official at the Department of Health Services, who also attended the planning meeting, quoted them as saying. “Disruption in antiretroviral treatment and other services will also be a serious international issue.”

The centre is among the multiple agencies under the Ministry of Health and Population, which are currently busy preparing programmes for the fiscal year 2025-26. Most of these agencies have voiced concerns about insufficient budget, which will directly impact basic healthcare programmes. What alarmed them further was the instruction to prepare programmes on a hypothetical budget, with unclear funding sources.

“The budget ceiling we have been given is insufficient even to continue essential services—including antiretroviral treatment, prevention of mother-to-child transmission programmes, CD4 count, viral load and testings, for a year,” said Lok Raj Pandey, information officer at the centre. “The budget ceiling for the next fiscal year has been reduced by Rs55 million compared to the current fiscal year.”

The centre provides antiretroviral medicines to over 25,000 people living with HIV, along with services like prevention of mother-to-child transmission, CD4 count and viral load tests, and HIV testing during pregnancy, among others, all free of cost.

“Several healthcare programmes for the ongoing fiscal year, including all committed by the USAID, have been halted due to an abrupt aid suspension,” said Dr Bibek Kumar Lal, director at the Family Welfare Division under the Department of Health Services. “If the budget ceiling is not revised, several crucial schemes, including vitamin A supplementation programme, purchase of essential commodities of family planning and nutrition will be affected.”

Vitamin A supplementation campaign is a success story in Nepal, as it has helped tackle the issue of vitamin A deficiency in children, which used to be a major public health problem in the country. Regular supplementation campaigns are estimated to have cut deaths among children under five by 23 percent over the past two decades.

Health facilities across the country are already out of stock of Depo-Provera, a birth control shot for women, as the government failed to purchase them on time. The shortage of this popular contraceptive injection could persist for months, as the procurement process has just started, officials say.

In Nepal, nearly half of all pregnancies are unintended, and close to two-thirds of them end in abortion, according to a report by the UNFPA.

Officials say that shortage of family planning instruments—condoms, pills, implants, and emergency pills—could worsen as the government has lowered the ceiling for health budget at a time aid agencies have also reduced their support. A further shortage of these items will lead to a rise in unwanted pregnancies, unsafe abortions, and maternal and neonatal deaths.

Every year, around 100,000 women undergo abortions in Nepal at legally authorised clinics and health facilities. Gynaecologists, however, say the actual number of abortions could be several times more, as many abortions, especially medical ones, go unreported.

Programmes of nutrition, newborn care and others are also associated with the targets of sustainable development goals (SDGs).

SDGs, a follow-up on the Millennium Development Goals (MDGs), aim to end poverty, hunger, and all forms of inequality in the world by 2030, and Nepal has committed to meeting the goals.

Lal told the Post that the budget ceiling for the division for the next fiscal year has been reduced by Rs520 million compared to the current fiscal year, which will affect most programmes.

The Ministry of Finance has set a ceiling of Rs83 billion for the Health Ministry’s expenditure—Rs3 billion less than the allocation for the current fiscal year. Officials have also complained that they are being asked to design programmes based on a hypothetical budget, whose funding sources are yet to be confirmed.

“We have been asked to prepare programmes based on a Rs2.2 billion donor budget, but the actual commitment is only Rs1.2 billion,” said an official at the Department of Health Services, asking not to be named, as the official is not authorised to speak to the media. “Several healthcare programmes have already been halted due to aid suspension by USAID, and now we are being asked to prepare programmes based on a fictitious budget.”

Officials say even if programmes are prepared, their implementation will remain uncertain due to lack of funds.

Several ongoing healthcare programmes have already been affected after the US government suspended nearly all foreign assistance worldwide for three months in the last week of January, soon after Donald Trump assumed presidency.

Among the terminated programmes are key health surveys, including the micronutrient survey, which was planned over the past 10 years, the lymphatic filariasis transmission survey, and the promotion of exclusive breastfeeding at 18 major hospitals.

Awareness programmes targeting female sex workers, homosexual men, and other high-risk groups have also been halted.

Other affected programmes include ‘outbreak investigation training’ for doctors, neonatal care training for hundreds of doctors and nurses, and various programmes related to the Sustainable Development Goals, including maternal and child health, nutrition, reproductive health, and family planning. Programmes under the Integrated Health Information Management System have also been hit.

Officials say liabilities of several social security programmes are rising every year, and the budget allocated for healthcare for the upcoming fiscal year is insufficient to meet these needs.

“We still hope that the budget ceiling will be reconsidered and increased,” said Dr Bikash Devkota, secretary for the Ministry of Health and Population. “We are already in a budget deficit trying to reimburse services of several social security programmes—including health insurance, safe motherhood programmes, and others.”