Despite the constitutional guarantee of health as a fundamental right, a workforce shortage at government health institutions across the country has affected service delivery, impacting patients and service seekers. Without adding permanent positions for health workers, these facilities are largely making do with contract staff.

Arun Tamang of Sarlahi arrived at Bir Hospital in Kathmandu a week ago for his mother’s treatment. The ordeal he faced during the treatment of his 65-year-old mother, who suffers from liver and heart ailments, has been equally distressing. He had to stand in long queues for tickets, payments and medicines, while tests for the liver and heart took weeks, adding to both cost and time.

As he travelled from Sarlahi, he had to rent a room in Bhaktapur, increasing his expenses. “Follow-ups are scheduled by day. The whole day is spent in queues. I don’t know how many more days I will have to run around. I have already spent Rs 25,000 and a lot of time,” he said.

Madhu Magar from Nuwakot shared a similar experience. He visited Bir Hospital for neurological care and said he was frustrated, adding that government hospitals have not improved.

The “Organisation and Management” (O&M) structure at government health facilities has not been updated since 1991. At the time, there were 1,212 approved posts for doctors for a population of 18.4 million. According to the 2021 census, the population has risen to 29.1 million, but the staffing structure remains unchanged. While vacant posts have been filled, no new positions have been created.

According to the Economic Survey 2024/25, as of mid-February and March 2025, a total of 366,505 health workers are registered, while 11,616 doctors are registered with the Medical Council. A projection published by the Medical Education Commission in 2022 estimates that Nepal will require 301,895 health workers by the fiscal year 2030/31, with a gap of 63,226 personnel between supply and demand.

Hospitals lack staff as per approved posts

Bir Hospital faces a shortage of 200 staff. Of 687 sanctioned government positions, only 487 are filled. The hospital employs 1,414 staff outside the approved posts. A similar situation exists in hospitals outside the Kathmandu Valley, with 56 vacant posts at Dadeldhura Hospital, 99 at Koshi Hospital and 53 at Bheri Hospital.

Dr Rajiv Jha, a neurosurgeon and department head at Bir Hospital, said the hospital faces nearly a 50 percent shortage of required staff. The neuro ward’s operating unit requires 25–30 nurses, but only 12 are currently employed. He said that an average of eight patients are admitted daily to the neurosurgery department.

“Only four government doctors are performing five to six surgeries daily, and one of them is on a contract basis,” he said.

Post-expansion remains limited to plans

Despite World Health Organisation standards requiring at least 4.45 doctors, nurses and midwives per 1,000 population, Nepal’s ratio stands at only 1.49. The Commission projects the ratio will reach 4.97 by 2030, but this appears difficult given budget constraints.

Efforts by the Health Ministry to add around 15,000 posts remained unfulfilled after the proposal was returned by the ministries of finance, law and general administration. Although it later received theoretical Cabinet approval, the process stalled due to a lack of budget clearance.

Prof Dr Lochan Karki, former president of the Nepal Medical Association, said the crisis stems from the government’s failure to prioritise the expansion of posts. “The average life expectancy of Nepalis has increased, the nature of diseases has changed, and the number of chronic patients has risen, but the workforce remains stuck in an outdated structure. This shows the health sector is in crisis,” he said.

He added that the shortage has led to delays in treatment, limited access to specialised services, overcrowding and inadequate patient care. “There are buildings and equipment in remote areas, but no staff to provide services,” he said, urging the government to address workforce gaps.

Delays in government recruitment

Delays in recruitment by the Public Service Commission have further complicated workforce management. While the commission has faced criticism for delays, spokesperson Purushottam Sharma said examinations are conducted as per the annual schedule.

He said exams depend on hall availability, manpower and management capacity. “In some cases, we have to conduct two to three exams in a single day. The same candidate may appear for multiple posts, making scheduling difficult,” he said, adding that efforts are underway to expedite the process.

Health workers migrating abroad

Rising migration of medical professionals due to limited opportunities at home has worsened the situation. According to the Nepal Nursing Council, 52,000 nurses have gone abroad over the past 30 years, since 1995. Medical Council data show a growing number of health workers obtaining certificates to work abroad. In fiscal year 2020/21, 1,087 doctors obtained such certificates, rising to 2,681 in the fiscal year 2024/25.

Public health expert Sharad Chandra Wasti said that although health is recognised as a fundamental right, it has not been prioritised in practice. “Many policies and workforce plans exist, but implementation is weak. The inability to create new posts has emerged as a major challenge,” he said. “The government must prioritise the health sector, manage human resources effectively and ensure proper implementation and monitoring.”