A few days ago, 16-year-old Sunita Kumari from Bara district was admitted to the Shahid Gangalal National Heart Centre in Kathmandu for the fourth time to undergo heart valve replacement and repair surgery.

On each of the previous three occasions, however, she was discharged without undergoing the life-saving procedure because her parents could not arrange the money needed.

The surgery costs more than Rs400,000, excluding the cost of medicines and other related expenses. Although the hospital provided financial assistance of up to Rs250,000 under the government’s free treatment scheme, the total cost of Sunita’s treatment exceeded the ceiling, leaving her family to arrange the remaining amount on their own.

“Even during her fourth visit, her parents had managed to collect only Rs70,000 through donations, and most of it was spent on medicines, laboratory tests, travel expenses and other costs,” said Meena KC, in-charge of the hospital’s pre-operative ward.

Sunita’s case represents the plight of hundreds of children across the country with serious heart diseases who have been unable to receive timely treatment because the hospital’s previous funding ceiling fell far short of the actual cost of complex cardiac surgeries.

That situation is now expected to improve. The hospital has revised the financial assistance ceiling for children requiring heart surgery, ensuring that patients like Sunita will no longer be denied treatment simply because their families cannot afford the shortfall.

Under the revised scheme, the assistance ceiling, which was previously fixed at Rs250,000 for all types of cardiac surgeries, has been categorised according to the complexity of the procedure which stands at Rs250,000 for minor cases, Rs400,000 for moderate cases and Rs600,000 for critical cases.

“We have seen too many children being taken home without treatment, and many never return because their families cannot arrange the money,” said Dr Rabindra Bhakta Timala, acting executive director of the hospital, which is also the country’s national referral centre for cardiac care.

When the government stopped providing additional funding for free cardiac care for children under 15 years of age some two and a half years ago, the hospital started charging families for costly surgeries and other procedures. The decision of the government and the hospital administration deprived hundreds of children of the life-saving treatment, and many poor parents started taking their children back without treatment.

Some parents’ pleaded with the doctors for free treatment or discounts, while others sought loans from relatives and acquaintances. Those who cannot arrange treatment costs or secure donations and relief from doctors had no option but to take their children home without treatment.

Sartima Kumari Gupta’s 12-day-old baby has a serious heart ailment and needs surgery. However, her family cannot afford the treatment costs. The hospital administration has assured the family that they will not be charged for the baby’s treatment.

Timala said that the decision to increase the treatment ceiling was taken by the hospital itself and that he is prepared to face any action by the Commission for the Investigation of Abuse of Authority or any other oversight agency if the move was found to have violated existing rules. “Saving children’s lives is our priority,” he said.

The government provides Rs120 million a year to the hospital for free cardiac surgeries for 500 children (Rs250,000 per patient) under 15 years of age. However, the number of children seeking free treatment far exceeds 1,000.

Officials say the hospital has been covering the costs through its charity fund for poor and needy children whose families cannot afford the services.

“Hundreds of children having serious cardiac conditions are in the queue for surgery,” said Timala. “Some families arrange money by selling their properties, or taking out loans, but many cannot, meaning their children are deprived of treatment.”

Doctors say that in some complex cases, treatment costs can reach up to Rs3 million per child.

“Many parents of children with heart disease cannot afford the cost of treatment,” said Shristi Shrestha, in-charge of the general ward of the hospital. “Some parents and their visitors cannot even afford to arrange meals for patients and themselves.”

The free cardiac care scheme for children was introduced by then health minister Gagan Kumar Thapa during his tenure in 2016-2017. At the time, the annual allocation of Rs120 million was sufficient to cover the programme’s costs.

It is estimated that eight to 10 out of every 1,000 children in Nepal are born with or develop serious heart disease.

Along with free treatment for children under 15, the government also provides free treatment for patients with rheumatic heart disease, free valvuloplasty (a procedure to open narrowed heart valves), free treatment for people aged 75 years and above, and treatment worth Rs100,000 for impoverished patients.