Eight of 10 local units of Achham, a remote hill district in Sudurpaschim Province, laid foundations for the construction of basic hospitals four years ago as part of the federal government’s ambitious plan to build a hospital in every local unit across the country.

The local people were hopeful of receiving quality health services in their own local units. However, four years on, the federal project remains incomplete in the district.

Ramaroshan Rural Municipality has not yet initiated the construction work to build the hospital building. Deepak Khanal, the information officer at the rural municipality, said that the rural municipality failed to proceed with any work for the hospital construction due to a dispute regarding the construction site.

“The rural municipality had invited a tender for hospital construction before the local elections of 2022 but nobody submitted a bid then,” Khanal said. “New people’s representatives were elected soon after that. The rural municipality has not taken any decision regarding the construction of the hospital building.”

With an objective of providing basic health services to the people, the federal government in the annual budget for the fiscal year 2019-20 had announced plans to construct one hospital each in all 753 local units of the country. On November 30, 2020, the people’s representatives had laid the foundation stones to construct five- to 15-bed hospitals in 396 local units simultaneously across the country with a plan to complete the project within two years.

There already are two hospitals in the district—the district hospital in Mangalsen Municipality and the Bayalpata Hospital in Sanphebagar Municipality.

For the construction of a basic hospital at a local level, the approval of that local unit concerned and the recommendation of the district coordination committee is required. For the construction of a five-bed hospital, 5.6 ropani [0.28 hectares] of land and 7.2 ropani [0.37 hectares] of land for the construction of a 10-bed and 15-bed hospital are needed, with a clear description of that land in the land ownership certificate.

After the land is secured, the detailed project report for the hospital should be prepared and submitted to the Ministry of Health and Population, and a budget is only allocated after the ministry approves the initial report.

The construction of a 10-bed hospital, which has been started in Turmakhand Rural Municipality, has not yet been completed.

Ekendra Bayak, head of the health unit at Turmakhand Rural Municipality, said that an agreement was signed with a construction company. But despite multiple deadline extensions, the construction remains incomplete. The last deadline expires at the end of the current fiscal year.

“It seems impossible to complete the construction by the end of the current fiscal year, and locals are outrageous about it,” said Bayak. “There is a dire need for a hospital in the rural municipality because the existing Turmakhand Health Post is in a dilapidated condition.”

Jhanakraj Dhungana, head of the Achham Health Office, said that the hospitals are being built from federal government funds, and once the construction contract is issued, it is the responsibility of the local unit concerned to monitor and regulate the work.

“The local units are the ones that awarded the contracts and are responsible for starting the work. If anything goes wrong, it is the local unit’s responsibility,” said Dhungana.

Nandaram Budha, a local of ward 4 of Turmakhand Rural Municipality, said that local officials complain that the construction company does not work on time, while the construction company blames the local unit. And as such, locals who will benefit from it are puzzled as to whose fault exactly it is.

“After hearing that there is going to be a hospital in our local unit, all the locals were thrilled because we only have a health post, and sick people were forced to make an arduous journey on foot to the district hospital,” Budha said. “But now I doubt our dream will come true.”

The 15-bed hospital in Chaurpati Rural Municipality has also not been completed.

Dhan Bahadur Thapa, chief administrative officer of the Chaurpati Rural Municipality, said that an agreement was signed with a construction company at a cost of Rs120 million three years ago to complete the work within two years of time.

“We already gave the construction company one extension, and as per the government regulations, we can grant another if needed. So far, the groundwork and foundation have been completed, and the deadline will end on May 28,” said Thapa. “A meeting will soon be held with the company to discuss the issue.”

Hikmat Bahadur Budha, chief administrative officer of Mellekh Rural Municipality, said that the construction of the hospital will be completed, but the real challenge will come after that.

“Although the federal government has provided the budget for the construction, the government has not said anything about essential manpower and equipment, among other things,” Budha said.