Bayalpata Hospital, which has long been recognised for its model of accessible rural healthcare in Achham, has suspended both health insurance and services under its social security unit since mid-August. The move comes after the hospital was brought under government management. Hundreds of patients, mostly poor and vulnerable, are now unable to afford treatment.

Sixty-five-year-old Basanti Shahi from ward 2 of Turmakhand Rural Municipality arrived at Bayalpata Hospital last week seeking orthopedic treatment. She was aware that the hospital, which had provided specialised care free of charge for nearly 17 years, began charging patients from mid-October. But she expected to be covered under the government’s health insurance scheme.

“I was told that my insurance would not work anymore and I would have to pay the full charges. I had come believing the treatment would be covered under insurance, but now it’s been stopped. I had to return without treatment,” said Shahi. She visited the health institution for the treatment of her leg that fractured some three years ago.

Another recent case involved a young orphaned girl from Kamal Bazar Municipality who was brought to Bayalpata for emergency care by her relatives. When they sought help through the hospital’s social service unit—meant to assist poor, orphaned or vulnerable patients—they were told that the facility had halted the service from August 17.

“We brought all the required documents and ward’s recommendations. But when we reached the hospital, they said the social service unit had been shut down. We cannot afford to pay for treatment ourselves,” the girl’s guardian said.

The Social Security Unit under the Ministry of Health and Population is designed to ensure healthcare access for marginalised groups such as the poor, elderly, persons with disabilities, survivors of gender-based violence, and endangered communities. The discontinuation of these services at Bayalpata has raised concerns among both patients and rights advocates.

Established in 2008 through a partnership between Nyaya Health Nepal and Possible, a US-based NGO, Bayalpata Hospital has grown into a critical health facility for rural communities in the far western districts of Achham, Bajura, and Doti. Since its inception, the hospital has provided free treatment to more than 1.4 million patients, including over 100,000 annually in recent years. It was one of the first institutions in the region to offer free specialist services, including surgical deliveries, internal medicine, and diagnostic services, and it continues to serve as a health lifeline in a historically underserved area.

Bayalpata’s public-private model was regarded as a successful template for rural healthcare reform in Nepal. The facility was widely praised for providing free or low-cost quality care to rural residents. With the closure of the health insurance scheme and social security unit, the poor and needy people of various remote districts of Sudurpaschim Province are hardest hit.

After years of financial crisis threatening its services for a long time, Bayalpata Hospital in Sanfebagar Municipality was formally brought under the management of the Sudurpaschim provincial government from August. However, after the move, rebranding it as Bayalpata Provincial Hospital, both the insurance and social service programmes were suspended.

According to hospital officials, an average of 50 insured patients and around 7 to 8 people relying on the social security programme are being denied treatment every day.

Yagya Raj Bhatta, the hospital’s administrative chief, said the services were halted temporarily due to procedural delays. “We have already completed the necessary documentation and sent it to the National Health Insurance Board,” he said. “Once the board approves the renewal process, the insurance service will resume. Similarly, the hospital will soon establish its own social security unit as required under government regulations.”

Bhatta confirmed that the hospital began charging fees for all services from October 18. “The free service system that existed before has been fully discontinued. Patients who relied on insurance and social support are now in real difficulty,” he said.

As the new provincial management works to establish the hospital’s insurance and social security mechanisms, patients like Shahi remain uncertain. “For poor people like us, Bayalpata was the only hope,” she said. “Now even that door seems closed.”