Shortage Of Health Workers

The non-operational Intensive Care Unit (ICU) and High Dependency Unit (HDU) at Bardiya District Hospital reflect the institutional inertia that mars Nepal's health sector. Built during the COVID-19 pandemic, the intensive care facilities were to serve as the lifeline of the district for its most critically ill patients. But even after five years, they remain non-operational due to a shortage of medical staff and facilities. A well-functioning healthcare system relies on human resources and infrastructure. Health infrastructure provides the physical equipment needed —emergency rooms, hospitals, and medical equipment — and human resources ensure that the services are utilised efficiently. Without trained physicians, even the best-equipped health facilities are meaningless. 

The ongoing crisis of Bardiya Hospital is an example of height of such ineptitude on the part of authorities, whereby millions have been invested in the construction of ICUs and HDUs but not enough recruiting and retaining of human resources required to utilise them. Nepal's healthcare system has also seen poor funding, skewed allocation of resources, and a chronic shortage of human resources. While the government and local administrators often invest huge amounts in infrastructure initiatives, the lack of securing sustainable running means that such investment becomes meaningless. Equipped with oxygen-enriched beds, cardiac monitoring, and other essential medical gear, Bardiya's ICU and HDU wards are unoccupied, and seriously ill patients have to travel to distant places like Nepalgunj, Kathmandu, or even Lucknow, across the border in India. 

This not only imposes a tremendous economic hardship on the family but also results in unnecessary death due to delayed receipt of emergency care. While Bardiya Hospital is required to have 59 permanent staff, the hospital is operating with less than half of this number. While additional personnel have been hired on temporary and contract bases, this ad-hoc approach is not sustainable. Intensive care units require specialist doctors, anaesthesiologists, trained nurses, and support staff. Without these, even highly advanced medical equipment is of no use. This situation raises some serious questions of accountability. Who is responsible for ensuring that a well-equipped medical facility is not unused while patients die? Why were ICU and HDU units constructed without a firm plan for staffing and long-term financing of operations? The lack of planning for healthcare is evident, and the consequences are disastrous. 

The broader health crisis in Nepal is just as much a governance problem as a problem of infrastructure. Bardiya is not alone in this state of affairs. Many hospitals across the nation have been built or expanded without providing adequately trained staff. The problem is also exacerbated by a lack of incentives for qualified health professionals to remain in rural districts. Most specialists also choose to practice in large cities or seek employment abroad due to better pay and working conditions. A well-equipped hospital can dramatically alter survival rates, reduce the burden on the family, and facilitate timely intervention by doctors. However, without a quality healthcare workforce, infrastructure alone cannot realise its potential. Federal and provincial governments must prioritise healthcare staffing and release the funds to activate existing infrastructure ahead of new builds. A human resource strategic plan is also required, including incentives to get medical staff to work in rural areas and a focus on permanent employment rather than short contracts.