Nepal’s political parties are preparing their manifestos for the upcoming House of Representatives elections. This time, the country deserves more than familiar promises of new hospitals, bigger buildings, and high visibility infrastructure. These may win headlines, but they don’t necessarily save lives. What strengthens a health system is not what stands above the ground, but what runs beneath it: financing, governance, workforce, supply chains, digital systems, preventive care, and above all equity.
The data tells a sobering truth. Nepal has made notable progress in reducing maternal mortality to 142 per 100,000 live births in 2023 and under five mortality to 26.5 per 1,000 live births in 2022. But these achievements mask sharp inequities that persist across geography, income, and social identity. Health outcomes remain deeply unequal, and access to affordable care is still the exception, not the rule. [fwd.gov.np]
Political manifestos must shift their focus accordingly. Here is what they must prioritize if they are serious about delivering the constitutional promise of health for all.
Equity Must Be the Compass, Not a Footnote
Despite constitutional guarantees, Nepal remains one of the most inequitable health systems in South Asia. Out of pocket (OOP) spending perhaps the starkest marker of inequity remains catastrophically high at 55.79% of current health expenditure as of 2022. This forces families to borrow, sell assets, or simply forego care. The burden of NCDs is harsher still: average treatment costs in Bagmati Province reach NPR 37,793 per episode, a sum that can push low income households into immediate crisis. [data.worldbank.org] [herdint.com]
Even the government’s own insurance program leaves millions behind. Only 10% of adults aged 15–49 is covered under the National Health Insurance Program (NHIP), with enrollment as low as 2.7% among women in Madhesh Province. A manifesto that does not put equity at its core is one that has misunderstood the moment. [dhsprogram.com]
Strengthen Health Financing Before Expanding Buildings
Every party talks about building hospitals; few talk about how to fund the services inside them. Nepal’s OOP spending remains stuck in the 50–60% range, despite policy commitments to cut it to 25% by 2030. Meanwhile, the National Health Insurance Program launched with great ambition faces high dropout rates, with reports estimating that 47% of members exit the program after their first point of service.
Political parties must commit to:
• Expanding NHIP coverage with simplified processes and consistent reimbursements.
• Ensuring uninterrupted financing for primary care facilities, especially in remote municipalities.
Without reforming financing, promises of “free care” will remain hollow.
Rebuild Primary Health Care - the True Backbone of Universal Health Coverage
Nepal has an extensive physical network of public health facilities, including hundreds of hospitals and thousands of health posts and BHSCs. Yet many facilities operate without adequate staff, diagnostics, or drugs. When the primary level falters, patients flood hospitals unnecessarily, overwhelming already strained services.
Parties should prioritize:
• Filling chronic vacancies through the timely implementation of the Federal Health Service Act.
• Ensuring uninterrupted supply chains, especially for essential medicines.
• Integrating NCD & Mental Health, maternal, and emergency care more robustly into PHC.
• Revisiting Basic Health Care Package and targeted intervention to address urban health issues. If we fail urban health, we fail sustainable development.
Primary care is not glamorous but it is the only path to sustainable universal health coverage.
Invest in the Health Workforce: Retention, Training, and Dignity
Progress in health outcomes is impossible without a well distributed, well supported workforce. Yet workforce gaps remain acute, especially in remote areas. Studies highlight persistent shortages, uneven deployment, and poor incentives issues that also undermine the NHIP and weaken service quality. [sph.cuny.edu]
Manifestos must emphasize:
• Incentive packages for remote postings.
• Better working conditions, housing, and safety.
• Long term career pathways and continuous education.
• Reforming the FCHV program compatible with the urban health concerns, which remains Nepal’s most cost effective health asset.
Health infrastructure is nothing without the people who run it.
Embrace Digital Transformation - But Close the Digital Divide
Nepal is on the cusp of a major digital health revolution. The government has already expanded online services to 2,481 health institutions and internet access to 431 local governments. Over 80 stakeholders engaged in drafting the Digital Health Blueprint in April 2025, and interoperability initiatives such as FHIR based claims submission are underway. [who.int] [digitalhealth.mohp.gov.np]
But digital progress remains uneven. Rural facilities often lack stable connectivity, trained staff, or digital literacy.
Political parties must commit to:
• Finalizing and implementing the Digital Health Blueprint.
• Ensuring nationwide interoperability across EMRs, insurance systems, supply chains, and NHIS.
• Expanding telemedicine to mountainous regions and climate vulnerable districts.
Digital health is no longer optional; it is foundational.
Confront the NCD and Mental Health Crisis
NCDs account for 71% of all deaths in Nepal, and the burden is rising. Gandaki Province’s 2024–25 screening campaign found high prevalence of hypertension, diabetes, and obesity among 2,976 high risk individuals aged 40+. Despite this, NCD services remain under integrated into PHC. [who.int] [researchgate.net]
Mental health indicators are equally concerning, with limited services outside urban centers.
Any serious manifesto must include:
• Comprehensive NCD screening nationwide.
• Mental health integration into PHC with digital follow up systems.
• Stronger referral and continuity of care mechanisms.
The next health crisis will not be infectious—it will be chronic.
Prepare for a Climate Stressed Health Future
Climate change is already reshaping Nepal’s disease patterns. Dengue cases surged to 54,784 with 88 deaths in 2022, affecting even hilly regions once considered too cold for Aedes mosquitoes. By 2024, more than 28,000 cases were recorded, including in Solukhumbu at 2,500 meters altitude—an unprecedented spread linked to warming temperatures and urbanization. [wjgnet.com] [straitstimes.com]
Parties must therefore pledge:
• Climate sensitive surveillance expansion.
• Strengthening provincial laboratory networks.
• Dedicated financing for Health NAP implementation.
• Local adaptation plans and community preparedness.
Climate change is not coming for Nepal, it is already here.
Ensure Medicine Security and Regulatory Strengthening
Frequent drug shortages and high private-sector prices undermine universal health coverage. Medicines remain the largest contributor to household spending on both communicable and non communicable diseases.
Political commitments should include:
• Expanding quality assured local production.
• Strengthening market regulation.
• Ensuring essential drugs into Basic Health Service Centers.
A Call to Political Courage
The 2026 election presents a rare opening. Nepal is young, digital, climate exposed, and increasingly engaged in its own governance. What it needs now is not symbolic development but systemic transformation.
A credible health manifesto must be built on Equity as the compass; Quality as the foundation; Digital and AI as accelerators; Partnerships as the strength.If political parties are willing to rise above the old politics of ribbon cutting and think instead in terms of systems, evidence, and fairness, Nepal can finally build a health system that works for everyone - everywhere.
The question is no longer whether Nepal can do it. It is whether our leaders will choose to.
