While the private hospitals are mushrooming in the capital city, the rural villages of Nepal are deprived of access to health services due to the apathy of the government. The total population of Nepal is approximately 27 million people, more than 80% of whom live in very rural, inaccessible areas. Given this fact, the health services of rural people are of paramount importance, but Nepal’s government does not seem to recognize this. The following statistics will shed some light on this dismal fact :

The shortage of healthcare workers in Nepal is reflected in the population per doctor at 18,439 and per nurse at 4,987. The number of public sectors hospital beds for a population of 24 million is very low at 1 bed to 5,435 population; the situation is made more difficult by the reported under-staffing and hence under-utilization of district beds (MOH, 2003). Furthermore, the rural to the urban disparity is reflected in the physician-to-population ratio of 1:850 in Kathmandu and 1:30,000 outside of the capital (NSI, 2004). The overall distribution of staff in terms of the mix of skills shows a deficiency in the middle technical grades, particularly managerial staff.

Staff vacancies and absenteeism are common with only 85% of sanctioned posts filled and only 70% manned (MOH, 2003). Some of the push factors leading to poor retention of healthcare workers in rural areas include poor infrastructure, lack of opportunities (e.g. further training, career mobility, good schools for children, and jobs for spouses) for themselves, their children, and family, low salary and lack of support, lower social recognition compared to urban areas, and lack of security. Frequent changes in government and thus, leadership also lead to a cascade of staff changes down to the level of division chiefs and lower (Agarwal, 1997).