Ramita Thapa, 27, of Upper Khopri, Tila Rural Municipality-9, Jumla, went into labor two weeks ago. There had been heavy snowfall in the village. Relatives carried Ramita on a stretcher to the Rasa Health Post. She gave birth in Chayapatan, where there was about two feet of snow on the way.

Khopri, with 60 households, is the most remote village in Tila Rural Municipality. From there, it takes 5 hours to reach the nearest health post, Rasa. In between, you have to cross a lake at an altitude of about 4,000 meters. “If someone in the village experiences labor pains, they have to be carried on a stretcher and rushed to the health post, but most of them give birth on the way,” said local health volunteer Tulsa Thapa. According to her, Ramita had previously given birth to two daughters on the way. 

Karuna Dangi, 18, of Thulibheri-8 in Dolpa and her newborn baby were rescued by an army helicopter on Monday and brought to Surkhet. The newborn baby, who was born at the Jufal health post, was rescued by a helicopter with her mother after she had difficulty breathing. The baby is being treated at the NICU of the Provincial Hospital, Surkhet.

Dhanarupa Bishwakarma of Jiula, Chhayanathrara-10 in Mugu, gave birth at home on 23 Pus last year. After bleeding for 2 days after giving birth, her family members were preparing to take her to the district hospital.

‘The road to the hospital is very difficult, there are no young people in the village to carry a stretcher,’ said her husband Ram Bahadur Bishwakarma, ‘She died due to a small carelessness.’ It takes about 2 hours to walk from Jiula to the district hospital in Gamgadhi, the district headquarters.

In the last 9 years, 172 women in childbirth have died in Karnali due to lack of timely treatment. According to the Health Services Directorate of Karnali Province, 33 women in childbirth died in the most recent fiscal year 2070/71. Three years ago, 17 women in childbirth lost their lives. The directorate has data showing that 14 people died in the last fiscal year and 9 in the current fiscal year. According to the directorate’s information officer Padam Bahadur KC, most women in childbirth in Karnali are between the ages of 15 and 25. About 80 percent of the deaths are in this age group. According to a study conducted by the Ministry of Social Development of the provincial government last year, only 23.6 percent of families in Karnali can reach a health facility within half an hour. There are 371,125 households in Karnali. 

Out of a total of 184 doctor posts for the province's population of 1,694,889, 152 are vacant. Out of 70 specialist doctor posts in Karnali province, 60 are vacant. Even if the posts are filled, there is a situation where only 1 doctor is available for 9,200 people. According to the World Health Organization's standards, 1 doctor is required for 1,000 people. Nepal's average ratio is 1 doctor for 3,000 people.

There are 359 birthing centers across Karnali province. Until the fiscal year 2074/75, the Health Division under the Ministry of Health of the federal government had arranged 'air lifting' for pregnant women at risk. Then, under the federal government's President's Women Upliftment Program, 26 new-born and pregnant women were air-rescued in the fiscal year 2075/76, 33 in 2076/77, 28 in 2077/78, and 48 in 2078/79. The directorate has data that 158 ​​people were rescued by Nepali Army helicopters in the past three years.

The neonatal mortality rate in Karnali is also alarming. The Health Services Directorate has stated that 777 newborns have lost their lives in the last 4 years. 199 infants also died in the last fiscal year. 'Women are forced to do hard physical labor during pregnancy,' says pediatrician Dr. Nawaraj KC, 'Initially, they try to give birth at home in an unsafe way, but later, when the situation becomes complicated, they are taken to the hospital, which has also increased the maternal mortality rate.'

According to the first five-year plan made public by the Karnali Provincial Planning Commission, the neonatal mortality rate in Karnali is 29 per 1,000. The infant mortality rate is 32 per thousand across the country, but it is 47 in Karnali. The mortality rate of children under 5 years of age is 58 in Karnali, while the national average is 39 per thousand.

Only 72 percent of pregnant women in Karnali Province receive maternity services at health institutions. According to the Ministry of Health, 79 percent of women nationwide give birth at health institutions. ‘As most women in the province still give birth at home and often give birth during adolescence, maternal and neonatal mortality rates, and the mortality rate of children under five years of age are relatively high in Karnali Province,’ the health policy of Karnali Province states, ‘Health care is not accessible to citizens of backward, poor, helpless, and extremely remote areas within the province. In the event of a serious illness, the cost is high, putting the family at financial risk and leading to poverty or death at home without receiving treatment.’

Although 33 percent of citizens across the country are covered by health insurance, only 29 percent of citizens in Karnali participate. The shortage of health workers is a major problem in Karnali. According to the Health Services Directorate, only 463 people are working in Karnali out of the 908 posts set for health services. Currently, there are 184 vacancies for doctors in Karnali, but only 32 vacancies, excluding contract ones, have been filled.

According to the director of the directorate, Dr. Rabin Khadka, there are barely 5 percent specialists at the 11th level in Karnali, while only 20 percent of the vacancies at the 10th level have been filled. Although there are vacancies for specialist doctors at the 10th and 9th levels in all districts of Karnali, district hospitals are providing services based on contract doctors.

The provincial government has brought an attractive package to retain employees, but the long-standing problem of shortage of health workers remains to be solved, Khadka said. "Due to the lack of doctors, patients are forced to go to other provinces for treatment," he said.

In accordance with the policy to retain doctors in Karnali, allowances ranging from 75 to 105 percent have been given. There are 12 government hospitals and 13 primary health centers in Karnali. It is difficult to find regular doctors in hospitals other than the Provincial Hospital Surkhet and the Karnali Institute of Health Sciences in Jumla. There is a shortage of health workers above the eighth level throughout the province. The Provincial Health Directorate has stated that there is a shortage of anesthesia, radiographers and other employees at the eighth level as well.

The health policy of Karnali Province has also pointed out that the number of doctors and health workers in hospitals and health institutions is not as per the posts and their survival is also low as a challenge. The policy also mentions that the physical condition of health institutions is weak.

The problem of shortage of medicines is also a big problem in Karnali. Three months ago, seasonal flu spread in Mugu, including Chayanathrara Municipality, Mugamkarmarong and Khatyad Rural Municipality, and nearly four hundred people fell ill. After they showed symptoms including high fever, cold, headache, chills, vomiting, and body aches, only a team of doctors from the District Hospital and the Provincial Health Directorate were able to control the outbreak.

‘The municipality has not purchased medicines this fiscal year, after taking medicines from the district, the outbreak was brought under control in two weeks,’ said Dr. Dipendra Jung Shahi of the District Hospital, ‘Every year, outbreaks spread in the village, the medicines purchased by the municipality are not enough, there is an obligation to send medicines from the district and the province to bring the situation under control.’ Doctors say that the supply and distribution of quality medicines has not been possible due to lack of medicine storage (space, cold chain, etc.).

Due to lack of manpower, equipment worth crores of rupees has been left stranded in hospitals in Karnali. The District Hospital in Rukum West has a 2-bed ventilator and a 6-bed ICU ward. They are not in use due to lack of manpower. The hospital, which has 2 specialist doctors and 11 medical officers, receives 250 to 300 patients daily for treatment. Hospital Management Committee Chairman Tek Bahadur Kusari said that due to the lack of ventilators and ICUs, up to 10 patients have to be referred every week.

It has been almost 3 years since the ventilator and ICU installed at Salyan Hospital, which cost Rs 25.8 million, have been lying idle. ‘Even after training two medical officers and two nurses for a week to operate the ICU and ventilator, it was not enough,’ said Dr. Arjun Budha, head of the district hospital. ‘The equipment is also not enough.’ According to him, some ventilators and ICUs were brought into operation during the corona epidemic. He informed that up to 10 patients with critical conditions are being referred from Salyan every week.

During the corona epidemic, the Karnali government had arranged 62-bed ICUs and 26 ventilators in all 10 districts. About Rs 400 million was spent on it. But except for the Provincial Hospital Surkhet and the Karnali Institute of Health Sciences, Jumla, all district hospitals are without high-level technology and equipment. ‘Medicines are also needed to operate the ventilators and ICUs,’ said Dr. Arjun Budha, head of the Salyan Hospital. Budha said, ‘Health workers and doctors should also work on ventilators 24 hours a day, but the manpower is not enough.’

According to the Provincial Health Directorate, up to 40 patients are referred from various district hospitals to the Pratishthan Teaching Hospital in Jumla and the Provincial Hospital in Surkhet. ‘The same number of patients are also being referred to Nepalgunj and Kathmandu. If the manpower is managed, treatment can be provided in the district except for those seriously injured in accidents,’ said Provincial Health Director Dr. Rabin Khadka. ‘There is a shortage of health workers in the province of about 50 percent, which has had a major impact on the treatment of patients.’ Currently, the Provincial Hospital has a 25-bed ICU and 10 ventilators, while the Pratishthan has a 10-bed ICU and 6 ventilators.

Director Dr. Khadka said that the ICU and ventilators have been installed in the hospital for facilities such as providing oxygen to patients in critical conditions, monitoring their health through monitors, and performing complex surgeries. ‘It is necessary to have various specialists in the hospital to operate those equipment,’ he said, ‘to make the patient unconscious, an anesthesia specialist or health worker is mandatory. It is also necessary to provide basic training to nurses for critical care.’

Provincial Hospital Surkhet has a kidney transplant facility. So far, two people have undergone kidney transplants. But for this, the chief doctor has to come from Bhaktapur. ‘Doctors come from outside for the main operation, we only provide support,’ said hospital director Dr. Ganesh Thapa.

48 municipalities without hospitals

According to the Health Services Directorate, only 31 out of 79 local levels in Karnali Province are operating basic hospitals. There are 25 municipalities, 54 rural municipalities and 718 wards in the province. 117 wards do not have health posts.

There are five in Kalikot, four in Rukum West, four in Dailekh, three in Jajarkot, four in Surkhet and two in Salyan. Dolpa, which has eight local levels, Mugu, which has four local levels, and Humla, which has seven local levels, still does not have a hospital at the municipal level. Dolpa has 23, Mugu has 24, and Humla has 26 health posts.

Malnutrition increasing among children

Samjhana Bik, 21, of Kanakasundari Rural Municipality-4 in Jumla, got married at the age of 15. Her eldest daughter is five and her youngest daughter is one year old. When she was taken for a check-up at a health camp in the village three months ago, it was found that both her daughters were malnourished. Her one-year-old daughter is undergoing treatment under the supervision of health workers after severe malnutrition was detected.

Samjhana's health is also deteriorating day by day. 'I did not get good care during childbirth, I had to stay in a separate hut,' she said. 'I could not eat anything spicy, I could not even eat fish and meat because it would affect the child and mother. They didn't even give her curd, green vegetables and vegetables because she felt cold, now her life is ruined.'

Samjhana weighs only 48 kg, and she has trouble walking properly. 'Even doing small tasks makes her body ache,' she added, 'During menstruation, she bleeds for 15 days, her eyes are blurry, and sometimes I can't sleep all night because of body aches.'

Manju Nepali, 22, of Chaukune Rural Municipality-7 in Surkhet, also has two malnourished children. Her one-and-a-half-year-old son Dilip and her six-month-old daughter are both severely malnourished and are being treated under the supervision of health workers. 'The food at home is not enough for a month, her husband, who has gone to India, sends 4-5 thousand rupees a month, how can he provide nutritious food with that?' She said, 'Children cannot eat properly because they don't have money.'

According to the Health Services Directorate, 6.8 percent of children born in Karnali are underweight. कर्णाली प्रदेशमा गत आर्थिक वर्षमा शीघ्र कुपोषणको एकीकृत व्यवस्थापनको बहिरंग सेवाबाट २ हजार ५ सय ११ बालबालिकाले सेवा लिएका थिए, जसमा ६ जनाको मृत्यु भयो ।

सुत्केरीमा आफ्नो र बच्चाको स्वास्थ्यमा ख्याल पुर्‍याउन नसक्दा आमा र बच्चा दुवै जोखिममा पर्ने गरेको जुम्लाको कनकासुन्दरी गाउँपालिकास्थित हाटसिजा स्वास्थ्यचौकीका इञ्चार्ज वीरेन्द्रप्रसाद उपाध्यायले बताए । ‘आमाले राम्रोसँग खान नपाएरै बच्चामा कुपोषण देखिने गरेको हो,’ उनले भने, ‘सुत्केरी हुँदा महिलाले पर्याप्त नुन नै खान पाउँदैनन् । तरकारी र घिउ खाँदा जन्डिस हुन्छ भन्ने सोच छ,’ उनले भने, ‘धर्मकर्मका नाममा माछामासु पनि खाँदैनन् । पाएको खानेकुरा नखाने र पाइने खानेकुरा पनि बार्नुपर्छ भन्ने चलनले आमा र बच्चाको स्वास्थ्य कमजोर हुने गरेका छन् ।’

उपचारमा धामीझाँक्रीको भर

सल्यानको कालीमाटी गाउँपालिका–१ की १९ वर्षीया केशरी रोकालाई गत वर्ष साउनमा सुत्केरी व्यथाले च्याप्यो । वडामा प्रसूति सेवासहितको स्वास्थ्यचौकी नभएपछि आफन्तले घरेलु उपचार र धामीझाँक्रीको विश्वास गरे । ‘व्यथा लागेको दुई दिनसम्म धामीझाँक्रीबाट उपचार गराइयो, अवस्था झन् जटिल बन्दै गएपछि मात्र जिल्ला अस्पताल पुर्‍यायौं,’ उनका पति खलबहादुरले भने, ‘अस्पताल पुर्‍याउँदा त बच्चा पेटमै मरिसकेको रहेछ ।’

कालीमाटी–१ का वडाध्यक्ष रविलाल बस्नेतले वडामा अझै पनि झन्डै एकतिहाइ बिरामी धामीझाँक्रीको भर पर्ने गरेको बताए । ‘केही हुनेबित्तिकै पहिले धामीलाई नै बोलाउन जान्छन्,’ उनले भने, ‘अन्तिम अवस्थामा मात्र अस्पताल लैजाँदा बिरामी र सुत्केरीको ज्यान जोखिममा पर्ने गरेको छ ।’

कालीमाटीस्थित जनता आधारभूत विद्यालयका शिक्षक उमेश खड्काले हरेक दिन गाउँका कुनै न कुनै घरमा ढ्यांग्रो बज्ने गरेको बताए । उनका अनुसार धामीझाँक्रीले गर्ने जडिबुटीको उपचारबाट स्थानीयको रोग सञ्चो हुने गरेकाले पनि उनीहरूको विश्वास बढेको छ । परम्परागत सोच, स्वास्थ्यचौकी टाढा हुनु, स्वास्थ्यचौकीमा औषधि र स्वास्थ्यकर्मी सधैं नहुनुलगायत कारण अझै पनि धामीझाँक्रीको भरमा दुर्गममा उपचार भइरहेको बालरोग विशेषज्ञ डा. नवराज केसी बताउँछन् ।

दुई अस्पतालले धानेको उपचार

सुर्खेतस्थित प्रदेश अस्पताल र जुम्लास्थित कर्णाली स्वास्थ्य विज्ञान प्रतिष्ठानले सिंगो प्रदेशको उपचार सेवा धानिरहेका छन् । प्रदेश अस्पतालका निर्देशक डा. थापाले कर्णालीका अधिकांश जिल्ला र सुदूरपश्चिमका केही जिल्लाबाट बिरामी आउने गरेको जानकारी दिए । ‘बाहिरी जिल्लाबाट आउने बिरामीको चाप प्रदेश अस्पतालमा दिन प्रतिदिन बढिरहेको छ,’ उनले भने ।

प्रतिष्ठानबाट यो वर्ष झन्डै ४ लाख बिरामीले उपचार सेवा लिएका छन् । तीमध्ये ४ हजार ३ सय ८५ जनाको मेजर अपरेसन गरिएको अस्पतालले जनाएको छ । अस्पतालमा अहिले २ सय ८० शय्या सञ्चालनमा रहेको जानकारी दिँदै अस्पतालका सूचना अधिकारी विनोद बस्नेतले बिरामीको चापअनुसार स्वास्थ्यकर्मीको संख्या न्यून रहेको बताए । ‘करारका स्वास्थ्यकर्मीको भरमा अस्पताल चलिरहेको छ,’ उनले भने, ‘प्रदेशको लोकसेवा पनि खुलेको छैन, चिकित्सक पनि करारकै मात्र छन् । दरबन्दीको स्थायी चिकित्सक ८ जना मात्र हुनुहुन्छ ।’ 

अस्पतालमा ७५ चिकित्सकसहित साढे ४ सय कर्मचारी कार्यरत छन् । तीमध्ये झन्डै ८० प्रतिशत करारका हुन् । अस्पताल स्तरोन्नति गरी स्वास्थ्य विज्ञान प्रतिष्ठान बनाउने प्रदेश सरकारको योजना छ । त्यसअनुसार भवनलगायतका पूर्वाधार निर्माण भइरहेको निर्देशक डा. थापाले जानकारी दिए ।

कर्णाली स्वास्थ्य विज्ञान प्रतिष्ठानमा ३ सय शय्या व्यवस्था गरिएको छ । प्रतिष्ठान हाडजोर्नीको शल्यक्रियाका लागि ‘हब’ नै मानिएको छ । अधिकांश बिरामी हुम्ला, कालीकोट, मुगु र डोल्पाबाट आउने गरेको र झन्डै ७५ जनाले दैनिक रूपमा ओपीडी सेवा लिने गरेको प्रतिष्ठानका उपकुलपति एवं हाडजोर्नी विशेषज्ञ डा. पुजन रोकायाले जानकारी दिए । उनका अनुसार चालु आर्थिक वर्षमा हाडजोर्नीका ५ सय २० बिरामी निको भएर घर फर्किएका छन् ।

अस्पतालमा अरू शल्यक्रिया पनि हुन्छ । प्रतिष्ठानबाट यो वर्ष झन्डै ४ लाख बिरामीले उपचार सेवा लिएका छन् । तीमध्ये ४ हजार ३ सय ८५ जनाको मेजर अपरेसन गरिएको अस्पतालले जनाएको छ ।

चुनावी वाचा अधुरै

संविधानमा स्वास्थ्यसम्बन्धी हकलाई मौलिक हकअन्तर्गत राख्दै ‘प्रत्येक नागरिकलाई राज्यबाट आधारभूत स्वास्थ्य सेवा निःशुल्क प्राप्त गर्ने हक हुनेछ र कसैलाई पनि आकस्मिक स्वास्थ्य सेवाबाट वञ्चित गरिनेछैन’ भनिएको छ । यही मौलिक हक प्रत्याभूत गराउने गरी राज्यले पूर्वाधार व्यवस्थापनमा ध्यान नदिँदा कर्णालीका बासिन्दालाई आधारभूत स्वास्थ्य सेवा सहज रूपमा लिन मुस्किल परिरहेको छ ।

राजनीतिक दल र नेताले भने स्वास्थ्य सेवा सर्वसुलभ बनाउने वाचा भने गरिरहेकै हुन्छन् ।

डोल्पाबाट नेपाली कम्युनिस्ट पार्टीका उम्मेदवार धनबहादुर बुढाले जिल्ला अस्पताललाई आधुनिक उपकरणसहित सुविधायुक्त बनाउने र सबै प्रकारका 

विशेषज्ञ सेवा दिने गरी सेवा विस्तार गर्ने उल्लेख गरिएको घोषणापत्र सार्वजनिक गरेका छन् । उनले यस्तो वाचा गरेको चौथोपल्ट हो । उनी एक पटक संविधानसभा सदस्य, दुई पटक प्रतिनिधिसभा सदस्य र दुई पटक मन्त्री भइसकेका नेता हुन् ।

बुढा डोल्पाबाटै २०७० मा संविधानसभा सदस्य, २०७४ र २०७९ मा प्रतिनिधिसभा सदस्य बनेका थिए । उनी संस्कृति, पर्यटन तथा नागरिक उड्डयन राज्यमन्त्री र सहरी विकासमन्त्री बनेका थिए ।

बुढाले यसपालि पनि दोहोर्‍याएको अर्को एजेन्डा हो– माथिल्लो र तल्लो डोल्पाका लागि कम्तीमा ५ सय शय्याको अस्पताल स्थापना गर्ने र आयुर्वेद अस्पताल तथा अनुसन्धान केन्द्रको स्तरोन्नति र विस्तार गर्ने ।’

माथिल्लो डोल्पामा स्वास्थ्यकर्मी र औषधि अभावको समस्या सधैं हुने शे–फोक्सुन्डो–३ का छिरिङ लामाले बताए । ‘गाउँमा सडक सुविधा छैन,’ उनले भने, ‘कोही बिरामी परे हेलिकोप्टरमा रिफर गर्नुको विकल्प छैन ।’

शे–फोक्सुन्डो गाउँपालिकाका उपाध्यक्ष पेम्मा बाङछेङ गुरुङले ३ महिनाको अवधिमा १० जनालाई हेलिकोप्टरबाट उद्धार गरिएको जानकारी दिए । उनका अनुसार पालिकाको केन्द्रबाट सदरमुकामस्थित जिल्ला अस्पताल पुग्न कम्तीमा दुई दिनको पैदल दूरी छ ।

कालीकोटबाटै नेकपाबाट उम्मेदवारी दिएका महेन्द्रबहादुर शाहीले सबै नागरिकलाई आधारभूत स्वास्थ्य सेवा निःशुल्क दिने, सबै स्थानीय तहमा अस्पताल र सबै वडामा सुविधायुक्त स्वास्थ्यचौकीको स्थापना गर्ने आफ्नो एजेन्डा भएको बताए । उनी २०७९ मा प्रतिनिधिसभा सदस्य, २०७४ मा प्रदेशसभा सदस्य र २०७० मा संविधानसभा सदस्य भएका नेता हुन् । ‘हाम्रो नेतृत्वमा सरकार लामो समय नहुँदा स्वास्थ्यका केही एजेन्डा पूरा गर्न सकिएन,’ उनले भने ।

जुम्लाबाट कांग्रेसका उम्मेदवार बनेका दीपबहादुर शाहीले सार्वजनिक गरेको घोषणापत्रमा ‘स्वस्थ जुम्लावासी, समुन्नत जुम्ला’ कार्यक्रममार्फत घरघरमा ज्येष्ठ नागरिक, बालबालिका, सुत्केरी आमालाई निःशुल्क स्वास्थ्य परीषण गर्ने, सिँजामा ५० शय्याको अस्पताल निर्माण गर्ने र स्वास्थ्य बिमालाई निःशुल्क बनाउने प्रतिबद्धता गरेका छन् । मुगुबाट कांग्रेसबाट उम्मेदवारी दिएका खड्गबहादुर शाहीले निःशुल्क स्वास्थ्य आफ्नो पहिलो प्राथमिकता भएको बताएका छन् ।

२०६४ देखि रुकुम पश्चिमबाट निरन्तर निर्वाचित भएका र पटक–पटक मन्त्री बनेका प्रगतिशील लोकतान्त्रिक पार्टीका उम्मेदवार जनार्दन शर्माले चौरजहारीमा 

मेडिकल कलेज स्थापनाको एजेन्डा अघि सारेका छन् । ‘जाजरकोट, डोल्पा, सल्यानलगायत आसपासका जिल्लाको समेत मेडिकलको हब बनाउने योजना छ,’ उनी भन्छन्, ‘यही कार्यकालभित्रै रुकुम पश्चिममा मेडिकल कलेज स्थापना हुन्छ ।’

गएको निर्वाचनमा कांग्रेसले केन्द्रबाट जारी गरेको घोषणापत्रमा संविधानअनुसार निःशुल्क आधारभूत स्वास्थ्य सेवा प्रभावकारी कार्यान्वयन गर्ने भनेको थियो । यस्तै, हरेक वडामा आधारभूत स्वास्थ्य केन्द्र स्थापना गर्ने, गाउँ/नगरपालिकामा विशेषज्ञ सेवासहित प्राथमिक अस्पताल सञ्चालन गर्ने भनिएको थियो ।

कांग्रेसको घोषणापत्रमा जनशक्ति, पूर्वाधार, प्रविधि र उपकरणको व्यवस्था गर्ने, टेलिमेडिसिन सेवा विस्तार गर्ने, नियमित प्रयोगशाला सेवा वडास्तरमै विस्तार गर्ने, स्वास्थ्य बिमा सबै नागरिकको पहुँचमा पुर्‍याउने जस्ता वाचा गरिएको थियो ।

एमालेको घोषणापत्रमा पूर्वाधार, जनशक्ति र वित्तीय व्यवस्थामार्फत मौलिक हक कार्यान्वयन गर्ने भनिएको थियो । प्रत्येक पालिकामा निर्माणाधीन आधारभूत अस्पताल सम्पन्न गर्ने, प्रत्येक वडामा स्वास्थ्यचौकी निर्माण तथा सञ्चालन गर्ने, स्वास्थ्य बिमा अनिवार्य गर्ने, औषधिको गुणस्तर र नियमित आपूर्ति सुनिश्चित गर्ने, गर्भवतीका लागि प्रोत्साहन र पोषण कार्यक्रम सञ्चालन गर्ने पनि एमालेको घोषणापत्रमा उल्लेख थियो ।

तत्कालीन माओवादी (हाल नेकपा) को घोषणापत्रमा आधारभूत स्वास्थ्य सेवा सुनिश्चितता गर्ने, निःशुल्क आधारभूत स्वास्थ्य सेवा उपलब्ध गराउने भनिएको थियो । सबै नगर/गाउँपालिकामा आधारभूत अस्पताल र सबै वडामा स्वास्थ्य केन्द्र सञ्चालन गर्ने वाचा पनि गरिएको थियो ।

निर्वाचनपछि एमाले र तत्कालीन माओवादीले सरकारको नेतृत्व नै गरेका थिए । कांग्रेस पनि पटक–पटक सत्तामा पुगेको थियो । तर चुनावी वाचाअनुसार स्वास्थ्य सेवाको सहज पहुँच बढाउन उल्लेख्य काम हुन सकेन ।