It has been 4 years since the government announced the expansion of trauma services in major highway accident-prone areas. However, identification and mapping of the places where more accidents occur have not been started for service expansion. Due to the lack of trauma services on major highways, most of the injured in road accidents have to come to Kathmandu for treatment. Some of the injured died due to lack of timely treatment.

The main highways of the country include East-West, Prithvi, BP, Tribhuvan, Araniko, Mechi, Koshi, Sagarmatha, Siddharth, Rapti and others. According to the Metropolitan Traffic Police Division, 24,095 people have lost their lives in road accidents in the last 10 years and more than 50,000 have been seriously injured. In the financial year 2080/81, only 2 thousand 369 people died in road accidents according to the division. In this way, 7 people die every day due to road accidents. 

The government had announced the expansion of trauma services on major highways through the policies and programs of the fiscal year 2077/78. The government also made a procedure in 2077 regarding the implementation of trauma services. In Section 6 of Trauma Service Operation Procedure 2077, it is mentioned that in coordination with the Ministry of Physical Infrastructure and Transport, the location of most accidents should be mapped and arrangements for trauma treatment should be made in health institutions located in suitable locations. Sushilbabu Dhakal, the spokesperson of the Ministry of Physical Infrastructure and Transport, said that if the Ministry of Health wants, it is ready to coordinate the study of the accident area. Trauma services are classified into levels 1 to 5 in the

procedure . In the highest level fifth level service, there is a provision to have medical officers, physician doctors, health assistants, trained nurses, paramedics, x-ray technicians working 24 hours . The equipment includes ventilators, monitors, spinal back ward, operation theater, X-ray, ECG etc. According to experts, usually Rs 15 to 20 crores are needed to set up a fully equipped trauma unit. An ambulance alone costs one crore rupees. It costs more than one crore to make an operation theater. 

The Ministry of Health has allocated a budget of 230 million rupees to construct buildings in various places in the current financial year without even preparing necessary studies. The Ministry has allocated Rs 50/50 lakh to Belkhu of Dhading and Lamki of Kailali, Bardghat of West Nawalparasi and Zorayal Rural Municipality-2 Buder of Doti to build buildings in the current financial year. 5 crores in Devchuli in East Navalparasi, 2 crores in Pathalaiya/Kamalamai Shivanagar in Sindhuli in Bara, 4 crores in Sainamaina Municipality in Rupandehi, 6 crores in Rakam Karnali in Dailekh and 3 crores have been allocated for Dadeldhura Hospital . 

But due to lack of preparation such as mapping and land acquisition, there is no situation in which the allocated budget will be spent. The ministry has not even ensured resources for multi-year contracts. Deepak Shrestha, Senior Divisional Engineer of Urban Development and Building Construction Department, said that there is a problem of land for constructing buildings in most places. "It is also difficult to complete the construction of the building with the allocated budget," he said, "as it seems that it has to be left half done, it is difficult to proceed with the work until the Ministry of Health secures the source of a multi-year contract."

Health Ministry spokesperson Dr. Prakash Budhathoki admitted that the budget should be allocated after studying it. "Currently, the budget has been allocated as requested by the local and state governments," he said, "If the budget can be allocated after studying, the compulsion to go to the capital for the treatment of trauma patients will be removed."

former director of National Trauma Center Dr. Santosh Paudel says that instead of allocating the budget in pieces, we should proceed to start operating only one tram on one highway every year . "Rather than allocating the budget to build a new building, we should identify the area with more accidents and manage the budget to operate the trauma unit in the primary health post, district or provincial hospitals that are operating around there," he said.

In the current financial year, up to two trauma units can be operated with 23 crore rupees. Paudel says. "It is very difficult to build a new building and set up a separate trauma unit due to manpower and other reasons," he said. It is also difficult to get many patients treated at the same time due to a major accident in such units.'