As per the plan to build 15-bed hospitals in municipalities across the country, Malika Rural Municipality decided to acquire land to build 'Malika Basic Hospital' on 31st July 2076.

After three and a half months, the municipality transferred the 12 ropanis of land donated by Dhanu and Ishwar Giri of Malika-5 Chapahile, as well as Deviram Aryal. A year after receiving the land, the foundation stone of the hospital was laid on Mangsir 2077.

However, the foundation stone was not laid on the land taken for the hospital. The foundation stone of Malika Basic Hospital was laid at Thulichowr in Arkhabang of Malika-4. After donors raised their voices saying that the land donated for the hospital was lying idle, the municipality responded by asking the federal government to lay the foundation stone elsewhere. The federal government had decided that the construction of the hospital should be completed within two years of the foundation stone laying. The local government, however, was wandering around for two years without being able to finalize the land.

According to the municipality, a land dispute flared up again during the construction of the hospital near Thulichowr where the foundation stone was laid. After that, the construction site was shifted a little lower than the place where the foundation stone was laid. Khadka/Sagun JV signed a contract for the construction of the hospital at a total cost of Rs 116.7 million. Immediately, the contract was canceled due to the risk of land and tenders were invited again. The work on the basement is currently being done after signing a new contract, informed Jagat Poudel, the information officer of the rural municipality. 

Bhaktapur's SCSPL/DLB JV has signed a contract for the construction at a total cost of Rs 154.1 million. Initially, it was agreed that the construction should be completed within two years . Even after five years, only 10 percent of Malika Basic Hospital has been constructed . The construction deadline is till Asad 2084. Looking at the pace of work, there is no change in the completion period . 

'Chhatrakot Basic Hospital' also found itself in the middle of a controversy over where and when to lay the foundation stone . The foundation stone was laid even though the land was not acquired as per the requirement . However, five years after the foundation stone was laid, there is no decision on the construction of the hospital. While preparations were being made to acquire the land and award the contract, there was a Genji movement in the country. The process was stopped by showing the movement. There is no indication when the hospital building estimated to cost Rs. 180 million will be constructed. There is no interest in the construction.
The construction of the hospital was started at Rajsthal in Dhurkot Rural Municipality-6. At that time, the construction was stopped after a landslide. Then the municipality started by revising the DPR and map. Currently, the physical progress of Dhurkot Hospital is about 15 percent.

Rabina/Arjun/New Lisa JV is doing construction work with an investment of more than Rs. 130 million. The work of the hospital being built in Kaligandaki Rural Municipality-3 is also slow. Khimti/Shreshtha/Anjana JV is doing the construction work at Rs. 123.7 million. So far, 50 percent of the work has been completed. A similar hospital is also being built in Satyawati Rural Municipality-6, Johang. Ramesh Shahi, an engineer of the municipality, informed that Ashish Nirman Sewa is working on the project with an investment of Rs 120 million. According to him, 40 percent of the physical progress has been made. A 15-bed hospital is being built in Musikot Municipality-7 of the district. According to the municipality, Khimti/Shreshtha/Kaligandaki JV is building the hospital at a cost of Rs 111 million. Its physical progress is 70 percent. ISMA Rural Municipality-4 is building a hospital at Gurunggade in Dohali. Sunil Samir Nirman Sewa is building the hospital with a total investment of Rs 194.5 million. So far, 32 percent of the construction work has been completed. A hospital is being built in Purkotdaha, Madane Rural Municipality-6. Himdum/AC Construction Company is constructing the hospital by signing a contract for Rs 124.8 million. So far, 40 percent physical progress has been made.

Rurukshetra Rural Municipality has also constructed a 15-bed hospital. Construction is underway in Ratamata, Ward 1 of the municipality. Prakriti-PTR-Adhikari-Rajeshwari JV Sandhikharka is constructing the hospital by signing a contract for Rs 144.2 million. So far, 85 percent of the work of the hospital has been completed.

A 15-bed hospital has been constructed in Gulmidurbar Rural Municipality-3. Bikoi-Arjun-New Liza JV had constructed the hospital for Rs 129.4 million. Similarly, a hospital building has been constructed in Chantakot Rural Municipality for Rs 136.6 million. This hospital has already started operating.

Excitement before, silence now

There was a different enthusiasm in the then Nepal Communist Party (NCP) government during the hospital foundation laying ceremony. There was a rush for ministers and MPs to lay the foundation stone. Ministers and MPs used to gather at the foundation stone laying ceremony of a single building. The foundation stone of two to three hospital buildings was laid in a single day. There was also enthusiasm among the citizens in the hope of getting treatment in rural areas after the construction of the hospital. That enthusiasm did not last long. The delay in the construction of the building and the difficulties seen in its operation have led to disappointment.

Stakeholders here say that the hospital has been left stranded due to the rush to lay the foundation stone without a clear implementation, lack of efficient management, lack of coordination between the union and local governments, and lack of accountability among stakeholders.

There are two medical officers, 10 health workers, and two office assistants at the Gulmi Durbar Basic Hospital. There are a total of 14 employees here. Chandrakot Basic Hospital has two medical officers, two birthing centers, four paramedics, one lab technician, one administration and three office assistants. There are a total of 13 employees here. Apart from the medical officer, other health workers are drawn from nearby health workers.
Narayan Aryal, head of the health department of Gulmidarbar rural municipality, says that the municipality alone cannot operate a 15-bed hospital and that it will not operate in all municipalities. 'Citizens have more faith in hospitals than health posts, but 15-bed hospitals are not running,' he said. 'There is a possibility that only a five-bed hospital can run.'

He said that even though the physical infrastructure has been established, management of manpower has become a challenge. 'There are hospitals that are much higher than the status of the local government,' he said. According to him, 30 manpower is required to run a basic hospital in the current situation. But 27 municipalities have to manage. ‘This is not possible,’ he said, ‘the municipality does not have the required income for that.’
The federal government has made arrangements for such hospitals to have one medical generalist ninth/tenth level, two eighth level medical officers, six staff nurses, four health assistants, one Ayurveda officer/assistant, one lab technician, one radiographer, one pharmacy assistant, one dentist, one anaesthetic assistant, one ophthalmic assistant, one deputy sub-inspector, six office assistants and three sanitation workers.

Out of the 12 municipalities in Gulmi, 8 municipalities have an annual internal income of less than Rs 10 million. Only four municipalities have an internal income of more than Rs 10 million. Which is not stable. It keeps fluctuating. In the current situation, the municipality has to recruit 27 out of 30 basic hospital employees as per the vacancies. According to which, more than one crore rupees are spent annually on salaries alone. Which does not help with the fluctuating internal income.

Civil Society District President Padamprasad Pandey said that the basic hospitals, which were laid without a plan, have now turned into white elephants for the municipality. ‘Initially, there was a lack of budget, then there was a delay in construction and even after the construction was completed, there is difficulty in operation due to lack of staff,’ he said, ‘There is a lack of manpower, equipment and medicine. There is no point in just building a luxurious building.’

If the responsibility of operating a luxurious building with an elevator is given to a municipality that cannot clean, paint and maintain it, and the federal government becomes irresponsible, he said, the citizens of rural areas will be deprived of access to health services and their rights.

District Health Office Chief Pushpa Thapa said that despite coordination and collaboration with the hospital, the office has no role in other matters. Chandrakot Rural Municipality Chairman Yubaraj KC says that the municipality alone cannot operate the hospital. ‘Keeping the completed structure empty will only increase the frustration among the citizens,’ he said, ‘It has been operated with the intention of starting it even if it is a normal service.’ He said that the hospital will be operated only if the association itself bears the operating expenses as per the approved quota. He argues that local resources and means alone cannot cover the expenses of the hospital.
Chief District Officer Badrinath Gairhe said that coordination and facilitation are being done for the operation of the hospital. ‘The work of following up the abandoned project is underway,’ he said, ‘We do not have the role of operation, but if necessary, we will have the role of facilitation.’