In the 1990s, Nepal's healthcare infrastructure was very poor. There were no well-equipped hospitals outside the Kathmandu valley, even the rural health posts lacked electricity, essential medicines and medical personnel. Medical education was limited to only three medical colleges. Many students had to go to neighboring countries to acquire medical education.

In rural areas, traditional healers were dominant, leading to conflict with modern medicine. The National Health Policy, formulated with the establishment of democracy, helped to decentralize services, reduce maternal and neonatal mortality, and accelerate immunization programs. The rapid growth of private hospitals in the city helped to expand access to healthcare.

Between 2000–2010, the development of subspecialty services such as organ transplantation, oncology (cancer treatment) and interventional radiology remained slow. Intensive care units (ICUs) were available only in the main cities. was being operated by limited and inadequate staff. Cancer treatment services were available only in a limited number of centres. By the 2020s, kidney transplantation had matured. A liver transplant began. Heart and lung surgeries have grown rapidly in terms of quality and quantity. These services were made available at a relatively low cost through the initiatives of government and non-government organizations. Technology such as CT scan, MRI and ultrasound became available even in small towns.

The Covid-19 pandemic tested the resilience of Nepal's health system. This epidemic led to the expansion of ICUs in cities. But there is still a lack of ICUs in rural areas, forcing complex patients to make risky referrals to cities. Rural hospitals still lack laboratories, basic diagnostic services and simple surgery facilities. This has deepened the health care disparity between urban and rural areas. 

Growing inequalities, systemic and cultural barriers As service delivery progresses, even as primary health care has expanded to rural areas, urban-to-rural disparities have widened. Today, most people in Nepal live in rural areas, but only 15 percent of specialist doctors serve them. There is an acute shortage of skilled manpower and state-of-the-art technology in government hospitals.

 Over the past three decades, Nepal's health system has transformed from a scattered network dependent on limited resources to a more structured, institutionalized but still deeply unequal system. Political reform, technology development and determination of health workers on the frontline have determined the journey of health care in Nepal. 

The lack of standardization, accreditation, practice audit and professional accreditation of healthcare providers in Nepal is a serious challenge. This not only creates disparities in service quality, but also increases risks to patient safety. Pre-hospital care is extremely poor, which hinders timely access to quality care for accident or emergency patients. Similarly, since there is no effective system for developing super-specialty hospitals in Nepal, patients are forced to go abroad for the treatment of complex diseases or receive services at retail level. 

There is a high possibility that a super specialty hospital operating without a multi-specialty general hospital in Nepal will put the patient's life at risk. For example, a cancer hospital focuses only on the treatment of cancer patients, if the patient develops other health problems such as diabetes, high blood pressure or sudden heart problems, they need to be referred to another hospital for proper treatment immediately.

Such referral processes increase the risk of treatment delay, additional financial burden and sometimes even death of the patient. Specialized super-specialty hospitals associated with quality general hospitals facilitate the development of specialized healthcare. Therefore, in the future, when establishing a super-specialty hospital in Nepal, it seems imperative to adopt a policy to connect multi-specialty general hospitals as well.

The development of medical education in Nepal took place around 1990. Although it has increased from 3 colleges to more than 30 today, the problem of shortage of health workers has not been solved. The 'brain drain' situation is still serious. 30% of doctors go abroad in search of better opportunities. The rest have to face various problems. Due to having to work up to 80 hours a week and having to make serious decisions, doctors have a high dropout rate. Cultural and social barriers remain. 

The monthly salary of a doctor in a government hospital is less than 50,000, so many are attracted to private practice. But not all private hospitals are in a position to pay well. 

Healthcare workers are part of society. They are also surrounded by the values, priorities and challenges of the same society. Their behavior, motivation and moral framework is determined by the society they serve. Our society, which prioritizes wealth and prestige, also pushes healthcare workers to be money oriented. They are also human beings, forced by society to become 'great', but not provided with the necessary means. Even as social development shapes its constraints, professional ethics provide a 'blueprint' for resistance. 

The pain of losing patients when hospitals lack beds, drugs or life-saving equipment deeply affects health workers. Being forced to not provide proper treatment while working with limited resources, systemic errors, unorganized administration, tiredness of working for long hours, society is adding to the moral crisis by trying to make doctors guilty. 

Nepal's health system needs to be improved through equity and moral reforms. Resource-rich hospitals (manpower, laboratories, diagnostic services, ICU and surgical facilities) should be established in rural areas. To ensure public health services, government subsidies should be made effective, and private sector health fees should be regulated and made accessible. By incorporating ethical education, humanities and community involvement in medical education, health workers can be made accountable to society.

Government and society should stop glorifying medical services and sacrifices. We should stop the tendency to continue the creation of conditions that will end that sacrifice and help sustain it. Health care can be made ethical and practical only by providing doctors with fair wages, safe work areas and institutional support.