Health is also a major basis for assessing the state of human development. In Nepal, access to health services has increased on average in recent decades, but citizens of all geographies have not been able to get equal access. As a result, people from one geography are able to take the maximum benefit of the modern system of health services, while people from another geography are forced to lose their lives without being able to reach the hospital.

Karnali Province is one such geography, where access to health services is extremely difficult. It is believed that birth and death should take place in hospitals to show the importance of access to health services, but even today in Karnali, news of babies being born on the way to the hospital and patients dying on the way are made public. This shows the failure of the provisions of the constitution and state policies. Therefore, the government at all three levels should take a serious approach and make creative and practical efforts to increase citizens' access to health.

On 16th Magh, 27-year-old Ramita Thapa of Tila Rural Municipality of Jumla gave birth to a baby in Chayapatan, where there was about two feet of snow. It takes 5 hours to walk from her village to the nearest health post, Rasa. When someone in labor pains in the village, they have to be carried on a stretcher and run, but most give birth on the road. Although Ramita and the baby are safe, some mothers and babies die during or after childbirth in remote areas of Karnali.

Dhanarupa Bishwakarma of Jiula, Chayanathrara-10, Mugu, gave birth at home on 23 Poush last year. After bleeding for 2 days after giving birth, her family members died while preparing to take her to the district hospital. In Karnali, 172 women have died in the last 9 years due to lack of timely treatment. According to the Health Services Directorate of Karnali Province, 14 people have lost their lives in the last fiscal year alone and 9 in the current fiscal year. 

Death is always tragic. However, it is known months in advance that a woman will give birth, and it is even more tragic when she dies without receiving timely treatment. On the other hand, most of the women in Karnali are between the ages of 15 and 25, and nearly 80 percent of the deaths are in this age group. Thus, the families and society concerned are also suffering from the death of a young and productive age group. The mental trauma caused by death on family members and its impact on the economic and social aspects of the family are additional aspects of discussion. Not only the mother, but also the mortality rate of newborns is alarming. There is data that 777 newborns have lost their lives in the last 4 years.

The main factor hindering access to health services in Karnali is geographical remoteness and the distance of the road determined by it. 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.  The main factor hindering access to health services in Karnali is geographical remoteness and the distance of the road determined by it. 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. The longer it takes to reach the hospital, the greater the chance of life-threatening or even death. In such a situation, the decades-old song "Someone dies without looking at the hospital, in our Nepal" is still valid. The state should create an environment where health services can be provided in the shortest possible time by targeting remote areas. For that, attention should also be paid to using modern technology.

There is a lack of physical infrastructure required for health services in remote areas including Karnali. There is also a shortage of doctors. Out of the 908 posts established in Karnali for health services, only 463 are working. Currently, although there are 184 posts of doctors in Karnali, only 32 posts, excluding contracts, have been filled. In accordance with the policy to retain doctors in Karnali, allowances ranging from 75 to 105 percent are being provided. But it is difficult to find regular doctors in other hospitals except Provincial Hospital Surkhet and Karnali Institute of Health Sciences Jumla.

The problem of shortage of medicines is also huge. Due to lack of medicine storage (space, cold chain, etc.), it is difficult to supply and distribute quality medicines. In addition, due to lack of manpower, equipment worth crores of rupees has been left stranded in hospitals in Karnali. For example, the District Hospital in Rukum West has a 2-bed ventilator and a 6-bed ICU ward. Due to lack of manpower, they are not being used. The unused health equipment is not only a waste of investment, but also a loss of opportunity to save lives through treatment of citizens.