According to Dhirendra Nath, Public Health Officer of the Health Directorate Sudurpaschim, who was involved in the study, the health of children in Sudurpaschim is in an emergency state according to the World Health Organization standards. ‘One in every four children is stunted for their age,’ he says.

According to the study report, women and children in rural areas of Sudurpaschim are caught in a vicious cycle of malnutrition. The report states that 31.45 percent of children in Sudurpaschim do not eat any vegetables or fruits. They are fed cow and buffalo milk in addition to mother’s milk before they reach 6 months. Similarly, four out of 10 children are seen eating ‘junk food.’ Public Health Officer Nath says, ‘In Kailali and Kanchanpur, stunting is seen twice as high as in Bajura, Bajhang and Darchula compared to the Terai.’

Sudurpaschim is also the province with the highest child mortality rate. According to the recently released Nepal Multi-Indicator Survey 081/82, 27 out of 1,000 live births in Nepal die before reaching the age of one year. In the Far West, the neonatal mortality rate is 38. Similarly, the mortality rate of children under the age of five in the country is 31 out of 1,000, with 48 deaths in the Far West, the highest among all provinces.

Even though the health of the Far West is in a critical condition, the state has not been able to do anything to improve it. However, this region has produced one leader after another. Lokendra Bahadur Chand of Baitadi became the Prime Minister four times during the Panchayat period and the democratic period. Sher Bahadur Deuba of Dadeldhura led the government five times. He has been a continuous member of parliament since 2048. Many leaders from this region have been ministers repeatedly.

There are not enough health institutions including hospitals in the Far West, and the existing health institutions lack manpower and equipment. Some health institutions are being closed. Raising public awareness about nutrition has not received enough priority. Local residents blame leaders for the lack of health improvements. They say, ‘They come to seek votes by making many promises in elections, but even if they win, they forget their promises, and the situation here remains the same.’

The mortality rate of children under the age of five in the country is 31 per 1,000, while the Far West has the highest death rate of all provinces, with 48 deaths. Selapakha Community Health Center is a health institution located in a remote area of ​​Budhiganga Municipality in Bajura. A birthing center was also in operation here. The health service center, established in 2072, has been closed for five and a half months. ‘An average of 30 patients used to come per day and five women gave birth per month,’ said Devika Singh, an assistant at the health center. ‘After the institution was closed, residents of this area are forced to go to Bayalpata in Achham.’

Not only in Selapakha, but also in other health institutions of the municipality, the service is affected. The health service has been affected after the municipality removed temporary and contract service employees from 46 health institutions.

The circular issued by the Ministry of Finance stating that employees other than those on fixed posts cannot be retained, the provisions of the Act on the Formation and Operation of Local Services in the Far West, 2081, the irregularities pointed out by the Auditor General's report, and complaints to the Commission for the Investigation of Abuse of Authority, said municipal spokesperson Hemraj Jaisi. 'Health institutions in our municipality have been closed for five and a half months,' he said, 'We will find a solution after the election.'

What is the health situation in Bajura, where health services are being closed? Last year, more than 287 children under the age of 5 who came to local health institutions for treatment were found to be suffering from malnutrition.

According to the 'Nepal Health Fact Sheet-2025', the number of public hospitals across Nepal is 8,100. There are 988 public hospitals in the Far West. In terms of the number of hospitals, the Far West ranks sixth among the seven provinces.

There is a provision for every local level to have a basic hospital with 5 to 15 beds. But only 33 out of 88 local levels in the Far West have basic hospitals. 'Residents of rural and remote areas are deprived of minimum medical services,' says Kailali Health Office Chief Ramesh Kunwar, 'The local level should operate basic hospitals, and the provincial government should operate specialist hospitals. But most of the hospitals in the province have only 15 beds.'

25 to 50-bed hospitals are for specialist services. There are 18 specialist hospitals in this province. Most of them are just nominal specialist hospitals. There are only three specialist doctors in Bajura Hospital. 'Nepal Health Fact Sheet' has classified only four hospitals in the Far West as hospitals providing specialist services, including Seti, Mahakali, Tikapur and Geta Hospitals.

There is only one 100-bed hospital in this province. Dadeldhura with 100 beds The hospital has been included in the list of hospitals providing specialized health services by the government. Dadeldhura Hospital, which is under the federal government, is like a sick person. Although there are 59 permanent, temporary and scholarship posts in this hospital, all the posts except two temporary service posts are vacant, the hospital has stated. Similarly, out of 42 permanent, temporary and scholarship posts, only 19 medical officers are working, including eight permanent and 11 temporary service, informed the hospital's information officer Tanka Pant.

Be it Baitadi or Darchula, Bajhang or Bajura, there is no alternative to bringing the injured in accidents in the seven hilly districts of the Far West to Dhangadhi. On 23 Magh, a bus returning from Bhauni of Purchaudi Municipality-7 in Baitadi to Sunkuda in Bajhang met with an accident at Badgaun Ghumti in Purchaudi-7. Thirteen people died in the accident. Dadeldhura Hospital, which is located near the accident site, is the nearest hospital to the accident site. But since there were no treatment facilities for the injured there, Dadeldhura Hospital referred 32 people to Dhangadhi after providing primary treatment.

Former Director of the Provincial Health Directorate Dr. Gunaraj Awasthi says that it is very important to establish a trauma center somewhere that is convenient for the seven hilly districts of the Far West. ‘We have been raising our voice on this for a long time.’ He says that there is no response yet.

The health service situation in the hilly districts of the Far West, except for the two districts of the Terai, is critical. There is one gynecologist and one MDGP in Darchula Hospital. Apart from that, since there are no specialists, patients in the district are forced to go to Dhangadhi or Pithoragarh in India for treatment.

Women and children in rural areas are in a vicious cycle of malnutrition, but the state has not received enough attention, health institutions including hospitals are not enough, the existing health institutions lack manpower and equipment, and some health institutions are being closed. According to Birendra Bhatta, Chief of the Darchula Health Office, a complex problem had arisen in the rural areas on Sunday. A woman was suffering from labor pains at the Basic Health Service Center Patha in Apihimal Rural Municipality. A pregnant woman was brought. After treatment was not possible there, she was referred to the district headquarters. ‘We were carried for about 6 hours on foot and then about five hours by car, with difficulty, to the district headquarters, Khalanga,’ said Bhatta. ‘We were worried that it would be too late to reach the headquarters.’ Thankfully, the pregnant woman’s life was saved after being taken to the headquarters.’

Bhatta, the head of the health office, says that there is even a shortage of iron in health institutions in rural areas. ‘The nutritional situation is also critical,’ he said, ‘Most of the patients here are forced to go to Dhangadhi or Pithoragarh in India. Pithoragarh can be reached in three hours, while it takes 12 hours to reach Dhangadhi.’

A Sudurpaschim is the only province without a teaching hospital. Although the Shaheed Dasharath Chand University of Health Sciences was recently established in Geta, medical education has not started there. The government is operating a 50-bed temporary Geta Hospital there. The government had decided to make Geta the Shaheed Dasharath Chand University of Health Sciences on 27 Magh 079. The bill related to the university was passed by the House of Representatives and published in the Gazette on 4 Ashar.

A 50-bed temporary hospital has been operating in Geta since Kartik 080. But the 600-bed hospital built here with an investment of about 7 billion and the physical infrastructure for teaching medical education were ready three years ago. A vice-chancellor and registrar have recently been appointed in this university. ‘We are preparing to start MBBS, BSc MLT and BSc Nursing from the next academic session,’ said the university’s registrar, Dr. Khemraj Joshi.

From the private sector The number of health institutions operated by the private sector is also the lowest in the Far West. According to the Nepal Health Fact Sheet, out of the 2,451 health institutions operated by the private sector in Nepal as of 2081/82, only 69 are in the Far West. The number of basic health service centers is only 950 in the Far West, which ranks sixth among the provinces.

The Far West is also lagging behind in other health indicators. Everyone born should receive the BCG vaccine, but in the Far West, only 77 out of every 100 births receive the vaccine. The number of deliveries in health institutions is 74 out of every 100, meaning that 26 out of every 100 pregnant women in the Far West give birth outside health institutions.

Most heart patients in the Far West cannot reach health institutions. There are only three cardiologists in the province, said Dr. Khagendra Bahadur Bam, director of the Provincial Health Directorate. ‘Heart patients are not able to come out due to the lack of necessary hospitals and doctors,’ he said, ‘heart disease has been getting worse lately.’

The number of deaths from non-communicable diseases such as high blood pressure, diabetes, heart disease, cancer, and kidney disease is increasing in this province. ‘The burden of the disease is starting to be seen at a young age,’ says Ramesh Kunwar, head of the Kailali Health Office, ‘Our service structure is still treatment-oriented. Preventive and lifestyle-based health services have not received enough attention.’

The Provincial Health Policy-078 states that services such as cath lab, dialysis, radiotherapy, and chemotherapy will be expanded for specialized treatment of major non-communicable diseases in provincial and second-tier hospitals. But cath lab services are not available in any government hospital in the Far West. According to the National Census 078, the average life expectancy of the residents of the Far West is 71.3.

In the Far West, one in four children is underweight for their age, one in six children is stunted, and the neonatal mortality rate is 26 per thousand. Seti Provincial Hospital is currently carrying a heavy burden of treatment services. The hospital, which is called a 'referral' hospital, is facing a shortage of resources and manpower. However, relatively specialized doctors and services are available in this hospital.

Seti Zonal Hospital, which was established as a district hospital in 1997, was upgraded to Seti Zonal Hospital in 2040. Seti Zonal Hospital, which has been treating more than one lakh patients annually, has a permit for only 50 beds. But 242 beds are in operation. The hospital has operated additional beds with its own resources and initiatives.

With the implementation of federalism, this hospital was brought under the provincial government after the formation of a government at the provincial level. Seti Zonal Hospital, which is currently under the Ministry of Social Development, was transferred to the provincial government in July 2079. मा प्रदेश सरकारले दुई सय शय्यामा स्तरोन्नति गर्ने निर्णय गरेको थियो, तर कार्यान्वयन हुन सकेन ।

प्रदेश सरकारमातहत रहेको सेतीलाई गेटाबाट यथाशक्य चाँडो चिकित्सा शिक्षा र विशिष्टीकृत स्वास्थ्य सेवा सुरु होस् भनेर सुदूरपश्चिम प्रदेश सरकारले गत वर्ष नै संघ सरकारमा हस्तान्तरण गर्ने निर्णय गरिसकेको छ । तर कार्यान्वयन प्रक्रिया अघि बढेको छैन । प्रदेश स्वास्थ्य नीति–०७८ मा स्वास्थ्यमा सबैको पहुँचको अवधारणालाई साकार पार्न स्वास्थ्य सेवा प्रणालीको विस्तार र सुदृढीकरण, जनसंख्या, भूगोल र स्वास्थ्य समस्या अनुसार स्वास्थ्य जनशक्तिको उत्पादन, वितरण, परिचालन तथा व्यवस्थापन गरिने भनिएको छ ।

स्वास्थ्य निर्देशक डा. बम हाल स्वास्थ्य क्षेत्र सुधारका लागि तीन तहबीच समन्वयको अभाव रहेको बताउँछन् । प्रदेश सरकारले स्वास्थ्य क्षेत्रमा विनियोजन गर्ने बजेटमा प्राथमिकता नदिने अर्को मुख्य समस्याका रूपमा रहेको उनको भनाइ छ । ‘स्वास्थ्य क्षेत्रमा हरेक वर्ष पाँच प्रतिशतभन्दा माथि बजेट छैन,’ उनी भन्छन्, ‘न्यूनतम १० प्रतिशत विनियोजन त गर्नैपर्ने हो ।’

दरबन्दीबाहेकका कर्मचारी राख्न नपाइने भन्दै अर्थ मन्त्रालयको परिपत्र, प्रदेशको स्थानीय सेवाको गठन तथा सञ्चालनसम्बन्धी ऐन २०८१ को प्रावधान, महालेखा परीक्षकको प्रतिवेदनले औंल्याएको बेरुजुका कारण अस्थायी एवं करार सेवाका कर्मचारी हटाइँदा स्वास्थ्य सेवा प्रभावित। सरकारले पूर्वाधारमा प्राथमिकता दिएर स्वास्थ्य जनशक्ति व्यवस्थाको प्राथमिकतालाई ओझेलमा पारेको निर्देशक डा. बमको भनाइ छ । स्वास्थ्य क्षेत्रमा पनि प्राथमिकीकरण आवश्यक रहेको उल्लेख गर्दै उनले सुदूरपश्चिममा क्यान्सर, न्युरोको जाँच तथा उपचार हुने अस्पताल नहुनु विडम्बनासरह भएको औंल्याए । ‘अर्कातिर थारू समुदाय सिकलसेल रोगबाट ग्रसित छन्,’ उनले भने, ‘स्वास्थ्य क्षेत्र सुधारमा अहिलेका प्रयासहरू पर्याप्त छैनन् ।’ स्वास्थ्य बिमालाई थप सुधार गर्नु आवश्यक रहेको उनले बताए । 

सरकारले आधारभूत स्वास्थ्य सेवा उपलब्ध गराउने संस्थालाई ९८ प्रकारका औषधि निःशुल्क उपलब्ध गराउने प्रावधान छ । ‘सबै संस्थालाई वर्षभरि तोकिएबमोजिम निःशुल्क औषधि उपलब्ध गराउन सकिएको छैन,’ प्रदेश स्वास्थ्य आपूर्ति व्यवस्थापन केन्द्रका प्रमुख झनक ढुंगाना भन्छन्, ‘बजेट लगायतका कारण मानसिक स्वास्थ्य र नसर्ने रोगका औषधि उपलब्ध गराउन समस्या छ ।’ प्रदेशको कुल जनसंख्या भने ०७८ को जनगणनाअनुसार २६ लाख ९४ हजार ४ सय ८३ छ ।

आसन्न निर्वाचनमा प्रतिस्पर्धामा रहेका सुदूरपश्चिमका १६ वटै निर्वाचन क्षेत्रका अधिकांश उम्मेदवारले आफ्ना वाचा/प्रतिबद्धतामा स्वास्थ्य सेवाको सुधारलाई छुटाएको देखिँदैन । कैलाली–५ धनगढी क्षेत्रका सबै उम्मेदवारले सेती प्रादेशिक अस्पतालको स्तरोन्नति तथा सेवा सुधार गर्ने वाचा गरेका छन् । तर मतदाता विश्वस्त देखिँदैनन् ।