Ministry of Commerce And Supplies - Enhanced Integrated ...

N T I S2010medical services are being provided by Ayurveda hospitals. The association of the private sector healthservice providers, called Association of Private Health Institutions of Nepal (APHIN), has about 40 registeredmembers, with only about 27 estimated to be active. The Ministry of Health and Population is the regulatorin the health services of Nepal.The services provided include gynaecological and obstetric (including IVF), cancer treatment, laparoscopysurgery; orthopedics, general surgery and urology; cardiac, neurosurgery, general surgery/medicine; and eyehealth services, intra-ocular lens production and harvesting corneas – eye bank. The cost of providing an IVFservice ranges between NRs 25,000 to 300,000. There is a state-owned Ayurveda Hospital, with servicesprovided to foreigners by this hospital being estimated at only 2 per cent of the total (US$1,500 in FY 2007/08).Norvic International Hospital in Kathmandu reports that 20 per cent of its patients are foreigners. In B&BHospital (Kathmandu), the foreigners’ share in treatment is estimated to be 2-3 per cent (US$30,000) and forNGO/INGO staff working in Kathmandu 5 per cent (US$60,000).Quality of Service: Overall, the quality of medical services in Nepal is low, in particular in rural areas. Noreliable source has been found that assesses the high-quality segment of medical services in Nepal. Accordingto industry sources, certain treatments, such as eye treatment service and gynaecological service, includingIVF, are rated to be very good. Similarly, the quality of orthopaedic surgery is considered to be in line withinternational standards. The quality of Ayurvedic health services provided is rated low, though expected toimprove in the future.Availability and Quality of Labour Force: Nepal, as many other developing countries, has a shortage of medicalpersonnel. According to WHO statistics, the number of doctors/nurses per 10,000 inhabitants is very low (2/5)compared to other countries in the region, such as India (6/13), Sri Lanka (6/17) or Thailand (4/28). There isalso anecdotal evidence that a lot of doctors and nurses are migrating, e.g. to the UK and the USA. In some ofthe medical schools, practically all graduated doctors migrate. This does not mean that there is no availabilityfor exporting health services, especially if such work were better remunerated, but Nepal certainly has noabundance of doctors or other health workers.Labour Cost and Overall Production Cost: Though there is some labour cost advantage, there is no advantagein terms of overall costs, mainly because of high equipment (mainly imported) and energy costs.Business Environment: The country’s accession to the WTO and its commitment to liberalize health trade isopening many doors for health service export. Nepal has not put major specific limitations in this subsector,except in market access in mode 3 where foreign service providers must be incorporated in Nepal with amaximum foreign equity capital of 51 per cent. NRB (2005) projects that the WTO membership will result inan increase in aggregate services-related credit and debit flows by 150 and 155 per cent respectively, implyingNepal remaining a net importer of health services for some time.Government Initiatives and Donor Involvement: The GoN provides some tax holidays and customs reductionin the import of ambulance (1 per cent customs). This is limited to one ambulance for 50 hospital beds andtwo for 100 beds). No specific initiatives have been taken to improve competitiveness, except an accreditationworkshop mentioned by one interviewee. Customs exemption and tax incentives are provided to the eyehealth sector as well. USAID is involved in the development of the eye care sector. WHO is also involved inNepal’s health sector.Prospect for Domestic Supply Conditions: There is a huge demand of health services within the country. Betterinfrastructure, better equipment and international marketing could raise the working conditions and workingenvironment, in terms of both domestic and foreign supply. There is potential of expanding preventive andcurative health services with rehabilitation in case of Ayurvedic medicine.NEPAL TRADE INTEGRATION STRATEGY 2010BACKGROUND REPORT107