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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
N T I S2010Index 4: Socio-economic ImpactOverall Impact of Health Services Exports: It is not clear whether an increase in health services exports isdesirable. Exports of health services could lead to crowding out of health services to poor people within thecountry, or an even stronger concentration of health services in urban areas. On the other hand, such exportsgenerate revenues, which could have a positive effect on the overall quality of the health sector and alsolead to improvements for healthcare for the domestic population (see Lautier (2008) for an overview of thisdebate). There is, therefore, no clear-cut answer whether health services exports are actually desirable inthe case of Nepal and should be promoted by the GoN or donors. But significant ‘exports’ take place in anycase through migration of doctors and nurses from Nepal. A thriving healthcare export sector in Nepal couldpossibly reduce this outflow because it would offer better-paid jobs for healthcare workers in the country, butnot necessarily to the benefit of health services for the local population.Current Employment and Job-Creation Prospect: No data is available about employment provided as a resultof exports, but it is certainly not a significant number, excluding those Nepalese health workers who workabroad.Gender Impact: The sector as a whole provides opportunities for women in the sense that the percentage ofwomen employment in the institutions interviewed ranged between 70 and 90 per cent. 114Contribution to Skill Development: Being a very skill-intensive sector, heath services exports would certainlyhave a positive impact on local skills.Impact on Development of Disadvantaged Regions: The eye health services are available in 11 districts ofNepal, implying some impact on disadvantaged regions. In case of Ayurveda service as well, there is oneregional hospital, one district Ayurvedic primary health care in each district, and one dispensary in all VDCs ofNepal. However, as outlined above, thriving health services exports could channel scarce resources to urbanareas that are already better served by medical services.Energy and Water Constraints: The energy shortage has not affected the health sector as much as othersectors, as the government provides uninterrupted electricity supply to hospitals.Market Attractiveness IndexNo MAI could be calculated for this sector due to a lack of data.114The women employment in Norvic is about 70 per cent, in B&B 80 per cent in Om Hospital 95 per cent.108NEPAL TRADE INTEGRATION STRATEGY 2010BACKGROUND REPORT
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Nepal Trade Integration Strategy 20
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Table of ContentsForewordAbbreviati
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Table 2.17 Acreage and Production o
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List of BoxesBox 2.1 A Nepalese IT
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LoD Limit of DetectionM&E Monitorin
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Chapter 1Trading Environment, Expor
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N T I S20101.3 Capacity Development
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N T I S2010Table 1.1Balance of Paym
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N T I S2010Changes in the Nepalese
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N T I S20101.5 Expanding an ‘Incl
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N T I S2010 Index 4 measures the po
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N T I S2010Table 1.9Impact of 19 Ex
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N T I S2010Table 1.10Geographical D
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N T I S20101.7 Declining Importance
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N T I S2010negotiate for the inclus
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N T I S2010Types of Exported Produc
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N T I S2010Table 2.2Large Cardamom:
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N T I S2010Index 4: Socio-economic
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N T I S2010Index 1: Export Performa
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N T I S2010exporters. Nepal permits
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N T I S2010RankCountryExports Nepal
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N T I S2010like China and Australia
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N T I S2010The opportunities for pr
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N T I S2010Lentils are subject to o
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N T I S2010Production Capacity: Nat
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N T I S2010Gender Impact: This sect
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N T I S2010Export Prospect: Accordi
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N T I S2010Cost and Quality of Infr
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N T I S2010Attractive markets for T
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N T I S2010Market Access Conditions
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N T I S2010Gender Impact: The respo
Page 70 and 71: N T I S2010Information from industr
Page 72 and 73: N T I S2010Cost and Quality of Infr
Page 74 and 75: N T I S2010RankCountryTable 2.26Att
Page 76 and 77: N T I S2010# Botanical Name 41 Spec
Page 78 and 79: N T I S2010Current Export Destinati
Page 80 and 81: N T I S2010significant attention fr
Page 82 and 83: N T I S20109) Silver JewelryBackgro
Page 84 and 85: N T I S2010Availability and Quality
Page 86 and 87: N T I S2010Attractive Markets for S
Page 88 and 89: N T I S2010Production Capacity: Nep
Page 90 and 91: N T I S2010ii.iii.required for the
Page 92 and 93: N T I S201012345678910# Name of Ste
Page 94 and 95: N T I S2010Export Prospect: Accordi
Page 96 and 97: N T I S2010Gender Impact: Female wo
Page 98 and 99: N T I S2010The value added of those
Page 100 and 101: N T I S2010sheep population, which
Page 102 and 103: N T I S201013) TourismBackgroundTou
Page 104 and 105: N T I S2010Index 2: World Market Co
Page 106 and 107: N T I S2010There are also about 24
Page 108 and 109: N T I S2010Index 1: Export Performa
Page 110 and 111: N T I S2010Index 2: World Market Co
Page 112 and 113: N T I S2010Contribution to Skill De
Page 114 and 115: N T I S2010Types of Exported Servic
Page 116 and 117: N T I S2010Cost and Quality of Infr
Page 118 and 119: N T I S201016) Health ServicesBackg
Page 122 and 123: N T I S201017) Education ServicesBa
Page 124 and 125: N T I S2010should be interpreted ca
Page 126 and 127: N T I S2010foreign students. The me
Page 128 and 129: N T I S2010Under mode 4 (presence o
Page 130 and 131: N T I S2010Index 4: Socio-economic
Page 132 and 133: N T I S2010generate revenue of US$3
Page 134 and 135: N T I S2010monopsony power. Several
Page 136 and 137: N T I S2010The possibility of direc
Page 138 and 139: N T I S2010Dairy Products, specific
Page 140 and 141: Chapter 3Access to the Indian Marke
Page 142 and 143: N T I S2010The Nepal-India Trade Tr
Page 144 and 145: N T I S2010Most issues reported abo
Page 146 and 147: N T I S2010Nepalese Domestic Issues
Page 148 and 149: N T I S2010India’s view is that t
Page 150 and 151: Chapter 4Access to the Chinese Mark
Page 152 and 153: N T I S2010products must be wholly
Page 154 and 155: N T I S2010The findings discussed h
Page 156 and 157: N T I S20104.5 Other Impediments to
Page 158: N T I S20104.7 Recommendations: Cha
Page 161 and 162: N T I S2010inflow between 2000 and
Page 163 and 164: N T I S2010Industrial Parks and SEZ
Page 165 and 166: N T I S2010Lack of up-to-date polic
Page 167 and 168: N T I S2010Apart from the critical
Page 169 and 170: N T I S2010capabilities in all five
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N T I S20105.5. Combining Investmen
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Chapter 6Trade FacilitationN T I S2
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N T I S2010In the 2005 Trade Facili
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N T I S2010The latest phase of impl
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N T I S2010improve efficiency. Few
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N T I S2010Figure 7.1Future Organog
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N T I S2010EU countries, special pr
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N T I S2010Act 1980. So far, 130 fi
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N T I S2010The current projects inc
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N T I S2010The NBSM as a secretaria
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N T I S2010Many more organizations
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N T I S2010Table 7.8Existing Nepal
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Table 7.9Standards Issues for Ten E
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N T I S20107.14 Priority Actions an
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N T I S2010It is not clear what amo
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N T I S2010GeneralNepal’s general
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N T I S2010a crucial part of the PR
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N T I S2010residue limits (MRLs) ar
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N T I S2010The viral diseases chirk
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N T I S2010SPS issues Affecting Tra
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N T I S2010Indian phytosanitary sta
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N T I S20108.5 Conclusions and Reco
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N T I S2010Simpler requirements suc
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Table 8.4Summary of Export Environm
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N T I S2010To register a patent, a
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N T I S2010breaches of law. The Nep
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N T I S2010Intellectual Property is
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Chapter 10Barriers to Service Trade
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N T I S2010Constraints in the touri
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N T I S2010Table 10.2Nepal GATS Com
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N T I S2010locations favourable for
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N T I S2010Barriers to Exports of H
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N T I S2010Institutional IssueThe s
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N T I S2010 Strengthening sub-natio
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N T I S2010Observations from enterp
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N T I S2010Nepal Ginger Producers a
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N T I S2010 Helping paper manufactu
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N T I S2010Computer Association of
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N T I S20105. Also related to the a
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N T I S2010The key principles inclu
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N T I S2010That being said, Nepal h
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N T I S2010Nepal Business ForumOn M
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N T I S2010Third, capacity developm
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N T I S2010expected to emerge from
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N T I S201012.7 Possible Options fo
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N T I S201012.8 RecommendationsThe
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N T I S2010GoN / MoF (2009), Econom
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N T I S2010Thapa, Ajit N.S. (2006).
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N T I S2010NEPAL TRADE INTEGRATION
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N T I S2010MainOutcomes Recommended
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N T I S2010NEPAL TRADE INTEGRATION
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N T I S20102. GINGERStrengths Tradi
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N T I S20104. LENTILSStrengths High
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N T I S20105. TEAStrengths Very fav
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N T I S20106. INSTANT NOODLESStreng
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N T I S2010 Review, simplify, and i
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N T I S20109. SILVER JEWELRYStrengt
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N T I S201011. CHYANGRA PASHMINA PR
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N T I S201013. TOURISMStrengthsNatu
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N T I S201015. IT AND BPO SERVICESS
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N T I S201017. EDUCATION SERVICESSt
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N T I S201019. HYDRO-ELECTRICITYStr
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Appendix 1Methodology for Export Po
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N T I S2010B. Data SourcesThe analy
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Appendix 2Market Attractiveness Ind
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N T I S2010Rank13) Tourism1 Germany
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Appendix 3Updated Legislative Actio
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N T I S2010specified management sys
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N T I S2010than pesticide residues
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Appendix 5Malaysia GAP (Skim Amalam
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N T I S2010E. Document ControlQMS d
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Appendix 7Good Agricultural Practic
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