Key Takeaways:

• Expansion plan to cover all 14 districts of Koshi Province
• BPKIHS to act as specialist hub, local health facilities to deliver care
• Only 19 patients received home hospice care last year due to constraints
• Workshop stresses local government ownership and sustainability

DHARAN, AUGUST 10 The BP Koirala Institute of Health Sciences has unveiled plans to expand integrated palliative and hospice care services to all 14 districts of Koshi Province, with a focus on taking specialised care to patients' homes. The plan aims to connect the institute's specialist services with local health facilities and communities so that patients requiring end-of-life and supportive care can receive services closer to home. Presenting a paper on the institute's role in strengthening and expanding palliative care in eastern Nepal, BPKIHS Vice-Chancellor Prof Dr Smriti Karki said the institute should serve as the specialist hub while district and local health institutions become the foundation for delivering care in communities. Under the proposed model, BPKIHS would provide specialist consultation, training and technical support, while local health institutions and health workers would extend services to patients and families in their communities and homes. Only 19 patients received home hospice care The plan comes amid significant gaps in access to home-based hospice services. According to data from the institute's Medical Oncology service for the past year, around 200 cancer patients were identified as being in the final stage of life. However, limited human resources, time and geographical constraints meant that the institute could provide direct home hospice care to only 19 patients. BPKIHS began providing home-based hospice services through its Medical Oncology Department in June 2025. Where physical visits are difficult, health workers have also been following up with patients through remote consultations using platforms including WhatsApp and Viber, Karki said. 'We cannot physically reach every patient despite our efforts because of time, human-resource and geographical constraints,' she said. Building a system beyond the hospital The proposed expansion is being discussed under a project titled 'Development Project on the Fundamentals of Integrated Palliative and Hospice Care for Koshi Province'. A workshop being held at BPKIHS is examining ways to integrate palliative care into the wider health system, including clinical management, home hospice visits, pain-relief medicines, nursing care, referral mechanisms and telemedicine. Presentations at the workshop have also focused on the essential components of palliative care, strategies for integrating such services into the health system and lessons from existing models. BPKIHS doctors Dr Sonia Dulal and nurse Rojita Shakya presented an assessment of the impact of the institute's home-based hospice service in Dharan, focusing on its effects on patients and families and ways to measure service effectiveness. The workshop is also providing practical training, including hospital-based patient management, home hospice visits, case discussions and referral systems. Participants will undergo assessments before and after the training. Focus on sustainability The organisers say the objective is to ensure that palliative and hospice care does not remain limited to the project period. Karki said local government ownership, along with policy and resource commitments from the provincial government, would be essential to make the service a sustainable part of the health system. 'We should not stop the service when the project period ends,' she said. 'It needs to be transformed into a sustainable component of the health system through local government ownership and provincial policy and resource support.' The workshop is being organised by Nepal Hospice Care Centre in coordination with the BPKIHS Student Cancer Care Group, with support from Two Worlds Cancer Collaboration Canada, Rotary International's global grant, Rotary Club of Kathmandu, BPKIHS, the Koshi Province Ministry of Health and Dharan Sub-Metropolitan City. The four-day workshop began on Monday and will conclude with a certificate distribution programme on August 15.