Dr. Sanjib Kumar Sharma serves as the Acting Vice-Chancellor as well as Rector at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. A distinguished Professor of Internal Medicine and Cardiology as well as a Consultant Nephrologist, Dr. Sharma leads the KHDC-Nepal initiative, a community outreach program dedicated to preventing CVD and CKD through education and early intervention. Alongside his research, he is deeply involved in patient care, teaching and mentoring undergraduate, postgraduate, and postdoctoral students. His primary focus remains on primary and secondary prevention of cardiovascular and cardio-renal diseases, aiming to reduce the burden of these conditions in Nepal. In a recent interview with The Himalayan Times, Dr. Sharma discussed BPKIHS's role in delivering affordable healthcare to underserved populations and other pressing health issues. Excerpts:
Q1: Can you describe key initiatives enhancing Nepal's healthcare infrastructure?
Significant achievements include strengthening primary healthcare through Primary Health Care Centres, Health Posts, and Basic Health Service Centres, serving as the first point of contact. These deliver therapeutic, preventive services like immunisation, and health promotion. To address non-communicable diseases (NCDs) and mental health, the government implemented the PEN Protocol, focusing on curative, preventive, and promotional health. Free basic services – consultations, immunisation, HIV/TB treatment, family planning, maternal and child health services, 98 essential medicines, and basic diagnostics – are provided through public facilities to help economically disadvantaged populations. Federal restructuring has granted autonomy in primary-level health service delivery, making it more responsive to local needs, while multispecialty hospitals operate at the federal level. Subsidised dialysis, transplant facilities, and benefits for poor families treating chronic diseases like cancer are also provided. Maternal and Child Health Initiatives, including Safe Motherhood promoting antenatal checkups and institutional delivery with skilled birth attendants, have lowered maternal and infant mortality. Female Community Health Volunteers (FCHVs) are crucial in delivering basic services, health education, and reducing mortality. Telemedicine extends specialist care to remote areas. The government aims to reduce out-of-pocket expenditures through initiatives like the 2016 program covering basic services for registered households. Establishment and upgradation of institutions like BPKIHS, IOM, PAHS, and KUMS produce competent healthcare workers and inform policy through research. Post-COVID, priorities include health emergency preparedness, disease surveillance, laboratory capacity, and adopting digital tools like Electronic Medical Records. The One Health approach addresses zoonotic diseases, and public-private partnerships expand care access. Strategies to retain healthcare workers, like rural incentives, are being explored to combat brain drain.
Q2: How has BPKIHS impacted regional healthcare delivery?
BPKIHS's mission is to improve Nepal's health status by providing holistic care through training compassionate, communicative, and socially accountable health workers, advancing research and innovation. Its goals are Education, Service, and Research. As a centre of excellence, it produces highly skilled graduates, postgraduates, and doctoral professionals with curricula addressing national health needs. It delivers specialised services like cardiology, nephrology, pulmonology, and oncology in Eastern Nepal, reducing the need for patients to travel to Kathmandu or India. Pioneer clinical research contributes to national and international treatment guidelines. Community outreach programs ensure service delivery in Eastern Nepal. BPKIHS provides critical emergency medical services during disasters and epidemics for decades, offering care at reduced costs aligned with national directives. It strengthens the health system through government and international collaboration, helps retain health workers in the east through career opportunities and continuous medical education, supports national public health programs, outbreak investigations, and policy development, and promotes equity to bridge urban-rural disparities in specialised care access.
Q3: What improvements in patient care have been observed?
Significant improvements include advanced medical services through super-specialty care, skilled professionals, and comprehensive care models. A multidisciplinary approach ensures better diagnosis, treatment planning, and outcomes. Patients now access advanced care locally, eliminating long-distance travel for specialised treatment. Enhanced obstetric care, skilled birth attendance, and emergency services have significantly reduced maternal mortality; the institute is now a centre of excellence in fistula management. Improved neonatal and paediatric services, including better NICUs, have increased survival rates. Comprehensive chronic disease management (e.g., diabetes, hypertension, cardiovascular diseases) leads to better outcomes. Timely advanced diagnostics enable earlier detection and intervention, improving prognoses. Telemedicine provides expert consultations in remote areas. Patient satisfaction has increased due to better communication, compassionate care, and shorter waiting times. Continuous quality improvement and evidence-based guidelines contribute to safer, more effective care.
Q4: How has external support contributed to capacity building?
External partners support scholarships and fellowships (e.g., Fulbright, Australia Awards, WHO) for advanced training, exchange programs, workshops, and skill development, increasing competencies. Regular CME programs keep professionals updated. Technical assistance includes consultancy, mentorship, and curriculum development meeting international and local standards. Research collaborations with international institutions offer engagement in cutting-edge research. Specialized training in epidemiology, disease control, disaster preparedness, and emergency response enhances crisis management. Countries like India provide scholarships for training in medical specialties. Support also establishes simulation labs, e-learning platforms, telehealth training, leadership/management training, and provides regional/global exposure through conferences and networks, improving both individual skills and system-wide healthcare delivery and resilience.
Q5: Can you share success stories of enhanced facilities impacting communities?
Through community collaboration over two decades, led by BPKIHS's Department of Internal Medicine with Geneva University Hospitals, awareness of NCDs and kidney diseases has significantly increased. Communities now better understand risk factors and the importance of timely detection and treatment adherence. Similarly, BPKIHS-led snakebite projects, including a successful motorcycle volunteer initiative, engaged communities in helping victims seek timely care, reducing mortality. These models demonstrate how health centres, primary or tertiary, can effectively partner with communities to raise awareness on significant public health issues.
Q6: What role do international partnerships play in addressing Nepal's healthcare challenges?
International partnerships are crucial for sustaining progress. They enable capacity building, ensuring a competent healthcare workforce. Beyond this, they strengthen health systems, support emergency response, advance research, and improve technology access. Partnerships facilitate policy development, disease surveillance, and national programs aligned with global standards, contributing to reductions in maternal and child mortality. They provide vital financial and technical support during pandemics, disasters, and outbreaks. Sustained collaboration is essential for future challenges like climate-sensitive diseases, AMR, and health equity gaps.
Q7: What patient feedback have you received on enhanced facilities?
Feedback often reflects system limitations due to scarce services, especially for chronic NCDs, leading to concerns about care quality, waiting times, and local service availability. We address this through health promotion campaigns for risk factor awareness and early consultation. However, patients appreciate not travelling to Kathmandu or abroad for treatments now available locally, reducing financial and emotional burdens. Positive feedback highlights compassionate care from trained staff, better infrastructure, cleanliness, essential medicine/diagnostic access, and continuity of care for chronic conditions, building greater trust in the public system.
Q8: How important are international partnerships for Nepal's healthcare development?
They are vital. Limited national fiscal allocation is insufficient. Partners provide critical financial support for vaccination, HIV/TB control, and emergencies – the COVAX initiative was essential during COVID. Over 90% child vaccination coverage relies on Gavi and UNICEF. Partners assist health governance, including Social Health Insurance, Universal Health Coverage, and NCD Multisectoral Action Plans. Beyond finance, they strengthen technical capacity, introduce innovations, ensure equitable access in remote areas, support system resilience through training and infrastructure, and help address emerging challenges like climate change, AMR, and NCDs.
Q9: What challenges arose implementing healthcare projects, and how were they addressed?
Challenges include geographical barriers, unplanned settlements, political instability, corruption, and cultural diversity requiring community engagement. Federalism caused fragmented approaches and confusion. Over-reliance on donors is a major challenge. Solutions emphasize community engagement, health system decentralization, local capacity building, and improved federal-provincial-local coordination. Digital reporting tools, multisectoral planning frameworks, increased local infrastructure investment, workforce training, and accountability mechanisms help overcome logistical and governance barriers.
Q10: Discuss ongoing/future projects for healthcare infrastructure.
A massive BPKIHS infrastructure upgrade is underway with substantial government investment. Nationally, key projects include: Sector-Wide Approach Program (SWAp) Phase III (GoN, World Bank, UK Aid, ADB) upgrading rural PHC; the Equity in Health Project (USAID, UNICEF) equipping 500 facilities with solar power; a JICA-supported 300-bed tertiary hospital in Pokhara with trauma/cancer units (2026); National Trauma Center expansion; Integrated Health Information Management System (iHIMS) for digital health; and community-level screening/management for diabetes, hypertension, and cancers.
Q11: How does collaboration prepare Nepal for public health emergencies?
Collaboration is critical for Nepal's vulnerability to disasters. During COVID-19, COVAX provided over 11 million vaccine doses; bilateral aid (e.g., USAID, China) supplied ventilators, PPE, oxygen. Programs like GHSA invest in disease surveillance, labs, human resources, and emergency management. WHO-supported EWARS detects outbreaks (e.g., dengue). Cross-border One Health collaborations (FAO, WHO, OIE) monitor zoonotic diseases. Nepal accesses WHO's GOARN and CEPI for outbreak response and vaccine R&D. Post-2015 earthquake, partners (UN CERF, India, EU, US, JICA) delivered medical kits, rebuilt 400+ facilities earthquake-resistant, and provided trauma care. WFP/Red Cross facilitate supply chains. Training in epidemic management, disaster drills (JICA, ADPC), climate-risk prediction (UNDP, ICIMOD), and telemedicine enhance preparedness. The Health Emergency Operation Center (HEOC - WHO, USAID) and National Emergency Operation Center (NEOC) coordinate responses. FCHVs (UNICEF, UNFPA) disseminate alerts. Joint simulations and reviews identify gaps. Collaboration enables emergency stockpiling, guideline development, rapid mobilization, mental health support integration, and regional early warning systems.
Q12: What measures ensure healthcare access for underserved rural populations?
Measures focus on reducing rural-urban manpower disparity by upgrading infrastructure and road connectivity. Mobile health units provide maternal care, vaccinations, and emergencies in isolated areas. Telemedicine enables remote diagnostics. Over 50,000 FCHVs (trained by UNICEF, Norway) deliver maternal/child health services and combat malnutrition. Local-language radio/TV programs (UNICEF, UNESCO) promote sanitation and vaccination. iHIMS digitizes records across 1000+ facilities. Financial protection via the National Health Insurance Program reduces out-of-pocket costs. Incentives like rural service bonds attract professionals. Community birthing centers (EDP support), solar-powered cold chains, and e-logistics ensure medicine/vaccine supply. NGO/local government collaborations tailor outreach. Models like KHDC emphasize community engagement and primary care strengthening for chronic disease management.
Q13: How can technology improve healthcare through collaboration?
Technology offers significant benefits: drones for vaccine/medicine delivery; geospatial mapping for disease surveillance; AI for disease detection and management (e.g., SNAICS project for snake species ID); virtual reality for surgical training; machine learning for risk prediction (e.g., refining ASCVD screening through global ventures); digital twins and integrated OMICS for researching intergenerational health impacts; genomic studies (e.g., COPD project with Nottingham University) for innovative therapies; low-cost wearables for remote chronic condition monitoring; open-source tech for evidence-based treatment; and 3D printing for medical equipment. Maximizing impact requires integrating these within national digital health strategies, ensuring interoperability, building digital literacy among rural health workers, utilizing mHealth apps, addressing data privacy/cybersecurity/ethical AI, and accelerating scale via public-private partnerships for equitable access.
Q14: How do you envision Nepal's healthcare future with continued international support?
With support, Nepal can leverage AI to reduce capacity gaps, improve disease detection/management, and expand telemedicine reach via improved connectivity (e.g., Starlink). Establishing medical institutions in underserved provinces (EDP support) will reduce reliance on foreign education and brain drain. Digital tracking can ensure medicine supply and accountability, while centralised governance reduces fragmentation. Social media can combat health taboos. Political stability enables long-term partnerships. Gradual shift to domestic funding (e.g., taxing tourism/remittances) ensures sustainability. Infrastructure development and private investment in pharma reduce aid reliance. Partnerships with India can explore traditional medicine (e.g., Yoga) for healthy lifestyles. Vigilance against NCDs via resilient, responsive systems remains critical, aided by partners. The future includes fostering health-tech incubators, research in genomics/personalized medicine/digital therapeutics, integrating One Health for zoonotic/climate risks, strengthening regional cooperation for health security, institutionalizing quality assurance, UHC reforms, and ethical digital health governance.
Q15: What message on collaboration's importance for Nepal's health outcomes?
Collaborative efforts are fundamental. However, a shift from donor dependency to domestic resource mobilization (e.g., National Health Insurance) is essential, alongside ensuring aid accountability. Vulnerability to foreign policy shifts necessitates efficient resource direction. Focus must be on capacity building, knowledge transfer, and reducing health worker migration. Improving geographical access boosts both economic prosperity and healthcare. Politicians must prioritize evidence-based policies over short-term agendas. The private sector drives innovation and scalability; regulatory measures should encourage its investment. An inclusive approach, listening to diverse community voices, solves half the problems. Collaboration rooted in mutual respect and national priorities creates lasting impact. International partners, government, academia, private sector, and communities must unite to build a resilient, inclusive, people-centered system. Strengthening health diplomacy, investing in local innovation, and promoting ethical leadership are key to ensuring equitable, quality healthcare for every Nepali citizen.
