Strategy to Reduce Dependence on Foreign Healthcare Services
In recent years, an increasing number of Nepali citizens have sought specialized medical treatment abroad, particularly in India, Thailand, and other regional hubs. This trend is driven by limitations in our domestic health system, including inadequate access to advanced medical technologies, shortage of specialized professionals, and underdeveloped tertiary care services. In emergencies (e.g., pandemics, geopolitical tensions, natural disasters etc ), foreign care access may collapse. Self-reliance is critical for national preparedness.
Billions of rupees are spent annually by citizens seeking care abroad. Only wealthy individuals can afford foreign care. This outflow of patients is resulting in significant economic losses through out-of-pocket expenditure and capital flight. Continuous medical outflow discourages local investment in healthcare skills and infrastructure. Local expertise is underutilized or lost to brain drain. Widening health inequities, as only higher-income populations can afford foreign care creating a two-tiered health system.
National Vulnerability in Cross-Border Crises and Emergencies: The Case of Nepal
National vulnerability, especially for a country like Nepal that is geographically landlocked, and partially dependent on cross-border support—especially from India—for critical services like healthcare, fuel, and supplies. Nepal is highly vulnerable to natural disasters, such as earthquakes, landslides, and floods. In times of crisis, this vulnerability is made worse by the country’s reliance on cross-border support, particularly from India. Several examples from recent history highlight why such dependency is risky and unsustainable.
Earthquakes and Disruption of Foreign Medical Access
During major earthquakes, such as the devastating one in 2015, infrastructure like roads and airports can be severely damaged. If Nepal’s airports become non-functional, the option of transporting critical patients to better-equipped hospitals abroad—such as in India—completely disappears. This highlights the danger of relying on foreign healthcare access in times of national crisis. When the nation needs it most, it’s unavailable.
During the 2015 unofficial blockade by India, Nepal faced severe shortages of essential supplies, including liquefied petroleum (LP) gas, which is vital for cooking and heating. The suffering endured by people during that period shows how vulnerable the country becomes when its supply chains are dependent on one border and one country. Nepal’s experience shows that dependency during emergencies is not just a weakness—it’s a danger. By learning from the past and prioritizing self-reliance and resilience, Nepal can better protect its people during future crises.
Strategic Health Security and Self-Reliance
Given this context, it is unwise for Nepal to rely so heavily on foreign services —for essential health services, fuel, or emergency supplies. What happens if, during a disaster, all access is cut off? We must ask: Why should a sovereign country leave its people’s lives in the hands of external logistics?
Given the implications for economic sovereignty, health equity, and national preparedness, reducing foreign healthcare dependence must be treated as a strategic national priority in alignment with Nepal’s long-term goals of healthcare self-reliance, regional leadership in health services, and inclusive development.
To treat this issue as a national priority, the government should integrate domestic healthcare strengthening into national development plans allocating specific budget lines for specialized care development and biomedical workforce training, human capital development, research and international collaborations.
Nepal’s healthcare system is at a critical juncture, facing persistent challenges such as limited access to advanced medical technologies, a shortage of skilled biomedical professionals, weak incentives for the development of local expertise and infrastructure and growing reliance on foreign healthcare services. These issues not only strain the existing system but also undermine national health security and equity.
Nepal’s continued reliance on foreign healthcare services—especially for specialized treatments specifically assisted by high technology equipment s—not only reflects gaps in the domestic health system but also poses long-term risks to national resilience, economic stability, and healthcare sovereignty. Many patients seek treatment abroad due to the unavailability of specialized services within Nepal. Lack of expertise often forces patients to go abroad even if the infrastructure exists. Addressing this issue is not merely a health sector concern—it is a strategic national priority with wide-reaching implications.
Reducing foreign healthcare dependence is not just a health policy goal, but a strategic national priority that impacts economic stability, national confidence, and healthcare equity. Government should establish a national task force to map foreign healthcare outflows and guide strategic investments fostering regional centers of excellence to serve both domestic and South Asian patients exploiting the use of AI tools….powerful, data-driven tools to optimize healthcare resource allocation, forecast workforce needs, and plan infrastructure development more efficiently so that government can make informed decisions about where to invest, how to expand services equitably, and how to reduce the country’s dependency on costly external healthcare.
Nepal can build a smarter, more resilient, and self-reliant healthcare system—delivering better outcomes for its citizens while making efficient use of limited resources. To decrease Nepal’s dependency on foreign healthcare services, especially for specialized treatments, a multi-pronged national strategy is essential.
The Digital Nepal Framework 2.0 (DNF 2.0)
The Digital Nepal Framework 2.0 (DNF 2.0), unveiled by the Ministry of Communication and Information Technology, envisions a digitally connected nation with accessible and efficient healthcare services. Implementing Bio Medical Engineering (BME) programs aligns with DNF 2.0’s objectives, particularly in enhancing digital health infrastructure and services. This version of DFN 2.0 envisions a digitally connected nation, where healthcare services are accessible, efficient, and citizen-centered. This requires capacity Building & Partnerships by training of health professionals in digital tools in collaboration with universities, private tech firms, and NGOs for improved healthcare access for remote populations, real-time health data for decision-making, strengthened pandemic and emergency response capacity, cost-effective healthcare delivery and monitoring. Government agencies, development partners, and health institutions are urged to align strategies with DFN V2.0 and invest in building Nepal’s digital health infrastructure.
To accelerate the Digital Framework Nepal 2.0, government must make public premiere institutions resourceful through infrastructure investment, human capital development, governance reform, innovation & ecosystem activation. and establish globally competitive centers that not only address domestic needs but also contribute significantly to regional and international innovation landscapes. By integrating information technology, biotechnology, nanotechnology, and cognitive science, this revolution transcends traditional digital progress and positions data as the core asset linking human, physical, biological, and cyber domains. Converging Technology Impact Areas are AI-driven diagnostics and early childhood health, Precision agriculture, disaster prediction, Human Capital Development covers Personalized learning via AI platforms for rural education, AI-supported mental health care and chronic disease monitoring. Converging Technology synergizes breakthroughs across human, physical, biological & cyber domains powered by massive data integration, high -speed computing power and ubiquitous connectivity. Human Capital Development AI supported Personalized, quality learning at scale.
DNF 2.0’s focus on digital health infrastructure will not only transform healthcare delivery in Nepal but also serve as a catalyst for the growth of Nepal’s IT industry. By creating demand, building local capacity, and enabling innovation, it lays the foundation for a more robust and revenue-generating tech ecosystem.
The Need for Local Capacity Building
Nepal should establish and upgrade tertiary care hospitals with advanced diagnostic and treatment facilities (e.g. oncology, cardiology, nephrology, cognitive psychology etc etc ), expanding postgraduate medical training in critical specialties. Nepal should modernize Health System by deploying AI powered technologies to guide investment, workforce planning, and infrastructure development. Nepal must focus on strengthening local healthcare infrastructure, especially emergency and trauma centers, improving disaster preparedness, including stockpiling essential supplies, diversifying supply routes, potentially through air routes with other countries or agreements with China and others and investing in resilient transport systems that can function even in emergencies.
Premier public institutions such as the Institute of Engineering (IOE), Institute of Medicine (IOM), Nepal Academy of Science and Technology (NAST), and Lagankhel Mental Hospital are at the forefront of this transformation. There is a lack of coordinated efforts and targeted investments to establish Biomedical Engineering programs. Such programs are crucial for integrating medical science with technology, fostering innovation, and improving healthcare delivery. By fostering public-private-academic alliances, Nepal can strengthen its healthcare infrastructure, promote interdisciplinary research, and catalyze breakthroughs in medical science and technology. These partnerships are instrumental in positioning Nepal as a regional hub for healthcare innovation and excellence.
Given the Nepal’s target towards achieving universal health coverage and sustainable development targets, there is a need to review and understand the functioning of Nepal’s health system, its strengths, challenges, and opportunities. There is a need to explore the key health system factors influencing health services and healthcare needs, and forge actionable recommendations for the future. Nepal’s healthcare system faces significant challenges, including limited access to advanced medical technologies, a shortage of skilled biomedical professionals, and reliance on foreign healthcare services.
Aligning Nepal’s IT Budget and Digital Nepal Framework 2.0 with Systemic Education Reform
Nepal’s FY 2025 IT budget and Digital Nepal Framework 2.0 lay out bold targets—exporting IT services worth NPR 3 trillion and generating 1.5 million digital economy jobs within a decade. However, without systemic investment in quality education—particularly in digital literacy, creativity, and innovation—these aspirations risk remaining rhetorical.
Nepal’s current education system is disconnected from the realities of the digital economy. Outdated curricula, underfunded schools, and a lack of digital infrastructure in rural areas threaten to widen the gap between ambition and achievement. Reforming the education system is not just an option—it is a national imperative.
DNF 2.0 (Digital Nepal Framework Version 2.0) envisions a digitally connected nation, with a particular emphasis on enhancing digital health infrastructure and services. One of its key pillars—Capacity Building & Partnerships—focuses on equipping healthcare professionals with digital tools and technologies through collaborations with universities, private tech firms, and NGOs. These efforts aim to improve healthcare access in remote and underserved populations and build digital competencies among health professionals., facilitate real-time data access for evidence-based decision-making for remote cost-effective, tech-enabled healthcare delivery by encouraging multi-sector partnerships (govt., private, NGOs, academic) and push policy alignment and strategic investment in digital health infrastructure. Implementing DNF 2.0—particularly through the lens of digital health—can directly and indirectly contribute to a rise in IT industry revenues in Nepal. Government and institutional demand for digital health platforms (e.g., EHRs, telemedicine, health analytics) creates new business opportunities for local tech firms. Startups developing health apps, diagnostic platforms, and patient management systems will flourish. Nepali IT firms specializing in health-tech solutions may begin exporting services or products to other countries with similar needs, increasing foreign revenue inflow.
Collaborations between the government and IT sector (through PPPs) encourage increased investment in product development and infrastructure, stimulating IT sector growth. The demand for digital solutions in healthcare drives job creation in software development, data analytics, cybersecurity, and cloud services. Increased training and upskilling programs aligned with DNF 2.0 will foster a more competent IT workforce, enhancing service quality and export capability. Universities and research institutions partnering under DNF 2.0 to co-develop health-tech solutions will enhance innovation capacity. This creates a feedback loop of R&D, commercialization, and scaling within the IT sector. Rise in IT-based startups, particularly in digital health. By creating demand, building local capacity, and enabling innovation, it lays the foundation for a more robust and revenue-generating tech ecosystem.
Declaring Premier Institutions as “Institutions of National Importance”
Despite their legacy, premier institutions like IOE, IOM, and NAST continue to struggle with chronic underfunding and limited global engagement. Nepal must take a generational leap by recognizing these institutions as “Institutions of National Importance” through a Special Act of Parliament. Such a designation would guarantee long-term funding and institutional autonomy enabling global faculty and research exchange programs, attracting philanthropic and international. collaborations for enhancing research infrastructure and innovation hubs
Learning from India’s Strategic Vision
Nepal can take inspiration from India’s post-independence foresight. In 1946, India’s Sarkar Committee recommended creating world-class institutions (e.g., IITs, IIMs) that would align education with national development. These institutions became engines of innovation, STEM leadership, and global influence. Nepal has the opportunity to make a similar move—positioning its top institutions as anchors of innovation, scientific research, and economic progress aligned with Digital Nepal goals.
Expand postgraduate medical education, create incentives for specialists to remain in-country, and provide international-standard training programs. PPPs can accelerate the development of quality services domestically. Encourage investment from the private sector in high-end care facilities through tax benefits, subsidies, or co-investment and operational support for high-impact health ventures.
Regulatory authorities should establish clear quality benchmarks for high-end services and enforce compliance. Confidence in domestic care depends on maintaining high-quality standards. Public-Private Partnership promotion encourages private sector and foreign direct investment in specialized care.
Develop centers of excellence in major cities with potential to serve both domestic and international patients building global credibility and helps reverse the patient outflow offering attractive packages (funding, facilities, recognition) to Nepali doctors and biomedical professionals working abroad to return and serve locally. Access to experienced professionals boosts trust and service capacity. Connect rural areas to specialized urban centers using telehealth platforms reducing need for cross-border travel for consultations and follow-ups.
By prioritizing this strategically, Nepal can retain patients and capital within the country, ensure equitable access to advanced care and build a future-ready health system capable of withstanding shocks. Forecasting which services are most outsourced prioritizing domestic capacity-building accordingly, designing efficient referral and treatment networks.
Strategic interventions infrastructure development by establishing advanced tertiary care centers in each province by prioritize facilities for cardiology, oncology, neurology, and nephrology. Human Resource Strengthening by introducing a “Specialist Retention and Return Program” to attract Nepali doctors working abroad. Improve regulatory mechanisms to ensure international-quality healthcare services.
Government should establish well functioning National Task Force on Health Self-Reliance under the Prime Minister’s Office and setting up a real-time system to monitor outbound medical referrals and report semi-annually to the cabinet.
Recommendations
There should be a political will formally recognize reducing foreign healthcare dependence as a strategic national priority. Approve the development of a National Strategy for Specialized Healthcare Self-Reliance by the Ministry of Health and Population. . Mandate inter-ministerial collaboration (Finance, Education, Foreign Affairs, Industry) to support this priority area. Nepal has the potential to be a global destination for affordable, authentic, and spiritual health and wellness tourism. With the right mix of investment, infrastructure, training, and international marketing, Nepal can attract tourists looking not only for adventure—but also for healing and rejuvenation.
Nepal has the opportunity to transform specialized healthcare self-reliance into a permanent pillar of national resilience—immune to political whim and built to grow over time. With the right legal foundations, institutional structures, transparent governance, and sustained investment, this agenda can transcend electoral cycles and deliver lasting benefits for generations. It will not only curb costly medical outflows but also position Nepal as a beacon of affordable, authentic, and spiritually enriched health and wellness care—serving both its own citizens and the world.