The government has implemented a duty schedule in the health sector from 10 AM to 5 PM, which does not align with the actual working hours of doctors. Health is a special and sensitive sector, naturally a top priority for any government. In the past, efforts were made to make this sector more people-centric. The new government formed after the elections has also made several decisions regarding the health sector. However, the 10-to-5 duty schedule introduced by this government does not seem particularly scientific. In many hospitals, a 9-to-5 schedule has long been followed, with healthcare personnel working accordingly.
Doctors working in government institutions have faced challenges for decades. Low remuneration, uncertainty about professional development, extra duties without benefits, increasing patient loads, and unsafe workplaces are some of the prevailing issues. The government’s neglect of these problems is particularly disheartening. Many doctors working in both public and private sectors are deprived of fair pay corresponding to their labor. There is no clear or sufficient allowance for overtime, night shifts, or emergency duties.
Complaints frequently arise because the legally mandated working hours under the labor law are not enforced. The current schedule appears to recognize only the services provided between 9 and 5 as healthcare service. Services such as on-call, emergency, and intimate care provided by doctors are seemingly not considered as part of their service. Though some limited government health institutions provide extra allowances, health workers in hospitals outside Kathmandu are largely excluded from these benefits.
The doctor-to-patient ratio is extremely weak. With too few doctors relative to the population, a single doctor tends to see an excessive number of patients. On one hand, we discuss quality healthcare services, but on the other, it is a distressing reality that one doctor often must attend to up to 100 patients in a day. In the Terai-Madhes region, a local saying aptly describes this situation: “Dharphadi ke biwah, kanpatti me senur,” meaning a hasty marriage where sindoor (vermilion) is applied on the side of the forehead instead of the parting, symbolizing how haste affects proper diagnosis and treatment.
Due to inadequate infrastructure, many hospitals face a difficult working environment with shortages of equipment, beds, medicines, and manpower. Even now, like at Narayani Hospital — a central hospital — patients sometimes have to wait under makeshift shelters. Departments providing intimate care are dilapidated, and many patients suffer daily due to bed shortages. Why are doctors dissatisfied? Their contributions are not respected. They continuously provide services, but when policies are formulated, their actual conditions, mental fatigue, and professional rights are not sufficiently considered.
If such directives are implemented without adequate preparation, the quality of service could decline, and doctors’ mental fatigue might increase. This could lead to dissatisfaction and protests within the health sector, ultimately affecting patients the most. In all adverse situations in the country’s health sector, doctors and health workers have worked tirelessly with disregard for their own lives. Healthcare must be treated as a priority, there is no debate on that. However, merely extending duty hours without improving the rights, benefits, and working conditions of the service providers, i.e., the doctors, is not a sustainable solution. The government must focus on adequate workforce management, appropriate salary and allowances, strict enforcement of legal working hour provisions, and strengthening health infrastructure. Only when doctors are satisfied will healthcare be effective. Otherwise, there is a risk that the system will weaken under the guise of ‘service expansion.’ We urge the government to introduce policies that restore doctors’ smiles and enable them to treat patients with a genuine smile. (Dr. Uday Narayan Singh works at Narayani Hospital in Birgunj.)
