Summary: Although an agreement was reached on November 7 to provide health workers with benefits equivalent to the fifth pay scale, most private medical colleges have yet to implement it. At Kathmandu’s Shahid Memorial Hospital, 40 health workers have gone on strike since May 15, refusing to provide services except for emergencies due to unpaid minimum wages. While the Ministry of Health has established monitoring mechanisms, private medical colleges have failed to comply with the agreement, leading to complaints of governmental impotence.
May 17, Kathmandu – On November 7 last year, an agreement was signed to provide nurses and health workers with fifth-level pay and benefits at health institutions. This pact was endorsed by the Association of Private Health Institutions of Nepal, the Nursing Association, the Medical and Dental College Association of Nepal, and representatives of the protesting health workers, with coordination led by the Ministry of Health.
According to the agreement, health workers were to start receiving a monthly salary of NPR 34,730 from the month of Kartik. This amount did not include night shift or overtime pay. However, after six months, the majority of medical colleges have not disbursed salaries as agreed. Instead, some institutions have resorted to threatening language, telling workers, “If you don’t want to work, you can leave—there are many unemployed nurses waiting.”
Since May 15 (Friday), health workers at Shahid Memorial Hospital in Kalanki, Kathmandu, have been protesting by withdrawing all services except emergency care. Health assistant Abiraj Shahi stated that health workers have been receiving only NPR 19,000 per month. “We repeatedly urged the hospital administration to provide government-mandated salaries, but they showed no concern,” Shahi lamented. Currently, 40 health workers at the hospital are participating in the strike.
Many nurses in other health institutions do not openly express grievances of labor exploitation, fearing job loss if they protest. Government bodies tasked with regulating labor exploitation in private institutions remain powerless. The shortage of adequate service provisions, lack of conducive environments for training, and excessive workloads have led to growing frustration in the nursing profession—the backbone of hospital operations. As a result, the number of nurses willing to work within the country is decreasing, while overseas opportunities appear more attractive.
According to nurse Jyoti Ranabhat, coordinator of the protesting health workers, many private medical colleges are unwilling to implement the agreement. Only a few institutions, such as Manipal Teaching Hospital in Pokhara and Gandaki Medical College, have increased salaries, while many private hospitals across the country maintain outdated and low pay scales. “Hospitals consider nurses weak and are intentionally disregarding the agreement,” Ranabhat said. Despite claims of compliance, hospitals have adopted strategies that do not effectively change salary structures, often setting basic wages between NPR 12,000 and 18,000, which cannot be considered implementation of the agreement. Examples include Nepal Medical College and Teaching Hospital in Jorpati, where basic pay is NPR 13,000 and with additional allowances, the take-home amount reaches about NPR 21,000.
“Nurses here cannot demand government-mandated benefits openly,” said a nurse, who requested anonymity. “The nursing in-charge often responds to complaints about salaries by telling nurses dissatisfied with pay to leave.” The nursing community, often neglected, is responsible for maintaining the entire country’s healthcare system. When Nisha Mehta, a nurse herself, took office as Health Minister on March 26, nurses felt hopeful that longstanding issues would be resolved. In the initial weeks, leaders from the Nepal Nursing Association and protesting nurses greeted her and shared concerns. Mehta assured them of support. However, Ranabhat has accused institutional collusion aimed at undermining the nurses’ movement, citing weak leadership on nurses’ rights and poor coordination among organizations as reasons hospitals do not honor the agreement. “The voices of nurses have been suppressed,” she said. “Collusion between professional bodies and hospital administrations has victimized nurses.”
The nurses are currently protesting, demanding an end to labor exploitation in private hospitals. Around a year ago, resident physicians staged nationwide protests for government-mandated services and benefits. Following months of struggle, private medical management agreed to provide doctors benefits equivalent to the eighth pay scale. However, nurses’ conditions remain unchanged. Labor exploitation combined with long shifts and minimal benefits continue to make nurses’ lives difficult. “Nurses are required to provide 24-hour service and bear full responsibility for patient care. Not receiving minimum wages amounts to open exploitation,” Ranabhat emphasized.
When Nisha Mehta became Health Minister on Chaitra 13 (March 26), nurses were optimistic. “The resolution that our decades-long struggle could not achieve seemed imminent,” said Mehta at the time. Being a nurse herself, she acknowledged the challenges regarding promotion and benefits for nurses, pledging to implement reforms.
Despite initial greetings and promises from the minister, substantive decisions on enforcing the agreement have yet to materialize. Striking nurses have repeatedly presented the agreement to Minister Mehta, who has remained silent. As one nurse recounted a recent incident, “We expected solutions after Mehta became health minister, but she said she is not just the minister for nurses.”
The November agreement was negotiated under the chairmanship of Additional Secretary Dr. Shrikrishna Shrestha. A 14-member committee was formed to recommend legal improvements on minimum wages, safe and dignified workplaces, and measures to encourage nurses to remain in the country. This committee has already submitted its report to the ministry.
“The report has been submitted, and based on it, the ministry has issued a few circulars two to three times,” Dr. Shrestha stated, “Monitoring mechanisms have also been set up at the provincial level.” He explained that committees chaired by chief district officers (CDOs) have been established in all districts, incorporating nurses, health workers, and relevant stakeholders to oversee compliance with the agreement.
However, six months later, many private medical colleges have not implemented the revised salary structures, with complaints reaching the ministry. Many nurses cannot openly claim labor exploitation for fear of job loss. Government actors entrusted to regulate exploitation by private institutions have been ineffective.
“Only two or three medical colleges have reportedly carried out the reforms, but most continue with old salary structures,” Dr. Shrestha revealed. The ministry has not been able to effectively monitor compliance.
A senior official at the Ministry of Health conceded that the ministry is powerless before medical college operators. “Their failure to implement their own agreement clearly shows who controls the government,” the official remarked. “The nurses’ issues have not been taken seriously, reflecting the state’s apathy.”
According to another official, medical colleges are sometimes granted leniency to defer implementation when profitability is affected. For example, allowances for resident doctors were increased only after agreeing to increase MBBS seats. “They earn billions from nurses’ work but maintain an exploitative mentality,” the official said. “Political influence often forces the government to concede, but the operators never relent.”
Private medical management openly states that they will release funds for nurses only if the government fulfills its obligations. The agreement covers 27 points, including improvements in health workers’ services and benefits and some concessions to medical colleges. However, management insists salary increases cannot be fully applied until their demands are met.
Dr. Padam Khadka, president of Afine, stated that unresolved government commitments have complicated the problem. The agreement is not legally binding, and the government’s failure to honor commitments has hindered implementation. The private sector agreed that the government should also establish supportive policies and administrative frameworks.
“Among the seven government commitments in the agreement, none have been fully realized,” Khadka said. “When the government neglects responsibilities, the private sector is reluctant to implement the agreement.” According to Khadka, no legal provision mandates the private sector to align salary structures with government hospitals. The agreement called for renewing private hospital operation permits as per the Public Health Regulation 2077, supporting legal enforcement with provincial health ministries, and coordinating with the Medical Education Commission on academic programs and student admissions in private medical and dental colleges.
“There is no legal clause that compulsory sets government-level salaries in the private sector,” Khadka emphasized. “It is a matter of consensus with the private medical management.”
