KATHMANDU: Nepal’s migrant worker medical screening system has long been dominated by a small group of private clinics, often accused of overcharging, cartel-like practices, and restricting access for workers outside Kathmandu.

Following widespread public anger, the government has recently introduced sweeping reforms. The policy has opened medical testing to all qualified public and private hospitals, aiming to break the syndicate, lower costs through competition, improve transparency, and decentralize services nationwide.

What is the core objective of the government’s decision to open medical examinations to all hospitals?

The core objective is to dismantle the entrenched “syndicate” of a select few private clinics that have historically monopolized the medical screening process for migrant workers. By opening the listing to all qualified government and private hospitals, the Balen-led government aims to foster a competitive market environment that naturally lowers costs for the average worker.

Furthermore, this policy is a direct response to the “Gen Z Uprising” demands for decentralization, ensuring that a laborer from a remote province no longer has to travel to Kathmandu and stay in expensive hotels just to complete a basic health check-up.

The government believes that by involving state-owned hospitals, they can guarantee a higher standard of integrity and eliminate the “fake report” scams that frequently result in workers being deported upon arrival in destination countries.

Which destination countries currently pose the biggest challenge to this “Open System”?

The biggest challenges come from major labor-receiving nations like Malaysia, Saudi Arabia, Oman, Bahrain, and Qatar, all of which maintain their own proprietary accreditation systems.

For instance, Saudi Arabia and other Gulf nations strictly recognize only those clinics registered under the “GAMCA” (Gulf Health Council) umbrella, while Malaysia has its own specific list of 36 approved medical centers.

Qatar operates through its own Integrated “VFS” centers where medicals are tied directly to the visa processing system. Because these countries prioritize their own health security protocols and bilateral trust with specific private entities, they do not automatically recognize Nepal’s domestic policy changes.

This creates a friction point where a hospital might be “legal” in Nepal but its reports are considered “invalid” by the foreign consulate.

Does the current reform guarantee that a medical report from a newly listed hospital will be accepted for a visa?

Currently, there is no such guarantee, which remains the most significant risk for migrant workers. While the Ministry of Labour has legally opened the doors for any hospital to apply for listing, it has admitted that the “diplomatic phase” of the reform is still in its infancy.

This means that a worker who completes a medical exam at a newly listed provincial government hospital might find their visa application rejected by the Malaysian or Saudi embassy because that specific hospital is not on the embassy’s pre-approved list.

The government is operating on a “domestic first” strategy, hoping that by proving the quality and transparency of these new labs, they can later negotiate their inclusion into international systems, but for now, the uncertainty persists for the individual worker.

What are the specific legal grounds for allowing government hospitals to conduct these tests?

The government’s decision is firmly rooted in the Foreign Employment Act of 2007 and the accompanying Foreign Employment Regulations.

Section 72 of the Act explicitly empowers the state to authorize any “recognized health institution” to perform screenings, while Rule 45 of the Regulations clarifies that the involvement of government-owned hospitals cannot be restricted by any existing private-sector agreements.

Essentially, the government is using the “sovereignty of the law” to override the informal “syndicate” agreements that past administrations had allowed to flourish. By citing these specific legal provisions, the Ministry of Labour is defending its reform against lawsuits filed by private health entrepreneurs who argue that the new “open system” violates their existing exclusive contracts with foreign agencies.

How has the medical examination fee fluctuated leading up to this reform?

The fee structure has been a volatile battleground between reformers and business lobbies. In late 2025, following the Gen Z protests, the interim government attempted to increase the mandatory screening package from Rs 6,500 to Rs 9,500, arguing that the inclusion of 34 different health parameters required a higher price point.

However, this hike was met with immense public backlash, as it was seen as an additional tax on the poor. When the new leadership took over, they attempted to scrap the increase, leading to a series of court cases.

The 100-point roadmap seeks to stabilize these costs by allowing government hospitals to offer the service at a “cost-plus” rate, forcing private clinics to lower their prices to remain competitive in a non-monopolized market.

What is the required process for a new hospital to get listed under this roadmap?

To prevent a drop in quality, the government has established a rigorous “Specialist Monitoring Committee” to vet every applicant.

A hospital must first demonstrate that it possesses the specific infrastructure, including advanced pathology labs, radiology equipment, and biometric registration systems that can link directly to the Ministry’s central database.

After an initial paper application, the hospital undergoes a physical inspection by a team of medical experts and labor officials. Only after this committee certifies that the hospital meets both the domestic 2015 Health Guidelines and the general international standards required by labor-receiving nations is it formally added to the list.

This “gatekeeping” is intended to ensure that destination countries eventually gain the confidence to trust these new institutions.

What happens if a migrant worker gets a medical clearance from a non-recognized hospital?

If a worker utilizes a hospital that is recognized by the Nepal government but rejected by the destination country, the consequences are severe: the visa process comes to an immediate halt.

Because systems like GAMCA are digitally linked to the visa portals of countries like Saudi Arabia, a “pass” report from an unlinked hospital effectively does not exist in the eyes of the foreign government.

The worker would be forced to pay for a second medical examination at an “approved” clinic, wasting both time and significant money. This is the primary reason why the government is being urged to accelerate diplomatic talks; until Malaysia or the Gulf nations update their own lists to include Nepal’s newly authorized hospitals, the “open system” remains a domestic victory that could potentially lead to international frustration.