KATHMANDU: Only 26 percent of the population in Sudurpashchim Province, or 703,905 individuals, are enrolled in the government’s health insurance program, despite its rollout in fiscal year 2015/16. The province has a total population of 2,694,783, leaving a majority still outside the coverage aimed at improving access to healthcare.

According to the Health Insurance Board, 228,398 families have been enrolled, including 154,505 from target groups such as impoverished, marginalized, and at-risk communities, and 73,893 from other categories. However, only 79,195 families remain actively insured as of April 13 in the current fiscal year 2025/26, indicating a sharp drop in renewals.

Enrollment trends show fluctuations in recent years, with 134,626 families covered in the fiscal year 2022/23, 126,045 in the fiscal year 2023/24, and 146,898 in the fiscal year 2024/25. A total of 673,953 individuals were insured last year.

The program, launched to shield vulnerable and rural populations from high medical costs through a low-premium system, currently operates through 34 health institutions in the province. Under the Health Insurance Act 2017, a family of five pays Rs 3,500 annually, with an additional Rs 700 per extra member.

Coverage is provided free of cost to extremely poor households, persons with disabilities, patients with leprosy, human immunodeficiency virus infection, and complex tuberculosis, and citizens above 70 years of age.

Despite expansion from Kailali to all districts, implementation has been hindered by geographical remoteness, limited public awareness, service delivery gaps, and weak coordination with local governments, affecting the program’s overall effectiveness.

(With inputs from RSS)