SURKHET: At least nine years after the federal government announced the establishment of Surkhet Medical College, the project remains stalled without even a Detailed Project Report (DPR) in hand, despite the infrastructure office spending over Rs 42.7 million over the past seven years.

The government has announced the dissolution of the said project office. Following the dissolution of the office, it is also not clear which agency will advance the remaining work of the medical college and how.

Through the policy and program and budget of the fiscal year 2016/17, the federal government had announced the establishment of government medical colleges in Bardibas of Madhesh Province, Butwal of Lumbini Province, and Surkhet of Karnali Province.

Three years after that, on May 16, 2019, the Surkhet Medical College Infrastructure Development Project Office was established in Birendranagar. However, the then Ministry of Education, Science, and Technology gave formal permission for the establishment of the college only in 2021. Operated from a rented house for the first two years, the office moved in the fiscal year 2021/22 to the building where the Education Development and Coordination Unit is located.

The office has prepared the feasibility study, master plan, and environmental impact assessment report. However, the federal government did not provide the budget required to prepare the DPR, says the Information Officer of the office, Engineer Shankar Timilsena. “The government has mentioned dissolving the office in the budget of the upcoming fiscal year. We have, however, not received an official letter,” says Timilsena, “Three important works have been done by the office. The remaining main work is the DPR.”

According to him, approximately Rs 45 million is required to prepare the DPR.

Birendranagar-based project office for the Surkhet Medical College Infrastructure Development. Photo: Office’s Website

Currently, six employees are working in the office. There are three permanent sanctioned posts consisting of an undersecretary, an officer, and an accountant, while three temporary employees, including an office assistant, are working.

From the fiscal year 2019/20 to the current fiscal year 2025/26, the office has spent over Rs 42.7 million. Out of that, Rs 34.6 million has been spent under current expenditure and some Rs 8 million under capital expenditure.

The office stated that the feasibility study, master plan, and environmental impact assessment report were prepared from the capital budget.

The master plan prepared by the office was approved by the federal government on July 14, 2022. The environmental impact assessment report was approved on November 23, 2023.

However, the proposal submitted on September 13, 2023, to prepare the DPR was not approved. The said proposal, submitted to the then Ministry of Education, Science, and Technology, was rejected by a secretary-level decision on February 25, 2024.

Land acquisition halted

The government had brought forward the concept of “One Province, One Government Medical College” in the fiscal year 2016/17. However, it took the ministry five years to give permission for the establishment of Surkhet Medical College.

The project office, which did not receive a clear mandate for two years even after its establishment, advanced the preliminary work related to infrastructure development only after receiving permission in late 2021.

The office had planned to prepare the feasibility study, master plan, environmental impact assessment, and DPR. Although the first three works among those were completed, the proposal for the DPR did not receive approval.

According to Timilsena, before the permission for establishing the medical college arrived, a budget of up to Rs 100 million annually used to be allocated to the office. After receiving permission, however, the annual budget decreased and was limited to around Rs 20 million.

The government had brought forward the concept of “One Province, One Government Medical College” in the fiscal year 2016/17. However, it took the ministry five years to give permission for the establishment of Surkhet Medical College.

According to the master plan, 29.89 hectares of land is required for the establishment of the medical college. For that, two locations have been proposed in Birendranagar Municipality-11 and 13.

It is mentioned in the master plan that 16.50 hectares of land is required for Site “A” and 13.39 hectares of land for Site “B.” There is a distance of about two kilometers between the two sites. However, because the DPR has not been prepared, the process of land acquisition has also been unable to move forward.

Assurance of not stopping the project

After the federal government announced the dissolution of the project office from the fiscal year 2026/27, the employees met with the Minister for Education, Science, and Technology, Sasmit Pokharel.

The employees expressed their concerns regarding the establishment of the medical college, the dissolution of the office, and the government’s upcoming plans to Minister Pokharel, who had reached Surkhet to participate in the 18th Senate of Mid-Western University.

In the meeting, Minister Pokharel assured them that even if the office is dissolved, the work of establishing the medical college will not stop, according to the employees. Information Officer Timilsena said that discussions are ongoing regarding advancing the work previously done by the project office through the ministry or the concerned department. “We met the Education Minister and presented the problems,” says Timilsena, “He said that even if the office is dissolved, the plan to establish the medical college will not be removed, and discussions are ongoing regarding which body, the ministry or the department, will run the remaining work.”

Satellite image of land site proposed for the Surkhet Medical College located in Gagretal, Birendranagar. Photo: Google Earth

The federal government had announced the establishment of Surkhet Medical College with the target of producing 100 doctors and 80 nursing personnel annually in the first five years.

The plan also targeted constructing a 600-bed hospital to provide easy and affordable health services to citizens.

Separate plan of the provincial government

At a time when the construction of the Surkhet Medical College announced by the federal government is failing to move forward, the Karnali Province government has brought forward a separate plan to convert the Province Hospital into an academy of health sciences.

Since the establishment period of the province government, the plan to develop the Province Hospital as a medical college or a teaching hospital has continued to be repeated. However, even after nine years have passed, the said plan has not reached the implementation stage. When the federal government initially announced the Surkhet Medical College, it had proposed using the then Mid-Western Regional Hospital (now the Province Hospital) as a teaching hospital.

After the hospital went under the provincial government, some confusion was seen for some time. The Karnali Province government had also given consent in late 2019 to allow the Province Hospital to be used as the teaching hospital of the medical college. However, the said consent was not implemented.

Currently, the provincial government is trying to convert the Province Hospital into an academy of health sciences to remain under its own jurisdiction.

To study the necessity of the overall upgrade of the hospital, the provincial government had formed a high-level committee under the leadership of Professor Dr. Bhagawan Koirala in the fiscal year 2024/25. The committee studied for four months and submitted a report with five suggestions.

The federal government had announced the establishment of Surkhet Medical College with the target of producing 100 doctors and 80 nursing personnel annually in the first five years.

The committee suggested expanding academic programs, health services, referrals, and research in the hospital in a phased manner and making the necessary policy and legal arrangements for the academy.

The report gave the option of running programs as a constituent teaching institution of the National Board of Medical Specialties under the Medical Education Commission or the National Academy of Medical Sciences (NAMS).

Similarly, the committee also suggested that academic programs could be run by collaborating with the medical college that the federal government is trying to establish, the Karnali Academy of Health Sciences (KAHS) located in Jumla, and Mid-West University. After that, the provincial government formed another committee to study the required human resources, infrastructure, and budget for operating the academy. The said committee conducted a field study of the Rapti Academy of Health Sciences (RAHS), Pokhara Academy of Health Sciences (PoAHS), and Madhesh Academy of Health Sciences (MAHS).

The provincial government is currently expanding the OPD building of the Province Hospital. However, it has not yet reached a conclusion to operate the academy immediately.

“In terms of infrastructure, human resource management, and operational costs, we are not in a position to build the academy right now,” says Social Development Minister Ghanshyam Bhandari, “We must move forward by expanding the physical structures and increasing the capacity of the available human resources.”

Handover ceremony of the feasibility report on upgrading the Province Hospital into a health academy. Professor Dr Bhagawan Koirala (left), Social Development Minister Ghanshyam Bhandari (center) and Chief Minister Yamlal Kandel (right). Photo: Social Development Minister’s Secretariat

Plan repeated in the budget

Since its very first budget, the Karnali Province government has been announcing the development of the Province Hospital as a medical college or teaching hospital.

In the first budget of the fiscal year 2017/18, it was mentioned that the then regional hospital would be upgraded to a medical college and provincial teaching hospital in coordination with the federal government.

In the fiscal year 2018/19 as well, Rs 100 million of budget was allocated, announcing that the regional hospital would be made a provincial teaching hospital.

However, in the three budgets from the fiscal year 2019/20 to 2021/22, this matter was not included. Since then, the announcement to develop Province Hospital as an academy of health sciences or teaching hospital has been repeated in the budgets.

In the budget statement of the upcoming fiscal year 2026/27 as well, it is mentioned that laws will be formulated to develop the Province Hospital into an academy of health sciences.

The provincial government has allocated Rs 236.5 million for the construction of a separate OPD building and other infrastructure of the hospital. However, the law to establish the academy, the operational structure, the required human resources, and the long-term budget are yet to be finalized.

Although the provincial government has allocated Rs 236.5 million to construct a separate OPD building and upgrade hospital infrastructure, critical foundation steps including the enabling legislation to establish the academy, its operational structure, staffing requirements, and a long-term budget remain completely up in the air.