BIRATNAGAR: The daily life of 49-year-old Goma Devi Paudel from Sulubung in Sandakpur Rural Municipality-3, Ilam, has become painful lately. Following spinal bone degeneration that resulted in a pinched nerve, she finds it extremely difficult even to sit down or stand up. When she had a medical check-up at Nobel Hospital in Biratnagar a month ago, the doctor recommended only one remedy: regular physiotherapy.

After undergoing therapy in Biratnagar for a few days, Goma Devi returned home. On Thursday afternoon, June 11, she arrived at Ilam District Hospital filled with hope. However, after traveling for nearly an hour from her home to reach the hospital, she was told, “The hospital has a physiotherapist, but there are no machines.”

She paid Rs 50 fee for an OPD ticket and consulted with physiotherapist Sanjit Mehta. She received medical advice, but no treatment. “I came to the government hospital thinking the treatment would be affordable. The doctor is here, but we cannot get the service because there are no machines,” Goma Devi lamented. “In the end, I have no choice but to go to a private clinic and pay expensive fees.”

The pain of 50-year-old Krishna Shahi from Narayanthan, Ilam Municipality-7, is quite similar. On March 27, 2026, he underwent surgery on three nerves of his right hand at Birtacity Hospital in Jhapa. The doctor advised him to undergo regular therapy for hand movement. Since he had already spent hundreds of thousands on his treatment, he planned to get affordable therapy at the local government hospital near his home. However, upon reaching the physiotherapy room of the district hospital, he had to return empty-handed due to the lack of equipment.

A certificate issued by Gomadevi Poudel, 49, of Sandakpur Rural Municipality-3, Ilam, for treatment at the District Hospital, Ilam.

“The hospital has a physiotherapist, but there are no tools to perform the treatment,” Shahi expressed his grief. “We have to pay Rs 500 daily at private clinics. A service that would cost Rs 50 at a government facility costs ten times more at a private one. Where are financially marginalized people like us supposed to arrange such money from?”

Goma Devi and Krishna are just representative figures. Over 300 patients visit the OPD of this 50-bed district hospital daily. Among them, an average of 8 to 12 are physiotherapy patients. Ironically, even though expert personnel are present at the hospital, they are forced to refer patients to private clinics or other districts due to the lack of equipment.

The tendering loophole around the budget

A total of 119 healthcare workers, including those from the Government of Nepal and the Development Committee, are currently working at Ilam Hospital. While there is a sanctioned quota for 19 specialist doctors, only 9 are currently working, and there are 5 medical officers against a sanctioned quota of 7. Although orthopedics, gynecology/obstetrics, and general surgery services are available at the hospital, the essential physiotherapy service remains completely stalled despite having the required human resource.

The position for a physiotherapist had been vacant for years. When Sanjeev Mehta was posted and arrived on October 17, 2025, the locals felt reassured that the service would finally begin. However, even though eight months have passed since Mehta reported for duty, the hospital administration and store department have failed to procure the physiotherapy machines in time.

Comment letter raised for the purchase of physiotherapy equipment at District Hospital Ilam.

“Ever since I arrived here, I have only been providing consultations to patients,” says physiotherapist Mehta. “Physiotherapy service is impossible without equipment. If there were adequate space and equipment, many patients would have received relief. But right now, I am practically left without any work.”

For the current fiscal year, the provincial government had allocated a budget of Rs 1.5 million for purchasing physiotherapy equipment. However, due to delays by the hospital administration and the procurement unit, this budget is almost certain to freeze.

The hospital had issued the first notice for equipment procurement on January 6, 2026. However, the applications received during the first tender were canceled, stating they did not meet the required criteria. Through a second tender call, ‘Himalaya Exim Pvt. Ltd.’ secured the contract on March 23, 2026. An agreement was signed, but the delivered equipment did not match the technical specifications.

When the hospital had the equipment inspected by a biomedical engineer, it was found that the quality and standards did not comply with the agreement. Consequently, on May 21, the hospital sent a letter to the supplier to take back the goods. The letter sent by the hospital states: “As the report from the biomedical engineer shows that the supplied materials do not match the specifications issued in the sealed quotation notice, please take back the goods within 10 days.”

A letter was sent to the supplier Himalaya Exim Pvt. Ltd. to return the machine after the physiotherapy equipment did not arrive as per the ‘specifications’ (set standards).

Due to this technical dispute, it is practically impossible to initiate a new procurement process and bring in the equipment within the current fiscal year. As a result, the allocated Rs 1.5 million budget will go unspent and will be sent back to the state treasury.

Dr. Prabhu Sah, the Medical Superintendent of the hospital, admits the delay in procuring the equipment. “Our hospital does not have its own biomedical engineer. It took some time because we had to request technicians from the Provincial Hospital in Bhadrapur to inspect the goods,” Dr. Sah said. “Rather than accepting substandard equipment and inviting problems later, we chose to follow the proper procedure, which caused the delay. Even if it cannot be completed this year, we will start this service on priority next year.”

Meanwhile, Nirmal Bhattarai, Deputy Secretary and Grievance Handling Officer at the Ministry of Health of Koshi Province, stated that the ministry has repeatedly directed the hospital to resume services. He said, “Returning the goods when specifications do not match is a legal obligation, but it is deeply unfortunate that patients are deprived of service.”

Govinda Giri, a provincial assembly member elected from Ilam, stated that his serious attention has been drawn to the hospital’s situation. “I visited the hospital just a few days ago, but I had not received detailed information about this specific issue,” Assembly Member Giri said. “Currently, the Health Minister is from our own party (Nepali Congress). I will meet the Minister tomorrow to ensure the budget does not freeze and to take initiatives to create an environment for the immediate purchase of the equipment.”