Fix what is broken
Inside the District Hospital in Mugu, one of Nepal’s remotest and underserved regions, hospital staff enter details of an elderly female patient with a prolapsed uterus into a computer instead of writing them into a heavy ledger like they used to.
This may seem like a modest improvement, but it is transforming medical care in the most isolated parts of Nepal – proving that digital systems can help the country leapfrog in strengthening healthcare delivery even in the most challenging setting.
In the past year, Nepal’s national health insurance information system experienced a major failure that exposed critical vulnerabilities. Months of insurance claims were inaccessible overnight, placing hospitals, particularly rural facilities, under critical financial strain.
Hospitals were unable to recover claims data in a timely manner, threatening continuity of patient care. But during this, Mehelkuna Hospital and others in Karnali Province demonstrated how digital health infrastructure can build system resilience.
Supported by an integrated electronic health record (EHR) system, this one hospital in Surkhet securely retrieved patient and claims data and resubmitted nearly 40,000 insurance claims within 15 days, safeguarding Rs8 million in revenue.
This was a crucial policy insight that digital health records are not an optional innovation, they represent core public health infrastructure.
The EHR initiative was launched at Bayalpata Hospital in Achham District by Nyaya Health Nepal (NHN) in 2016 and expanded to hospitals in Charikot, Aampipal and Aabu Khareni.
It has now also been scaled across eight districts of Karnali Province, helping track patients and aligning the data with government reporting and insurance mechanisms.
ENSURING INSURANCE
NHN has embedded its EHR initiative within public hospitals. For example, in Karnali Province this means the Ministry of Social Development (MoSD) in Surkhet has a Dashboard which aggregates realtime data across eight district hospitals.
Information on health outcomes of patients, service delivery, insurance utilisation are all available in real time and are at the fingertips of provincial officials. The Dashboard supports evidence-based decision-making, improves transparency in reporting, and strengthens the province’s capacity to monitor trends and identify gaps in care.
Earlier paper-based reporting was slow, and could not be accessed or cross-referenced easily, hindering prompt planning and resource allocation.
But digital transformation in healthcare is not just about technology. It is about system consolidation, linking service delivery, health financing, governance, and accountability through reliable and real-time data. Integrated EHRs improve transparency in insurance claims and enable evidence-based planning.
Unaffordable medical care and out-of-pocket expenses for family members can push households into poverty. Many Nepalis migrating overseas say one push factor is the cost of care of close relatives.
This is what makes universal health insurance so vital, but it is in crisis. The Health Insurance Board (HIB) was formed in 2016, and has now spread across all 77 districts, covering 10 million Nepalis.
But HIB faces problems of sustainability and claims settlements. This week it asked the government to replenish Rs1 billion in funds, and the government’s TUTH Hospital has stopped treating patients covered by the HIB citing delayed reimbursement of claims.
This underlines the need for stronger institutional autonomy, predictable financing, and enhanced operational capacity within the HIB. One way to streamline insurance and reduce risk is by embedding digital systems.
Universal Health Coverage depends on accurate, timely, and inter-operable data flows between service delivery points and national financing mechanisms.
Integrating EHRs with insurance platforms can significantly reduce claims backlogs, improve transparency and accountability, and enhance fiscal reliability for public hospitals.
The experience of NHN-EHR in Karnali hospitals with digital records and insurance provides a compelling model for the rest of the country.
Srijana Devkota is Director of Program and Partnerships at Nyaya Health Nepal (NHN).