The Nepalese Healthcare System: Basic Care, National Insurance, Altitude and Health Risks

The Ministry of Health and Population presents a system in which basic services are provided at the local level: a 2075 procedure frames the construction and operation of basic health centres by local authorities, while conditional health grants are managed by the provinces. The ministry also highlights ten free services: basic healthcare, kidney diseases, heart diseases, cancer, Parkinson’s, Alzheimer’s, spinal cord injuries, head trauma, sickle cell disease and burns.

The same website cites the Shahid Gangalal national heart centre among the reference public establishments, without publishing a list of hospitals or bed numbers. The eligibility conditions of these free programmes, intended for citizens, and access by a resident foreigner are not detailed: confirm them with the establishment concerned. The World Health Organization, for its part, publishes the cooperation strategy with the country.

The Health Insurance Board runs the national health insurance programme, launched on 25 Chaitra 2072 and based on the 2074 law and its 2075 regulation. Registration is compulsory for employees of the organised sector, with a contribution presented as equal to 1% of income; the State funds the premium for elderly people, for annual cover equivalent to 100,000 rupees. The 2075 regulation doubled the benefits package. The Board publishes the lists of affiliated establishments and the latest version of the benefits package, which you can consult on hib.gov.np.

The presentation page is designed for Nepalese citizens and does not describe an eligibility rule for a foreigner. A salaried resident confirms with their employer whether they are registered; other profiles rely on the CFE (the French social security fund for expatriates) or international insurance, because the French embassy recalls that the French State does not cover healthcare costs abroad. The page on healthcare reimbursement in Nepal compares these solutions.

France Diplomatie cites no hospital in its health sheet and refers to the website of the French embassy in Kathmandu for the list of healthcare establishments. It specifies that, without insurance, access to care can be refused, including in a life-threatening emergency, and that the embassy cannot cover any costs. Always keep your passport on you and give your contract details to your trekking agency.

• Local police: 100.
• Kathmandu tourist police: +977 01 5347041 or +977 1144.
• French embassy in Kathmandu: +977 1 45 12 332 during the day (Monday to Friday, 9 am to 5 pm) and +977 980 101 7201 outside office hours.
• Himalayan Rescue Association: medical posts at Pheriche (Khumbu) and at Manang (Annapurnas), which can organise rescue.

To prepare medical formalities before departure, see the guide to the medical questionnaire and medical history.

Acute mountain sickness occurs above 2,500 m when the body has not had time to acclimatise. The symptoms are shortness of breath, headaches, nausea, vomiting and sleep disturbances, and the course can be fatal. If symptoms appear, France Diplomatie recommends stopping the ascent, descending below 4,000 m accompanied and consulting a doctor. Prevention rests on a gradual climb, with at most 400 m of elevation gain between two consecutive nights above 2,500 m, good hydration, and no alcohol or heavy meals. High altitude is discouraged for children, and pregnancy or a history of heart, lung, neurological or kidney problems are contraindications.

• Payment in advance: helicopter companies fly only if payment is guaranteed; the assistance included in a contract is therefore essential.
• Bank card cover: the “snow and mountain” cover of the Visa card does not advance rescue costs, including in Nepal; some contracts cover accidents but not illnesses such as altitude sickness.
• Evacuation to Kathmandu: reserved for extreme emergencies (cerebral oedema, life-threatening accident); abuse can lead the insurer to claim large sums.
• What to do: keep your file number and the insurer’s telephone number, report your symptoms yourself, obtain the insurer’s agreement before any measure.
• Fraud: proven cases of evacuation fraud are reported; check the providers.
• Stays of more than three months: confirm before departure that your insurer does not treat the stay as an expatriation.

Take only strictly necessary medicines and a personal kit, in their original packaging, with a prescription using the international nonproprietary name, translated into English and valid for the whole duration of the stay, and check that each medicine is authorised in Nepal. Medicines should not be bought from street vendors because of the risk of counterfeits.

The Kathmandu valley has some of the highest air pollution in the world, with frequent peaks, notably in winter. France Diplomatie recalls the effects on the airways, the eyes and the immune system, and designates as the people most at risk the elderly, children, pregnant women and people with chronic illnesses (asthma, chronic bronchitis, emphysema, heart failure). It recommends checking air quality before departure, limiting time spent outdoors during peaks, wearing an N95, KN95 or FFP2 mask, preferably bought before departure, keeping doors and windows closed, including in the car, and consulting quickly if symptoms appear.

High altitude is not recommended for children, and pregnancy and a history of heart, lung, neurological or kidney problems are contraindications; specialist medical advice is recommended before any trek at altitude. The elderly, children, pregnant women and people with asthma, chronic bronchitis, emphysema or heart failure are the most exposed to pollution in the Kathmandu valley. For a family, vaccination against tuberculosis (children under 15) and against rabies (young children, isolated areas) should be discussed with a doctor before departure, and children’s cover is prepared with the guide to children’s health cover abroad.

France Diplomatie asks you to check the vaccines in the French schedule (diphtheria, tetanus, polio, whooping cough, measles), then to consider, depending on the length and conditions of the stay: hepatitis A, typhoid fever, hepatitis B, tuberculosis (children under 15), rabies (young children, isolated areas), chikungunya, dengue and Japanese encephalitis, notably during the rainy season in the Terai. Yellow fever is required for travellers arriving from endemic areas. A travel medicine consultation well before departure leaves time for boosters.

• Dengue and chikungunya: transmitted by mosquitoes; symptomatic treatment only, anti-inflammatory drugs to be avoided in case of dengue.
• Malaria: risk reported in the Terai; consult a doctor if symptoms appear during the trip or after returning.
• Cholera and typhoid: contaminated water and food; strict hygiene.
• Rabies: cases are reported; avoid animals and consult immediately after any exposure, even if you are vaccinated.
• Avian influenza: present notably in the Kathmandu valley, with exceptional human cases.
• Scrub typhus: transmitted by mite larvae in rural areas; doxycycline is the reference treatment and there is no vaccine.

To budget for these expenses, see the guide to budgeting for health abroad and the page on living in Nepal.