Nepal
A low-income South Asian country where terrain and referral distances shape access.
9 domains reviewed · 9 high-confidence · 5 dated estimates · 9 material gaps
WHO region: South-East Asia. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 11
- Sources behind this dossier
- 14
- Newest source 2026
Lessons from Nepal
- Permitting domestic manufacture is not the same as securing supply. Nepal licensed local morphine production, but one manufacturer importing all raw material leaves the whole country exposed to a single import licence delay.52
- Nepal has not solved prescriber scope. Its rural workforce is mid-level, and the literature names the lack of prescribing authority as the barrier, with Uganda as the model. It offers no South Asian precedent on prescriber scope.54,52
- A national strategy without an essential medicines list change had little effect on price. As of the 2024 study, years after the 2017 strategy, opioids were still off the free and fixed-price lists.55
- Two decades of donor and NGO-led growth left services clustered in the capital valley. Geographic spread did not follow from NGO expansion alone.53
- Hospices can blend religious and spiritual care with medical care, as Nepal's temple-side and monastery hospices do alongside NGO and hospital hospices.53
- Rural palliative care models should reach the women who do most home caregiving and the local medicine shops where many ill people already seek care.384,385
- Domestic manufacture of oral morphine raises national availability, and rural stocking and inclusion on free or fixed-price medicine lists decide whether patients can actually get it.56,52,55
Palliative care
Is morphine available in Nepal?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 0.88 mg per personSOURCE-CHECKED · 2020 DATA
Morphine consumption, Nepal, 202052
Last checked 2026-09-24.
As reported in a 2025 review, which gives Pakistan below 0.1 mg on the same basis.
Cite this figure: - 0.27 mg per personSOURCE-CHECKED · 2015 DATA
Opioid consumption, morphine equivalent, Nepal, 201553
Last checked 2026-09-24.
A different basis from the 2020 morphine figure; the two are not a trend line.
Cite this figure: - 1 manufacturerSOURCE-CHECKED
Licensed domestic manufacturers of oral morphine, Nepal, 202552
Last checked 2026-09-24.
Imports all raw material from Europe.
Cite this figure: - 2,582.20 times the minimum daily wageSOURCE-CHECKED
One month of fentanyl patch, cost, Nepal, 202552
Last checked 2026-09-24.
Fentanyl 25 mcg/h transdermal; not on the government health insurance list.
Cite this figure:
Oral morphine has been licensed for domestic manufacture since 2009, after imports from India began in 2005. A single manufacturer produces it from imported raw material, and shortages have followed delays in import licensing. Rural facilities rarely stock morphine.52,56
Has any second manufacturer been licensed, and what is consumption after 2020 on a morphine-equivalent basis?
Help answer it:Search PubMedHow does Nepal regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Stocking and dispensing of opioids sit under the national narcotics and drugs legislation administered by the Department of Drug Administration, which registers products and manufacturers and inspects pharmacy dispensing records.52
What does the narcotic drugs statute require of a district pharmacy, and has it been amended as it applies to morphine?
Help answer it:Search PubMedWho can prescribe morphine in Nepal?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
- 8,000 workers, lower boundSOURCE-CHECKED · 2018 DATA
Mid-level health workers delivering most rural services, Nepal, 201854
Last checked 2026-09-24.
Reported as more than 8,000.
Cite this figure:
Prescribing is limited to registered medical practitioners. Mid-level health workers, who deliver most rural care, state they are not permitted to prescribe morphine and would do so with training and legal authorisation, citing Uganda.52,54
Has any reform since 2018 extended morphine prescribing to nurses or mid-level health workers?
Help answer it:Search PubMedHow does palliative care reach patients in Nepal?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 5 hospicesSOURCE-CHECKED
Dedicated hospices for cancer patients, Nepal, 202153
Last checked 2026-09-24.
Cite this figure: - 4 unitsSOURCE-CHECKED
Palliative care units in major cancer hospitals, Nepal, 202153
Last checked 2026-09-24.
Cite this figure:
Services are concentrated in the Kathmandu valley. The exceptions named in the literature are the cancer hospital unit at Bharatpur, the Janakpurdham programme opened in 2018, and Green Pastures Hospital in Pokhara, providing palliative care since 2009. WHO classes Nepal as isolated provision.53
What is the service count after 2021, and what caseload reaches patients outside the valley?
Help answer it:Search PubMedWho pays for palliative care in Nepal?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
- 855 US dollars, approximateSOURCE-CHECKED
Government one-time treatment support for a cancer patient, Nepal, 202153
Last checked 2026-09-24.
Cite this figure: - 500 Nepalese rupees per daySOURCE-CHECKED · 2021 DATA
Health Insurance Board allowance for a patient receiving palliative care, Nepal, 202153
Last checked 2026-09-24.
About US$4.28 at the source's conversion.
Cite this figure: - 73 percentSOURCE-CHECKED
Essential palliative care medicines on the government insurance medicines list, Nepal, 202455
Last checked 2026-09-24.
Twenty-four of 33. From the abstract.
Cite this figure: - 46 percentSOURCE-CHECKED
Available essential palliative care medicines judged affordable, Nepal, 202455
Last checked 2026-09-24.
Nineteen of 41 available formulations, against the minimum daily wage. From the abstract.
Cite this figure:
Care is funded mainly out of pocket, with a one-time government cancer treatment payment and a daily palliative care allowance under the Health Insurance Board. Opioids were on neither the free nor the fixed-price medicines list as of the 2024 study, despite the 2017 national strategy.53,55
What share of palliative patients is enrolled with the Health Insurance Board?
Help answer it:Search PubMedHow are palliative care clinicians trained in Nepal?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 2,214 students, cumulativeSOURCE-CHECKED · 2021 DATA
Students given a one-day palliative care sensitization course, Nepal, 202153
Last checked 2026-09-24.
Cite this figure:
No standalone palliative medicine degree was found. Training runs through short courses: a national course with the National Health Training Centre since 2013, six-week courses at Hospice Nepal and the Bharatpur cancer hospital, and palliative care teaching for postgraduate residents at the National Academy of Medical Sciences since 2011.53
Is any palliative medicine fellowship accredited by the Nepal Medical Council, and how many hold it?
Help answer it:Search PubMedHow does Nepal prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Oral morphine is now manufactured in Nepal, but a single manufacturer imports all raw materials, rural health centres rarely stock it, and methadone syrup is available only for addiction treatment. Opioids are not on the government free or fixed-price medicine lists. Opioid agonist treatment operates in the Kathmandu Valley, and patients discharged on opioids in Western Nepal reported little counseling on dependence or tapering.56,52,55,566,567
Is naloxone stocked at hospitals and health posts that dispense morphine in Nepal, and how are opioid prescriptions recorded and monitored?
Help answer it:Search PubMedHow do children get palliative care in Nepal?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Online Project ECHO courses in pediatric palliative care have trained Nepali physicians, nurses and psychosocial counselors, with significant gains in knowledge and attitudes. One course enrolled 55 clinicians over 22 sessions, and 93% rated it effective learning.569,570
How many children in Nepal receive pediatric palliative care, and at which hospitals is a dedicated pediatric team available?
Help answer it:Search PubMedHospice care in Nepal
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Nepal?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Hospice Nepal, started in 2000 in Kathmandu Valley, is described as the first formally established modern hospice, with a Pashupatinath Hospice listed from 1995. Five hospices are dedicated to cancer patients alongside four palliative care units in cancer hospitals, run by NGOs, a Buddhist charitable foundation, a temple-linked site and a cancer hospital, and NGO programs also give home-based hospice care.53
Who can get hospice care in Nepal?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Most Nepali hospices admit cancer patients: a 2021 review lists five hospices dedicated to cancer care. Other NGO hospices serve people with HIV/AIDS, spinal injuries and survivors of human trafficking, and Blue Diamond Society runs a free hospice for LGBTQI+ people. At Hospice Nepal in 2006, 63% of admitted cancer patients were unaware of their diagnosis or prognosis, so admission did not depend on the patient knowing the prognosis.53,360,361
Do Nepali hospices use a prognosis or performance-status threshold for admission?
Help answer it:Search PubMedWho pays for hospice care in Nepal?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
Palliative care in Nepal is described as heavily donor dependent, and an international NGO has given financial support to hospices. The Health Insurance Board covers NRS 500 per day for insured patients receiving palliative care, but out-of-pocket spending remains the main source of funding.53
How many people reach hospice in Nepal?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Most hospice and palliative care centres are in the capital, with only a few in the periphery, and hilly terrain limits access. Most hospices serve cancer patients, while a few organizations serve people with HIV/AIDS, spinal injuries and trafficking survivors.53
What share of dying people in Nepal, especially outside Kathmandu Valley, reach a hospice?
Help answer it:Search PubMedWhat fills the gap in Nepal
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
In two rural districts, 81% of primary caregivers of people with palliative needs were women, most often daughters-in-law and wives. Families gave most support, followed by neighbours, and only 38% reported any support from health professionals.384
Subnational evidence- Substitute and informal pain relief
For 24% of rural residents with palliative needs, the nearest facility was a private pharmacy, locally called a medicine shop, which the authors describe as unregulated. Some people had chronic conditions diagnosed and followed up there, and 45% said worry about cost kept them from seeking care at times.385
Subnational evidence
Sources cited here
- 52Shrestha R, Shrestha S, Shrestha S, Shrestha A, Paudel BD, Munday D.
Opioid accessibility for palliative care in Nepal: a review of achievement and remaining challenges. Indian Journal of Palliative Care 2025;31(1):74-78. DOI 10.25259/IJPC_118_2024. Oral morphine licensed for domestic manufacture since 2009 and produced by a single manufacturer that imports all raw material from Europe; prescribing limited to registered medical practitioners; national morphine consumption and fentanyl patch cost against the minimum daily wage.
- 56Paudel BD, Ryan KM, Brown MS, Krakauer EL, Rajagopal MR, Maurer MA, Cleary JF.
Opioid availability and palliative care in Nepal: influence of an international pain policy fellowship. Journal of Pain and Symptom Management 2015;49(1):110-116. DOI 10.1016/j.jpainsymman.2014.02.011. Abstract read. Describes the fellowship work that led to domestic manufacture of oral morphine formulations.
- 53Gautam D, Adhikari S.
Palliative care services for cancer patients in Nepal, a lower-middle-income country. Palliative Care and Social Practice 2021;15:26323524211021105. DOI 10.1177/26323524211021105. Inventory of hospices and hospital palliative care units by year, location and beds; training programme history and counts; government cancer treatment support and the Health Insurance Board palliative care allowance; WHO category 3a (isolated provision).
- 54Gongal RN, Upadhyay SK, Baral KP, Watson M, Kernohan GW.
Providing palliative care in rural Nepal: perceptions of mid-level health workers. Indian Journal of Palliative Care 2018;24(2):150-155. DOI 10.4103/IJPC.IJPC_196_17. Focus groups with mid-level health workers in Makwanpur district, who state they are not permitted to prescribe morphine and cite the Ugandan nurse prescriber model.
- 55Shrestha R, Hayes B, Poudel A, Munday D.
Availability and affordability of essential palliative care medicines in Nepal: a cross-sectional study. Journal of Pain and Symptom Management 2024;68(1):61-68. DOI 10.1016/j.jpainsymman.2024.03.026. Abstract read. Measures availability and affordability against the 2017 National Strategy for Palliative Care; opioids were on neither the free nor the fixed-price medicines list.
- 566Adhikari S, Gurung R, Shrestha S, et al.
Knowledge, experiences, and practices on safe opioid use in patients recently discharged from hospitals in Western Nepal: a qualitative study. Front Pharmacol 2025;16:1572968. Qualitative interviews with 30 patients discharged on opioids from one tertiary hospital in Western Nepal; single site. Abstract read.
- 567Pant SB, Thapa SB, Howard J, et al.
Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal. PLoS One 2023;18(2):e0281437. Cross-sectional study of psychological distress and quality of life among 231 opioid agonist treatment service users in Kathmandu Valley. Abstract read.
- 384Pantha A, Shrestha N, Poudel A, et al.
Care burden for people with palliative needs in rural Nepal: mixed method study. BMJ Support Palliat Care 2026. Survey and interviews with 52 primary caregivers identified by house-to-house screening in two rural districts. Abstract read.
- 568Gajmer RK, Baral KP, Acharya PK, et al.
Resilience and its determinants among family caregivers of palliative care patients in Nepal. BMC Palliat Care 2025;25(1):17. Cross-sectional study of resilience among 422 family caregivers at five palliative care centers in Nepal. Abstract read.
- 569Lynch-Godrei A, Sapkota S, Rowe J, et al.
An Online Pediatric Palliative Care Education and Mentoring (Project ECHO) in Nepal: A Program Implementation Case Study and Assessment of Changes in Healthcare Providers' Knowledge, Confidence, and Attitudes. J Med Educ Curric Dev 2024;11:23821205241234541. Implementation case study of an online pediatric palliative care Project ECHO course for 55 clinicians in Nepal; self-evaluation by program team. Abstract read.
- 570Ghimire B, Rayala S, Doherty M, et al.
Impact of Palliative Care Educational Program on Knowledge and Attitude Regarding Pediatric Palliative Care Among Healthcare Professionals Working in Nepal. Paediatr Neonatal Pain 2026;8(1):e70024. Pre-post evaluation of a Project ECHO pediatric palliative care course in Nepal, 40 of 55 enrollees completing; self-evaluation by program team. Abstract read.
- 360Baskaran AB, Hauser J.
Maya Ta Maya Ho (Love is Love): A Qualitative Study on LGBTQI+ Experiences in Hospice & Palliative Care in Nepal. J Palliat Care 2022;40(4):313-321. Qualitative study (29 interviews) at a single NGO hospice run by Blue Diamond Society in Kathmandu. Full text read.
- 361Gongal R, Vaidya P, Jha R, et al.
Informing patients about cancer in Nepal: what do people prefer? Palliat Med 2006;20(4):471-6. One-year prospective survey of 96 patients admitted to Hospice Nepal plus a public survey; single site, 2006 data, authors affiliated with Hospice Nepal. Abstract read.
- 385Shrestha N, Poudel A, Bhandari S, et al.
Palliative care needs and health seeking behavior of people in two rural districts of nepal: a house-to-house survey. BMC Palliat Care 2025;24(1):247. Survey of 587 households in Lamjung and West Rukum identifying 58 adults with palliative needs and where they seek care; part of the authors' Sunita Project, which the findings are meant to inform. Full text read.