Nepal's Family Welfare Division has proposed covering laboratory tests worth up to Rs 1,845 for women giving birth at facilities that take part in the Aama programme, a response to a September case in which a woman delivered outside a hospital after her family said it could not pay for the required tests.
The proposal is a revised guideline from the division, which works under the Department of Health Services. It has not been approved and is not yet policy. Officials say the full range of tests can cost more than Rs 8,000 and that the division lacks the budget to cover all testing costs. Hospitals do not currently receive government reimbursement for these laboratory services.
Babita Kumari Paswan,30, arrived in labor at Gajendra Narayan Singh Hospital in Rajbiraj at around a.m. he family said they could not afford the blood tests requested before the maternity care. She gave birth on a pavement outside the hospital on September 9.
The hospital gave a different account. Its acting medical superintendent said staff requested a comprehensive assessment because she had not completed all recommended antenatal checks and had no previous tests reports. The tests mentioned included a complete blood count, kidney and liver function tests, coagulation tests, Hepatitis B and C screening, syphilis screening and blood group testing. The hospital say its social service unit could help patients who cannot pay but claimed the family had not told staff about its financial difficulty.
A probe committee recommended departmental action against doctors, nurses, paramedics and other staffs on duty. It found failures in counseling the woman, ensuring she stayed for treatment and monitoring her after she left, and identified problems with hospital administration and staff understanding of the Safe Motherhood Programme. It also recommended clarifying which services, including necessary laboratory tests, should be covered. The Health Ministry and the Nepal Medical Council ran separate investigations, and their reports have been submitted to the ministry.
The Aama Programme, also known as the Safe Motherhood Programme, has operated nationally since 2009 to encourage institutional births and reduce financial barriers. It covers normal, complicated and caesarean deliveries at participating facilities, subject to programme rules, along with free newborn services, transport incentives and antenatal incentives.
Facilities are reimbursed Rs 2,500 for a normal delivery, Rs 4,000 for a complicated delivery and Rs 10,000 for a caesarean section. These are payments to the facility, not cash for the mother.
The programme’s name does not mean every expense linked to pregnancy and childbirth is paid by the government.
The Public Health Service Act, 2075 (2018), establishes a right to basic health services free of charge, including maternal, newborn and childbirth-related services. It also says people must not be deprived of health services and sets duties relating to emergency care. The Safe Motherhood and Reproductive Health Rights Act provides for antenatal care and emergency childbirth and newborn services.
A former health secretary and maternal-health experts argued that necessary care should not be denied because a patient cannot pay.
Research suggests free delivery has not meant no cost. A 2020 study of 424 women who delivered in tertiary hospitals in Kathmandu Valley, 212 at Aama facilities and 212 at non-Aama facilities, found average out-of-pocket spending on hospital services of Rs 4,159.45 at Aama facilities, compared with Rs 19,051.94 at non-Aama facilities. Including transport and non-medical costs, the averages were Rs 9,841.05 and Rs 24,917.05. Even at Aama facilities, then, the average total came to nearly Rs 10,000.
If approved and funded, the Rs 1,845 allowance could reduce the cost of basic tests. It would not necessarily remove every barrier. Families could still face a balance if necessary tests cost more than the limit. Coverage may not apply at hospitals outside the programme, depending on final rules. And a subsidy alone may not help a family that cannot pay even a small amount unless hospitals have a clear procedure to treat women in labor without advance payment.
The central question remains how the government will ensure that a woman in labor receives timely assessment and emergency care even when her family cannot pay for tests immediately.
