The government’s Safe Motherhood Programme has yet to take off in Lumbini, depriving women in the province of free maternal health services.

Service seekers, mainly from the impoverished communities, complain that they have to spend large sums of money while visiting Lumbini Medical College and United Mission Hospital—two major health institutions in Palpa district.

Kopila Damai of Mujhung in Rainadebi Chhahara Rural Municipality-5 visited Lumbini Medical College last month to give birth to her baby. The Damai family, a poor Dalit family, spent Rs 16,000 at the health institution.

“It is a big amount for a poor family like ours. We took a loan from the neighbours to manage the hospital expenses,” said Kopila.

Had the Lumbini Medical College implemented the Safe Motherhood Programme, Kopila would have received government-stipulated travel expenses and encouragement allowance, saving her from debt.

Under the ‘Safe Motherhood Programme,’ mothers and babies are provided free medical treatment, transportation allowance and cash incentives for antenatal checkups. The federal government launched the programme to encourage pregnant women to visit health centres and hospitals and reduce maternal mortality rate in the country.

To encourage women to opt for institutional births and get regular checkups, the government provides transportation allowance and cash incentives. Women in the mountainous, hilly and Tarai regions are provided Rs3,000, Rs2,000 and Rs1,000 respectively. Additionally, a cash bonus of Rs800 is provided to women who complete all four antenatal checkups.

But most women, especially from rural areas, in Lumbini do not have the means to avail of such facilities.

“There is a birthing centre in the village. But the health workers usually refer pregnant women to well-facilitated hospitals in the city that are better equipped to handle complications,” said Tulsa Somai, a postpartum mother from Rainadebi Chhahara Rural Municipality. “So we have to go to the big hospitals and spend huge amounts of money.”

According to her, almost all families in the rural municipality go to Lumbini Medical College or United Mission Hospital for safe delivery in spite of the costs involved.

Hospitals, both private and government, in various districts are also yet to implement the Safe Motherhood Programme. In Palpa, Palpa Hospital, Rampur Hospital and some primary health centres and health posts are the only institutions to provide the allowances. But since these health institutions are not fully equipped to handle pregnancy complications, most women are referred to bigger hospitals in the cities.

According to the District Health Office, around 5,000 women in Palpa gave birth in the last fiscal year but only 1,000 of them received the allowances.

Shir Bahadur Rana, the health unit chief of Tansen Municipality, where Lumbini Medical College and United Mission Hospital are situated, says the local unit has the provision to issue budgets to health institutions for providing delivery service. The amount is issued for normal delivery, caesarean section and other critical surgery. But, according to Rana, the aforementioned two biggest hospitals have not accepted the budget since they do not run the Safe Motherhood Programme.

“United Mission Hospital never implemented the Safe Motherhood Programme despite our repeated requests. And Lumbini Medical College decided to discontinue the programme last year,” said Rana. According to him, a budget of Rs21 million under the Safe Motherhood Programme was frozen in the fiscal year 2020/21, as two major health institutions in Tansen Municipality refused to implement the programme.

The two major hospitals say the budget issued by the federal government through the local units is not sufficient to run the Safe Motherhood Programme.

“Our hospital has not implemented the programme, as the government’s budget is not enough to cover the total expenses. We have to bear a loss while implementing the programme,” said Jiban Bhattara, the manager at United Mission Hospital.

The government provides Rs7,000 to each surgery case under the Safe Motherhood Programme.

“Our hospital also provides free services to poor families. But not to those who can afford to pay,” said Bhattarai.

Krishna Prasad Parajuli, information officer at Lumbini Medical College, says the amount released by the government under the Safe Motherhood Programme does not cover the expenses since most delivery cases referred to the hospital are critical ones where the patients need surgical procedures.

“Almost all the patients visiting our hospital are referral cases. Most women are in need of surgery,” said Parajuli. “We have written to the federal health ministry to reconsider the budget under the Safe Motherhood Programme so that the hospital alone does not end up bearing the cost.”

The District Health Office in Tansen says the number of pregnant women visiting Lumbini Medical College and United Mission Hospital is around five times more than those visiting public hospitals and other health facilities in the local units.

According to Om Prakash Panthi, the information officer at the District Health Office in Tansen, a total of 5,044 women gave birth in the last fiscal year. As many as 2,566 women received maternity and delivery service at United Mission Hospital while 1,471 visited Lumbini Medical College for safe delivery.

“As many as 4,037 women were deprived of the Safe Motherhood Programme last year. Major hospitals are unwilling to adopt the programme. The government should enforce its policy and programme strictly,” said Panthi.