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Nepal’s formal occupational health and safety (OH&S) policies are well-articulated at the national level, but their implementation on the ground, especially Kathmandu, remains critically flawed. Health workers face a complex web of biological, chemical, and ergonomic hazards daily, yet these risks are often unrecognized by institutions and underreported by staff. Marasini et al. (2023) documented that over 88% of healthcare workers in Kathmandu encounter biological risks, while Dhulikhel Hospital’s outreach programs show an alarming absence of emergency protocols and equipment in rural settings (Hospital, 2023). This research, using mixed methods, explores the lived realities of essential healthcare workers to understand why policies fail to translate into practice. Qualitative interviews and quantitative data were triangulated to highlight the systemic vulnerabilities, which include overwork, unsafe infrastructure, and weak institutional accountability. The study frames these occupational hazards not as isolated issues but as manifestations of broader governance and equity failures in Nepal’s health system.
The gap between policy and practice stems largely from a lack of awareness and institutional ownership of OH&S principles among both managers and frontline workers. Many health professionals view OH&S as an external compliance requirement rather than a fundamental right tied to their dignity and well-being. This perception is worsened by limited public education, absence of training programs, and weak internal communication structures within healthcare institutions. Health workers often lack access to gloves, ergonomic tools, or even basic PPE (Personal Protective Equipment), especially in government and rural health centers. This normalization of risk has fostered a culture where unsafe environments are accepted as part of the job. Until OH&S is embedded as a shared institutional value, implementation efforts will remain tokenistic and ineffective.
The consequences of this neglect extend beyond physical health to include significant mental health impacts, with workers facing emotional exhaustion, anxiety, and burnout. Shah et al. (2024) and Bhusal et al. (2023) report burnout rates exceeding 60% among Nepalese health workers, especially those working in high-pressure, low-resource environments. Cultural stigma around mental health further suppresses open dialogue, leaving healthcare workers without proper support systems or safe avenues to report psychological distress. The World Health Organization (2020) has asserted that healthcare worker safety including mental well-being is essential for safe and resilient healthcare systems. In Nepal, however, mental health remains excluded from OH&S frameworks, making it a silent epidemic within the workforce. Without addressing these psychosocial dimensions, any occupational health strategy remains fundamentally incomplete.
Poor OH&S practices also elevate risks for chronic non-communicable diseases (NCDs) among health workers, including hypertension, diabetes, and musculoskeletal disorders. Aryal et al. (2015) found that Nepalese health professionals, especially in urban and rural clinics, showed high prevalence of NCD risk factors linked directly to occupational stress and inadequate lifestyle conditions. Long hours, inadequate rest, and poor diets exacerbate these conditions, particularly in facilities where workers serve disproportionately large populations. The absence of ergonomic design, occupational screenings, and wellness programs further compromises long-term workforce sustainability. As chronic diseases among healthcare workers rise, their capacity to deliver consistent care declines, creating a negative feedback loop for the broader health system. OH&S frameworks must expand to include preventive strategies for lifestyle-related risks in addition to immediate safety hazards.
The root causes of these failures are not merely financial, but institutional, as weak enforcement mechanisms have rendered Nepal’s OH&S laws largely symbolic. Kattel (2021) reported widespread underreporting of workplace violence and a lack of follow-up due to insufficient protective reporting structures. Employers often absorb OH&S-related fines as operational costs rather than reforming systems to prevent future violations. This lack of deterrence results in continued neglect of safety protocols, even in facilities that experience recurring incidents. The research argues for a shift toward behavior-based enforcement, including license suspension and mandatory retraining for repeat offenders. Such models have been successful in other sectors like traffic management and could be adapted to healthcare with appropriate oversight. Institutionalizing accountability is key to ensuring meaningful change in OH&S culture.
This study utilized the Socioecological Model (SEM) to understand how OH&S risks manifest at multiple levels from individual behavior and peer dynamics to institutional policies and national legislation. Through interviews with 15 frontline health workers, 6 public health academics, and 3 managers, the study found consistent patterns of organizational apathy, poor training, and uneven resource distribution. These findings were reinforced by secondary data, including Marasini et al. (2023) and Bhusal et al. (2023), which documented systemic exposure to biological risks and workplace violence. Focus group participants also cited irregular communication and lack of participation in decision-making as core issues. The SEM approach allowed the research to highlight not just the problems but the interconnected levers for reform. By integrating both qualitative narratives and quantitative benchmarks, the study presents a robust framework for systemic change.
Emergency preparedness was one of the most highlighted institutional shortcomings identified in the study. Despite Kathmandu’s vulnerability to seismic events and other natural disasters, health facilities rarely conduct drills, lack evacuation protocols, and offer no formal disaster resilience training to staff. BMJ Public Health (2024) found significantly higher occupational stress scores among workers lacking such training, further reinforcing the urgency of institutional preparedness. Several interviewees admitted that they would not know what to do in case of a major emergency, highlighting the danger of reactive rather than proactive planning. This neglect puts both staff and patients at risk and undermines public trust in healthcare institutions. Effective OH&S systems must include routine emergency planning as a core operational standard. Without preparedness, even the best-intentioned health systems become liabilities in crisis situations.
Potential solutions must be rooted in collaboration and local empowerment, starting with community-led participatory monitoring mechanisms. Prajapati et al. (2023) emphasized that when health workers participate in safety audits and risk assessments, adherence to OH&S standards improves substantially. Frontline involvement builds ownership and facilitates the development of peer accountability systems, such as anonymous feedback loops and safety champion programs. These low-cost, high-impact interventions align with the mandates of NEDI Nepal and Alternatives Montréal, both of which advocate for decentralized, rights-based approaches to public health. Empowering healthcare workers to co-design safety protocols ensures that reforms are not only implemented but sustained over time. Participation is not just ethical, it is strategic.
Digital technologies also offer a powerful avenue for improving OH&S monitoring and response across Nepal’s health sector. Mobile applications, SMS-based platforms, and online reporting tools can provide real-time data on hazards, staff well-being, and equipment shortages. These systems have shown success internationally in increasing reporting rates and improving response times. In Nepal, where mobile coverage has expanded even in rural areas, such platforms are not only feasible but necessary. Implementation would require training and infrastructure investment, possibly through CSR (Corporate social responsibility) partnerships with telecommunications providers. The integration of digital innovation into health safety aligns with Alternatives Montréal’s commitment to accessible and rights-based digital infrastructure. Technology, if used thoughtfully, can be a transformative tool for transparency and resilience.
CSR remains an underutilized but potentially game-changing resource in improving healthcare worker safety. Businesses can provide PPE, fund wellness programs, or co-sponsor safety training, thereby supplementing limited public health budgets. Canadian CSR models which I have been part of such as Cilantro and Chives’ Burger of the month, (C&C, 2025), programme as well as Aberta Health Services (AHS, 2025) offer recognition and discount to health workers and volunteers in collaboration with Canadian Tires have demonstrated that such partnerships can generate shared value when properly regulated and publicly recognized. Offering tax incentives or procurement advantages can encourage local businesses to support community health infrastructure. This approach aligns with the collaborative ethos of both NEDI Nepal and Alternatives Montréal, which promote intersectoral cooperation as key to sustainable development. CSR is not merely charity; it is an investment in the public good.
Decentralized and adaptive policy implementation emerged as a key recommendation from the study’s qualitative interviews. Local healthcare managers need the authority and resources to adapt OH&S protocols to their specific contexts rather than rely on rigid national mandates. Facility-level flexible funds earmarked for safety improvements can ensure timely and relevant responses to emerging risks. These decentralized strategies must still operate within a standardized national framework to maintain consistency and equity. Such adaptive governance is supported by NEDI Nepal’s emphasis on context-sensitive policy and Alternatives Montréal’s commitment to community-led development. Empowering local leadership fosters ownership, responsiveness, and long-term sustainability.
In conclusion, Nepal’s healthcare workers safety is not only a moral imperative but a strategic necessity for a resilient health system. The continued neglect of OH&S harms workers, reduces service quality, and undermines public confidence in health institutions. The research recommends multipronged reforms, including stronger enforcement mechanisms, digital innovation, community participation, private sector collaboration, and decentralized governance. These solutions not only address existing risks but also lay the groundwork for a safer, more equitable healthcare system. Government, institutions, and civil society must work in tandem to turn policy rhetoric into tangible protection. Only by centering worker dignity and safety can Nepal build a health system that is truly sustainable and just.
Bibliography
AHS. (2025). Alberta Heath Services. Retrieved from Benefits and Discount: https://www.albertahealthservices.ca/careers/page12210.aspx
Aryal, K. K. (2015, August 5). The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey. Retrieved from PLOS ONE: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134834
Bhusal, A. A. (2023, July 27). Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, Nepal. Retrieved from National Library of Medicine: 10.1371/journal.pone.0288680
C&C. (2025). Cilantro and Chive. Retrieved from Burger of the Month: https://cilantroandchive.ca/blog/category/lacombe/lacombe-burger-of-the-month/
HEALTH, B. P. (2024, Feb 4). Occupational stress and its correlates among healthcare workers of a tertiary level teaching hospital in Kathmandu, Nepal, during COVID-19 pandemic: a cross-sectional study. Retrieved from https://bmjpublichealth.bmj.com/content/2/1/e000126
Hospital, D. (2023). Outreach centers and rural health services. Retrieved from https://dhulikhelhospital.org/department-of-community-programs-and-public-health/
Kattle, P. (2021, December 29). Workplace Violence in Health Care Settings of Nepal. Retrieved from Research Gate: https://www.researchgate.net/publication/366896650_Workplace_Violence_in_Health_Care_Settings_of_Nepal
Marasini, R., Shrestha, P., & Chaudhary, Y. (2023, Janurary 27). Occupational health and safety hazards faced by health care professionals in Kathmandu based hospital: a cross-sectional analytical study. Retrieved from International Journal of Community Medicine and Public Health: https://doi.org/10.18203/2394-6040.ijcmph20230210
Prajapati, R. G. (2023, December). Status of Occupational Health and Safety in Nepal: Current Scenario and Strategies for Improvement. Retrieved from Research Gate: 10.3126/jomra.v1i2.61194
Shah, S. K., Sinha, R., Neupane, P., & Kandel, G. (2024, May 31). Burnout among Nurses and Doctors Working at a Tertiary Care Government Hospital: A Descriptive Cross-sectional Study. Retrieved from National Library of Medicine: https://pmc.ncbi.nlm.nih.gov/articles/PMC11261546/
WHO. (2020, September 17). World Health Organization. Retrieved from Health worker safety: A priority for patient safety. : https://www.who.int/docs/default-source/world-patient-safety-day/health-worker-safety-charter-wpsd-17-september-2020-3-1.pdf
Photo: Lele Primary Health Care Centre by Nehal Kumar
