Basic Health Service Package (BHS) 2075: 98 Free Medicines in Nepal

The Basic Health Service Package (BHS) 2075 - issued in the Bikram Sambat year 2075, which corresponds to 2018 in the Gregorian calendar (AD) - is the Government of Nepal's official definition of the health care that every citizen is entitled to receive free of charge. It was prepared by the Primary Health Care Revitalisation Division and the Department of Health Services (DoHS) under the Ministry of Health and Population (MoHP), specifically to give practical meaning to the constitutional promise of free basic health care after Nepal adopted a federal structure in 2015.

Before the package existed, Nepal already ran a Free Health Care Programme and distributed a shorter list of free drugs, but there was no single national standard defining exactly what counted as 'basic' health care across the country's new federal, provincial and local governments. The BHS package fills that gap. It bundles together preventive and promotive care, outpatient clinical services, basic inpatient and delivery services, and a list of 98 essential medicines that must be available without charge at the lowest tiers of the public health system.

The package is delivered mainly through three first-contact facilities: the Basic Health Service Centre (aadharbhut swasthya sewa kendra), the health post, and the primary hospital or primary health care centre. Larger district and referral hospitals also stock the full medicine list. Because the entitlement is universal, it applies to every Nepali citizen regardless of income, and it is separate from the contributory National Health Insurance Programme, which is a paid scheme covering a wider basket of services.

The foundation of the package is Article 35 of the Constitution of Nepal, promulgated on 20 September 2015 (3 Ashwin 2072 BS). Titled the 'Right relating to health', Article 35 makes health a justiciable fundamental right rather than a mere aspiration. Its first clause guarantees that every citizen has the right to free basic health services from the State and that no one shall be deprived of emergency health services.

To turn this constitutional right into a working system, Parliament enacted the Public Health Service Act 2075 (2018). The Act defines the free basic health services, assigns the duty of delivering them to the federal, provincial and local governments, and bars public providers from charging citizens for services on the free list. The National Health Policy 2076 (2019) and the Public Health Service Regulations add detail on how these services are financed and delivered across the three tiers of government.

Section 4 of the Public Health Service Act 2075 lists nine categories of basic health service that must be provided free of cost. Together they span a person's health needs from before birth through old age, covering prevention, treatment of common illnesses, mental health and emergencies. This is the legal backbone that the BHS package operationalises at each facility level.

In practice the package translates these headings into concrete programmes, including routine immunisation under the National Immunisation Programme, antenatal and delivery care under the Aama (safe motherhood) Programme, family planning and reproductive health services, integrated management of newborn and childhood illness (IMNCI), nutrition services, and screening and first-line treatment for common communicable and non-communicable diseases. All of these are meant to be delivered without user charges at public facilities.

The most searched-for part of the package is its list of 98 free essential medicines. These are the drugs the government commits to keep in stock and dispense without charge at basic health facilities, following the national Standard Treatment Protocol for basic health services. The list was expanded from a previous set of roughly 70 medicines as the package was rolled out under federalism, and it is revised periodically as needs change.

A notable feature of the expanded list is the inclusion of medicines for non-communicable diseases (NCDs). Around 20 of the 98 target chronic conditions such as high blood pressure, diabetes, chronic respiratory disease, mental health disorders and high cholesterol. This reflects Nepal's shifting disease burden, in which heart disease, diabetes, cancer and lung disease now account for a growing share of deaths. Alongside the medicines, the package also specifies a set of basic surgical and consumable items such as gauze, sutures, gloves and syringes.

It is important to understand that not every facility stocks all 98 medicines. In principle a primary or basic hospital carries the full list, while health posts and Basic Health Service Centres stock a subset matched to their staffing and scope. Reported per-facility figures vary between sources and revisions - health posts have been cited at roughly 35 to 57 medicines and primary health care centres at around 57 to 58 - so patients should treat these numbers as indicative and confirm what is actually available at their nearest facility.

The 98 medicines are drawn from Nepal's National List of Essential Medicines and cover most of the therapeutic groups a first-contact clinic needs: common infections, pain and fever, chronic diseases, reproductive and maternal health, mental health, childhood immunisation and emergencies. The exact formulation and strength of each drug is fixed by the standard treatment protocol so that prescribing is consistent nationwide.

The categories below give a representative picture of what the free list contains. Specific brand or generic availability can differ slightly between revisions of the list, so the examples are illustrative rather than exhaustive.

The free package is delivered through the public health network, which starts at the ward level. The Basic Health Service Centre is the newest tier, created under federalism to bring a package delivery point within reach of every ward; health posts remain the main first institutional contact point for most communities. Above them sit primary health care centres and primary or basic hospitals, which stock the full 98-medicine list and provide basic inpatient and delivery care.

In principle, any service or medicine on the basic health list should be provided free at these government facilities, and staff are not supposed to levy charges for them. For some programmes - such as the Aama safe-motherhood incentive - you may be asked for identification, and referral to a higher facility may be needed for conditions beyond the basic package.

In practice, availability can be uneven. Health posts sometimes run short of particular medicines because of supply-chain gaps, budget timing, or higher-than-expected demand, and the exact number of drugs stocked at each level continues to be harmonised across provinces. Citizens who cannot obtain a listed free medicine can ask the facility in-charge, escalate to the local (palika) health section, or seek the item at the next facility up the referral chain.