In September 2023, Nepal’s health workers stood at crossroads. After a harrowing attack on doctors at Manipal Teaching Hospital in Pokhara, the Alliance of Resident Doctors Association of Nepal formed the Committee for Safe Workplace for Health Care Workers. This committee led a week-long protest that shook the nation. White coats filled the streets, not with stethoscopes but with placards demanding dignity. The government, compelled by this collective cry, signed an agreement with the committee: violence against healthcare workers would become a non-bailable offense, and systemic reforms would follow. Today, that promise hangs in limbo, a testament to how easily urgency fades into inertia.
Punishment isn’t enough
The protests were never just about punishment. Yes, the demand for stricter legal consequences was vital—a signal that society would no longer trivialize assaults on health workers. But the heart of the movement was for something deeper. We understood then what the Ministry of Health and Population (MOHP) and other safety advocates turned a blind eye to: jailing a desperate relative who chooses violence does little to solve the problems of overcrowded wards, understaffed clinics, and institutional apathy that ignites such desperation. We fought not just for stricter laws but for shared accountability—one where hospitals, health workers, and patients share responsibility for a culture of mutual respect.
Collecting dust
This vision crystallized into the Zero Tolerance Policy—a comprehensive approach toward violence where call for punitive actions are replaced by need for change in health system with a focus on prevention of violence. The operational procedure of this policy has gathered dust on the desks of the MOHP’s healthcare workers and healthcare institution security coordination committee for over eight months. The coordination committee, the only government body that looks into violence against health workers, hasn’t even met for last eight months reflecting MOHP’s apathy and indifference toward this issue.
The policy is not an abstract manifesto. It mandates security committees in every hospital—not to police patients but to audit risks, train staff in de-escalation, and basic infracture improvements like proper lighting, vigilance in high-risk zones. It requires hospitals to fund legal battles for assaulted workers, sparing them the humiliation of fighting alone. For patients, it appoints grievance officers to address complaints, ensuring frustrations are heard, not weaponized. And yes, it allows hospitals to deny non-emergency care to those who physically assault staff—a painful but necessary boundary.
Hollow promises, broken trust
After his appointment Health Minister Pradip Paudel had called healthcare worker safety a ‘priority,’ pledging to amend laws to make violence against healthcare workers a non-bailable offense as agreed. That hasn’t materialized despite the draft of the amendment lying in MOHP’s desk for over one year.
The Zero Tolerance Policy is not merely a companion to the Healthcare Worker’s Security Act—it is its backbone. Without the procedural details, the bill has become another hollow law, strong on paper but that strength has never been materialized in reality. The policy provides the how to the bill’s what: it mandates standardized procedures for recording incidents, trains staff to respond with de-escalation, and requires hospitals to audit violence trends monthly. These steps transform the bill’s intent into actionable change. Yet, 15 years after first introduction of the bill, 14 months after the decision to implement the policy and eight months after the operating procedure was submitted, hospitals still lack these protocols. Without the systems to implement the bill, Minister Paudel’s prioritization of the healthcare workers safety has become a hollow promise.
Justice
Justice isn’t just penalizing the desperate family members who are angry—it’s dismantling the conditions that fuel this desperation. When a husband assaults a healthcare worker after losing his wife to a 12-hour wait, it’s easy to blame him. But what about the hospital director who ignored staffing shortages? Or the ministry that allocated funds for VIP travels while the hospital did not have life-saving drugs? The policy forces these questions, demanding that institutions—not just individuals—answer for the rot.
To patients, this policy says: Your pain is valid, but violence is not your voice.
To healthcare workers: Your safety is non-negotiable, but safety requires systemic courage.
To hospitals and the MOHP: You are custodians of trust—act like it.
Future still within reach
The 2023 protests were a watershed moment. For the first time, the MOHP acknowledged that violence in hospitals is not a personal conflict but a systemic failure. The Zero Tolerance Policy is the next step—a bridge from recognition to reconstruction. But bridges don’t magically appear, they have to be built.
This policy decaying on MOHP’s desk isn’t just a piece of paper—it’s Nepal government’s vow to protect its health workers. Act now, and hospital could turn from war zones to safe havens. The doctors who poured into streets in 2023 were not just asking, they were fighting for a Nepal where no parent’s pain becomes violence, and no doctor risks their life to save others. That future is still possible. But every day this document collects dust, the government fails its people.
Every day of delay deepens the wounds of health workers: nurses quit, doctors leave the country, patients suffer, and the social contract between health workers and public decays. Minister Paudel has two options to choose from: protect caregivers or watch them flee.
(The author is a practising doctor and Joint Coordinator of the Committee for Safety of Health Care Workers)
