Labour minister "under the grip of middlemen", hikes medical examination fees by Rs 3,000 per person

KATHMANDU, APRIL 1: Labour, Employment, and Social Security Minister Sharad Singh Bhandari has recently increased the medical examination fee for individuals seeking foreign employment. The fee has been raised by Rs 3,000, bringing the total to Rs 9,500 per person.

This hike comes less than two years after the last increase in mid-July 2023 when the fee was set at Rs 6,500.

Task force formation and recommendations ignored

To address concerns surrounding migrant workers’ medical examinations, the Labour Ministry formed a task force in August last year, led by Health Secretary Dr. Dipendra Raman Singh. The task force submitted its report to Minister Bhandari some four months ago.

The report proposed integrating medical examinations into the government’s health insurance scheme, standardizing fees, appointing health counsellors in countries with over 100,000 Nepali workers, and ensuring that only ‘B ’-grade laboratories or higher conduct these tests. However, rather than implementing these reforms, the minister merely raised the fees—a move critics say benefits medical institutions and intermediaries.

Increase in  tests and digitalization

The ministerial directive also expanded the number of mandatory medical tests from 19 to 34, introduced digitalized procedures, and aimed to improve health awareness among migrant workers.

Labour Ministry spokesperson Danduraj Ghimire defended the hike, arguing that additional tests naturally lead to higher costs. “With the inclusion of more tests, a fee revision was inevitable,” he stated.

Medical institutions voice concerns

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Medical professionals argue that the primary beneficiaries of this decision are intermediaries, not workers. The new regulations require medical institutions to upgrade their facilities, with estimated investments of at least Rs 4 million each.

One medical practitioner pointed out that the policy would force clinics to meet standards comparable to large hospitals. The real issue, he argued, is not the increased cost but the poor reliability of current medical examinations. Critics claim the minister's move serves vested interests rather than addressing these shortcomings.

Pattern of controversial fee hikes

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This is not the first time Minister Bhandari has introduced fee hikes. Previously, he increased pre-departure orientation training fees and mandated additional infrastructure, including biometric attendance systems and smart boards—devices reportedly supplied by a select company. Observers suggest a similar pattern is now unfolding with the medical examination fees.

Key recommendations from the task force:

Standardization of Medical Examination Fees
The report called for a uniform fee structure, as current charges vary by destination country, creating unhealthy competition among medical institutions.

Regulation of Health Institutions
All medical centers, whether government or private, should adhere to the same standards. Many facilities in Nepal fail to meet even national health guidelines, necessitating stricter monitoring.

Digitalization of Medical Examinations
The report recommended digitalizing the process to enhance transparency and curb fraudulent practices such as issuing fake "medically fit" certificates.

Bilateral Health Agreements with Destination Countries
Nepal should negotiate with key labor destinations—Saudi Arabia, Qatar, Malaysia, Israel, South Korea, Australia, and European nations—to establish shared medical standards and ensure annual health check-ups for workers.

Health Counselors in High-Worker Population Countries
The task force advised appointing health counselors at Nepali embassies in countries where Nepali workers exceed 100,000. These counselors would provide medical assistance, organize health camps, and ensure extended service hours.

Expansion of Medical Examination Services Beyond Kathmandu
Medical examination services should be extended beyond Kathmandu to cities like Bhairahawa and Pokhara. Each province should have a regional occupational safety and health center with trained personnel.

Requirement for ‘B’ Grade Laboratories
Only ‘B-grade medical labs registered with the Ministry of Health should be authorized to conduct examinations. The report also called for mandatory cervical cancer screening for female workers and stricter measures against fake medical reports.

Categorization of Worker Health Issues
The task force recommended classifying worker health concerns into the following categories:

• Physical Conditions: Musculoskeletal disorders, injuries, heat-related illnesses.

• Chemical & Respiratory Risks: Exposure to harmful chemicals, blood cancers, respiratory diseases.

• Mental Health Issues: Stress, anxiety, depression, PTSD, social isolation.

• Reproductive & Sexual Health Problems: Sexual harassment, lack of pregnancy care, menstrual health issues.

• Infectious Diseases: Tuberculosis, COVID-19, gastrointestinal infections, STDs.

• Non-Communicable Diseases: Heart disease, high blood pressure, diabetes, obesity.

• Neurological Disorders: Parkinson’s, Alzheimer’s, migraines, muscle-weakening diseases.

The report highlights the urgent need for improved monitoring, enforcement of health standards, and stronger bilateral agreements to protect Nepali workers abroad.