Every year, Nepal celebrates another graduating class of young doctors and nurses. Families gather with pride. Parents celebrate years of sacrifice. Universities produce another generation of highly trained healthcare professionals ready to serve their communities. Yet, for many of these graduates, another journey soon begins. Not to a district hospital. Not to a rural health centre. But to an international airport. Within months or years, many leave Nepal to build careers abroad in Australia, Japan, the United Kingdom, the United States or Gulf countries. Nepal loses some of the very people it has invested years in educating. Among many reasons, an important one is sole dependency on relatively low salaries from their medical practices. Whenever we discuss this problem, we usually ask one question. How do we stop doctors and nurses from leaving? Let’s ask a different question. How do we make staying in Nepal a better choice? No healthcare system can become stronger while continuously losing its most valuable resource. Buildings can be constructed. Equipment can be purchased. Technology can be installed. But experienced healthcare professionals cannot be replaced overnight. Healthcare ultimately depends upon people.
One uncomfortable reality deserves honest discussion. Many doctors and nurses in Nepal are not undertrained. They are underutilised, and many are underpaid. The years required to become a physician or a specialist are long and demanding. Nurses likewise carry enormous responsibility for patient care. Yet many healthcare professionals struggle to earn incomes that reflect their expertise and contribution. Some take on multiple jobs to support their families. Others conclude that the only practical path to financial security is to leave the country. This is not simply a workforce issue. It is a healthcare issue. Every doctor or nurse who leaves takes knowledge, experience and capacity with them.
Traditionally, earning additional income has required taking on another hospital appointment, opening a private clinic or working longer hours in the same physical location. Digital healthcare allows us to imagine another possibility. Instead of tying professional opportunities to a single building, why not connect healthcare professionals directly with patients who need their expertise? Imagine a physician finishing work at Patan Hospital. Rather than ending the working day, she chooses to make herself available for two hours that evening through a secure national digital care network. Patients request consultations at times that suit their schedules. The physician accepts consultations or other services within his/her area of expertise at their own convenient off-duty time. The consultation is not a random video call. It is informed by the patient’s authorised medical history, previous investigations, medications and recent clinical information. The doctor earns additional income. The patient receives timely specialist advice. No unnecessary travel is required. Everyone benefits.
Now imagine this happening across Nepal. A paediatrician in Kathmandu advises families in Humla. A psychiatrist in Pokhara supports patients in Bajura. An endocrinologist in Bharatpur follows patients with diabetes living hundreds of kilometres away. An experienced nurse provides postoperative counselling from home. Professional knowledge begins moving around the country instead of requiring patients to do all the travelling.
This is not simply about creating a “gig economy” in the conventional sense. Healthcare is fundamentally different. Clinical practice requires professional licensing, ethical standards, accountability and patient safety. Those principles must never change. What changes is access to opportunity. Healthcare professionals gain the flexibility to contribute beyond the walls of a single institution. Patients gain access to expertise that would otherwise remain out of reach. The platform becomes a professional marketplace built on quality, trust and continuity of care, not casual work.
One of the greatest opportunities may lie with healthcare professionals whose careers do not fit traditional models. Many highly trained women doctors reduce clinical practice after starting families because hospital schedules can be difficult to balance with caregiving responsibilities. Retired specialists often possess decades of clinical wisdom but no longer wish to work full-time. Experienced nurses may prefer flexible schedules while continuing to practice. A connected digital healthcare system allows these professionals to remain active, continue serving patients and generate additional income while maintaining flexibility. Healthcare does not lose its expertise. It gains new ways to use it.
There is another opportunity that deserves national attention. Thousands of Nepali doctors and nurses now practice overseas. Many continue to care deeply about Nepal. Imagine if they could contribute selected teleconsultations, specialist opinions, teaching or mentoring through a secure national platform. The experience gained abroad would no longer be entirely lost to Nepal. Instead, it could strengthen the country’s healthcare system while maintaining professional careers overseas. The healthcare workforce would become global, while still contributing locally.
This broader philosophy is reflected in the vision behind MEDeCLOCK. Beyond creating patient-centred digital health records, the platform envisions a secure national network where registered doctors and nurses can provide telemedicine services based on their expertise and availability. Combined with longitudinal health information and continuity of care, this approach could expand access for patients while creating additional professional opportunities for healthcare workers. In a country where low remuneration contributes to workforce migration, such opportunities may help some professionals build more sustainable careers while remaining in Nepal.
This idea should not be viewed as a substitute for fair salaries, better working conditions or continued investment in public healthcare. Those remain essential; rather, it is a complementary strategy. A way to unlock additional professional opportunity without asking doctors and nurses to leave the communities they serve.
Throughout this series, we have argued that healthcare should follow the patient. Perhaps another principle deserves equal attention. Opportunity should follow expertise. A doctor should not have to leave Nepal simply because opportunity is concentrated elsewhere. A nurse should not have to choose between serving her country and providing for her family. If digital health can help create meaningful new opportunities for healthcare professionals while expanding access for patients, then its benefits extend far beyond technology. It becomes an investment in Nepal’s most valuable healthcare resource. Its people!
