Tackling the challenges of providing surgical services in low resource LMICs: Shortcomings in surgical healthcare in Nepal.

Province-2 is small but densely populated area in the plains of Nepal with 20% of the population on 3% of the land. It is one of the two poorest provinces, with the lowest human and logistic resources. Therefore, there is an enormous and urgent need for improvement of appropriate health care facilities, accessible for all the people. The rural population remains desperately impoverished and to date the provincial and federal governments have lacked the funds to support these needy people. Our work aimed to create a small working model to address the existing problems by establishing the Janakpur Trauma and Orthopaedic Hospital, and ultimately in collaboration with Future Faces, the Craniofacial Centre Nepal, to provide appropriate care at an affordable price to the people in Province-2. This model has been successful, but one of the main challenge remains payments to the health care providers. It is difficult to balance the income and expenditure of hospital services in order to sustain these works and so regular external financial input is required for maintaining continuity of care. It is expected that government agencies and universities such as Madhesh Institute of Health Sciences (MIHS) should be able to educate and assist in the provision of standard care for common illnesses and create suitable human resources to face these challenges.