In resource-constrained healthcare systems, the intersection of acute oncology care, chronic symptom burden, and advanced disease management presents a formidable challenge. Tertiary center beds and intensive care units are routinely overwhelmed by complex chronic and terminal patients whose care can be effectively optimized outside tertiary settings, yet who lack access to structured palliative support in their communities.
To bridge this critical gap, a transformative pilot workshop was organized by the Nepal Hospice Care Center (NHCC) in collaboration with B.P. Koirala Institute of Health Sciences (BPKIHS),supported by Two Worlds Cancer Collaboration (TWCC), Canada, bringing together frontline doctors and nurses from all 14 districts of Koshi Province.
The Hub-and-Spoke Ecosystem, with BPKIHS serving as the central hub, is developing a decentralized, four-pillar framework designed to expand palliative care expertise across the province:
- Home-Based Hospice and Palliative Care: Dedicated regional clinical teams providing holistic symptom management and compassionate support directly in community settings.
- Intensive Workforce Capacity Building: Evidence-based training in symptom control, pain management, opioid protocols, and compassionate communication.
- Telemedicine & Referral Networks: A permanent digital cord connecting district health workers with tertiary specialists for real-time case consultations.
- Mobile Outreach & Field Mentorship: Direct on-site mentorship across the 14 districts to supervise community nurses and ensure quality delivery.
Optimizing Bed Triage and Human Dignity Beyond compassionate patient support, the model serves as an indispensable tool for healthcare resource optimization. By empowering trained physicians and community nurses to manage complex symptom trajectories and advanced illness locally, the program aims to reduce potentially avoidable hospital and ICU admissions and ease pressure on inpatient services.
A nation-wide sustainable framework developed by Dr. Soniya Dulal under the expert mentorship of Prof. Dr. Bishnu Dutta Paudel and supported by global expertise from the Two Worlds Cancer Collaboration (TWCC), the initiative is powered by strong multi-sectoral synergy between the Koshi Provincial Government and the Dharan Sub-Metropolitan City.
This project demonstrates that decentralized palliative care is not merely an ethical imperative—it is an operational necessity. As Koshi Province establishes this regional network, it lays the cornerstone for a scalable, sustainable national model across Nepal.
Written by Dr. Soniya Dulal, MD, DM (Medical Oncology)