Research shows that the healthcare needs of in- dividuals living in rural areas are different from those in urban areas, and rural areas often suffer from a lack of access to healthcare. These differ- ences are the result of geographic, demographic, socioeconomic, workplace, and personal health factors. Health care facilities, hygiene, nutrition and san- itation in Nepal are of poor quality, particularly in the rural areas. Despite that, it is still beyond the means of most Nepalese. Provision of health care services are constrained by inadequate gov- ernment funding. The poor and excluded have limited access to basic health care due to its high costs and low availability. The demand for health services is further lowered by the lack of health education. Reproductive health care is neglected, putting women at a disadvantage. In its 2009 hu- man development report, UN highlighted a grow- ing social problem in Nepal. Individuals who lack a citizenship are marginalized and are denied ac- cess to government welfare benefits.1 Traditional beliefs have also been shown to play a significant role in the spread of disease in Nepal.1,2 These problems have led many governmental and nongovernmental organizations (NGOs) to im- plement communication programs encouraging people to engage in healthy behaviour such as family planning, contraceptive use, and spousal communication, safe motherhood practices, and use of skilled birth attendants during delivery and practice of immediate breastfeeding.3 Much of rural Nepal is located on hilly or moun- tainous regions. The rugged terrain and the lack of proper infrastructure makes it highly inaccessible, limiting the availability of basic health care.4 In many villages, the only mode of transportation is by foot. This results in a delay of treatment, which can be detrimental to patients in need of immedi- ate medical attention.5 Most of Nepal’s health care facilities are concentrated in urban areas. Rural health facilities often lack adequate funding.6 In 2003, Nepal had ten health centres, 83 hospitals, 700 health posts, and 3,158 “sub-health posts”, which serve villages. In addition, there were 1,259 physicians, one for every 18,400 persons.7 On the other hand, the last two decades have seen a tremendous boom of medical colleges in Nepal. Before 1993, Institute of Medicine, Maharajgunj was the sole national institution for medical ed- ucation for almost 15 years. In the year 1993, BP Koirala Institute of Health Sciences, Dharan was established and this was soon followed by a rapid increase in the number of affiliated medical col- leges of Kathmandu University and also Tribhu- wan University later. Meanwhile, Kathmandu University also started its own medical college, Kathmandu University Medical School (KUMS) in 2001 and Patan Academy of Health Sciences was established in 2008.8 Under Kathmandu University affiliation some colleges like Lumbini Medical College, Nepal- gunj Medical College, Dhulikhel Hospital as University Hospital and community hospital are serving community in remote areas at their own strength as secondary and tertiary care centre in related fields. Lumbini Medical college per se is giving most of the services which are available in Capital. The college being in such a place it has become an example that people need and will utilize good health care services in every corner of the country and health care can be given with good outcome in any corner if we have strong de- sire to work and serve. Ironically, there are currently 19 medical colleges running their services indifferent areas of Nepal. And 8 more proposals in pipe line. The govern- ment has very minimum interaction with these projects which are run by the private sectors. In spite of having very good infrastructure with re- gard to district hospital and above, government is not able to propagate the service of secondary care centre, in these hospitals properly. These centre in partnership with medical colleges can be cen- tres to train the postgraduate students in different fields. There need to be a good collaboration with the Education ministry, Health Ministry, the Med- ical Council and the planning commission. To conclude, if we work it out once again and put all these sectors and issues in the health and edu- HEATH SYSTEM INFRASTRUCTURE OF NEPAL AND ROLE OF MEDI- CAL COLLEGES IN RURAL MEDICINE: is there need for collaboration? Nabin Pokharel Associate Professor and Academic Coordinator, Lumbini Medical College and Teaching Hospital, email: nabindai@yahoo.com EDITORIAL cation system infrastructure of the country we can do a lot. The health indicators of Nepal in present context is as follows. Parameters Overall Urban areas Rural areas Children under 5 years Stunned 51% 37% 52% Wasted 10% 8% 10% Underweight 48% 33% 49% 2. Beine, David. 2003. Ensnared by AIDS: Cultural Contexts -of HIV/AIDS in Ne- pal. Kathmandu, Nepal: Mandala Book Point. 3. Karki, Yagya B.; Agrawal, Gajanand (May 2008). “Effects of Communication Campaigns on the Health Behavior of Women of Reproductive Age in Nepal, Further Analysis of the 2006 Nepal De- mographic and Health Survey”. 4. International Fund for Agricultural De- velopment (IFAD) retrieved 20 Septem- ber 2011. 5. United Methodist Committee on relief; retrieved on 20 September 2011. 6. Shiba Kumar Rai, Kazuko Hirai, Aya- ko Abe,Yoshimi Ohno 2002 “Infectious Diseases and Malnutrition Status in Ne- pal: an Overview”. 7. Nepal Health Profile World Health Or- ganisation data (2010). 8. Dixit H. Nepal’s Quest for Health. Edu- cational Publications, 2005. 9. UNICEF Nepal statistics. 10. Health Organisation Data from the Glob- al Health Observatory. 11. Health Profile World Health Organisa- tion data (2010). Health lndicators9,10,11 Population growth 1.28 Life expectancy 67 Infant mortality 39 Fertility 2.64 Total expenditure on health per capita (Intl $, 2009) 69 Total expenditure on health as % of GDP (2009) 5.8 L M Coll J 2013; 1(2) REFERENCES 1. Beine, David. 2001. “Saano Dumre Re- visited: Changing Models of Illness in a Village of Central Nepal.” Contributions to Nepalese Studies 28(2): 155-185.