Medicosnext
Dr. Bhagawan Koirala
In Nepal’s medical fraternity, Dr. Bhagawan Koirala needs little introduction. A surgeon, institution-builder, and public health visionary, his career has been defined not by titles held but by systems transformed. Today, as the force behind the KIOCH network, Dr. Koirala is advancing a bold national mission – one that challenges Nepal to reimagine child healthcare as a moral, social, and governmental obligation rather than a privilege. In this conversation, he reflects on the journey, the lessons learned, and the conviction that no child should die simply because their family cannot afford care.
Having served as the Executive Director of major institutions like Gangalal Hospital, Man Mohan Cardiothoracic Center, and TU Teaching Hospital, what specific systemic failure in child healthcare convinced you to forgo a lucrative retirement to establish KIOCH?
To correct you, the idea of having an institution like this came to my mind almost 25 years ago when I was still in training in Toronto. I could experience that there was a great non-profit, a multi-specialty teaching hospital with very high standards of care and a loving environment for the children.
When I came back to Nepal, I was in the university system but soon I was deputed to Gangalal National Heart Center to build and run it. I tried to develop pediatric cardiac surgery together with the adult cardiac care at Gangalal itself. We did thousands of cases, but it was not really possible to achieve something of a global standard, largely because of lack of multispecialty support. Global practice generally requires a children’s hospital to be a separate, freestanding facility from adult care where all the people working there have a minimum standard of expertise in pediatric care. Decades went by trying to develop cardiothoracic and vascular care in general. After the earthquake, a lot of things were changing in my mind. I realized that life is so vulnerable, and we don’t have a lot of time in our life. So I started putting pieces together to think “what next” after a long tenure of professorship and leading multiple public sector institutions like Gangalal, Manmohan, and the Teaching Hospital.
We, together with a few of my friends, started thinking about having one multi-specialty, non-profit children’s hospital which would serve children not only in Kathmandu but also through satellites to be impactful at a national level. It is not just because I was retiring and wanted to engage myself, but a mission that was in my mind ever since I was training in pediatric cardiac surgery.
Your motto is “No child in this country shall die of heart disease because of poverty”. How has this personal conviction evolved into the broader mission of KIOCH?
This was not just a personal conviction; we actually convinced the then government to support bearing the cost of operations and inpatient admissions of all under-15 children in Gangalal Hospital. That was over 20 years ago.
At that time, we phrased a motto for the Government: “no child in this country shall die of heart disease because of poverty”. That was carefully coined to convince the government to pay for all of that cost.
We knew that children could still die because they may not reach doctors, or surgeons may not be competent enough, or there may be long waiting lists. But at least the government could say it was not because families could not pay. That was a very strong theme, and it worked.
Now, we want to extend that theme beyond heart disease. We are advocating a new motto:
“No under-five children in the country shall die of any disease because of poverty.”
Let that be the first quote through this magazine. We believe that the government—across all three levels—is responsible for those who cannot pay, at least for under-five children. This aligns with national goals and SDGs, and the timing is right.
In your memoir, Hridaya, you reflect on the “success and failure of organizations”. What single most important lesson are you applying to the daily operation of KIOCH?
The lessons have been consistent across timelines and institutions. If you are committed and doing something unconditionally and selflessly, it is possible to succeed. The fundamental qualities of a leader are honesty, commitment, and a little common sense. Institutions fail largely because of non-performance, active “bleeding,” incompetence, or unnecessary political intervention. Political intervention often stems from the incompetencies of those running the organization.
KIOCH utilizes a “hub-and-spoke” model with plans to operate in all seven provinces. Why is this configuration better suited to Nepal’s geographical and economic challenges?
It is simple and logical. If we don’t have comprehensive pediatric care in Kathmandu, there is certainly none elsewhere. We must decentralize.
Approximately 36% of Nepal’s population—about 10 million children—deserve specialized care at least as good as what adults receive. One or two hospitals in Kathmandu cannot cater to them all, and children should not be forced to travel to the capital for all types of medical care.
This is why the hub-and-spoke model is ideal for impact.
How will the Kathmandu hub facilitate the retention and rotation of specialists to ensure children in rural provinces receive the same quality of care?
The Kathmandu Center allows us to maintain a pool of physicians, nurses, and technical staff. When there is difficulty securing human resources outside Kathmandu, we can deploy staff on a rotational basis. It is much easier to send people for a few months rather than several years. Interestingly, in our Damak project, no one has left after joining over the past two and a half years. The rotation model will be especially relevant for remote sites like Karnali or Sudurpaschim.
With the Damak Children’s Hospital already operational, what have been the primary operational “growing pains”?
The Damak project has been a very successful proof of concept. The main challenge was initial funding for construction, equipment, and early operations. We haven’t sent a single child away from Damak due to lack of money. We are happy to share that the project is now almost self-sustainable. Developing core competencies in pediatric care among staff has been another challenge—but an achievable one.
How will KIOCH’s cross-subsidy model ensure children complete their treatment?
We use a cross-subsidy model where internal revenues from private cabins and higher-priced services subsidize general wards and outpatient services for those who cannot pay.
We also work with the government through insurance and other schemes so poor patients do not pay out of pocket. This helps ensure that our motto—“no under-five child shall die of any disease because of poverty”—is upheld.
How does KIOCH plan to integrate mental health services into a tertiary care setting to make them more accessible?
We developed a matrix to identify high-need and feasible areas, knowing not everything could be done at once. We selected five priority areas from the beginning: mental health, cancer, cardiovascular diseases, critical care, and trauma. These are common, high-impact areas that need immediate development. We are already running a mental health clinic in Damak. KIOCH will play a major role in supporting children with neurodevelopmental issues through full-time and visiting child psychiatrists. We are also supporting the Government in implementing the PEN Plus project in many districts, where identifying neurodevelopmental issues is a key focus. Other specialties will be developed gradually.
KIOCH recently signed an MoU with Kathmandu University. How will this partnership help create a sustainable pipeline of specialized pediatric health workers?
We must train the next generation, as there is a shortage of expertise in many subspecialties. While we are not yet a degree-conferring institution, we will be part of academic training programs for future pediatricians.
Currently, we have partnered with Kathmandu University, and in the future we will also collaborate with NAMS, TU, and MEC. Once fully operational, we will offer non-degree fellowship programs as well.
If you were to name five people who contributed to turning the dream of KIOCH into reality, who would they be?
I cannot and should not name only five people—it would be unfair. There are founding board members, technical advisors, philanthropy advisors, donors, and the dedicated staff working at KIOCH today.
I am just one among many. I must thank the Government, our patrons, and our senior management team, without whom this project would not be possible.
What would you say to specialists in other fields about collaborative leadership in turning a neglected specialty into a national priority?
To colleagues hesitant to enter neglected fields, I say this: you will never understand all the problems unless you put your hands into the project. Once you begin, only then do you identify challenges—and solutions.
We often blame society for being negative, but in our case we have been blessed. We have received immense support—financial, in-kind, moral, and otherwise. Despite adversities over the past five years—COVID-19, economic crises, and national turmoil—society has stood with us.
Today, we have two operational non-profit hospitals serving the children of our nation.
