India was a British colony for several centuries until Independence in 1947 and currently has over one billion people, 85% of whom are Hindu and only about 2-3% of whom are Christian¹. Until 1990, Nepal was an absolute monarchy, ruled by a king who is believed to be a reincarnation of Vishnu, a major Hindu deity. It has never been colonized. In 1990, following a brief revolution, a shaky democracy was established, although the king still has substantial influence and power. Nepal has a population of 23 million people of whom 75% are Hindu, 15% are Buddhist and 2% are Christian². The effect of these two very different political backdrops has been associated with a very different history of Christian mission.
In India, during the colonial period, Western mission organizations had their heyday, establishing educational institutions, hospitals and seminaries, almost at will. Following Independence, however, the phrase “Be Indian; Buy Indian” reflected the desire to shirk the colonialism, and to take over and do things the Indian way and by Indians. Thus it became progressively more difficult for Western missionaries to obtain visas. Nowadays very few people with missionary visas are left. All mission hospitals in India are either closed or run by Indian Christian organisations. Indian Christians are discriminated against, and there is some persecution, which has increased in recent years with the rise in Hindu fundamentalism. However, Christians do enjoy the protection of the Indian constitution, which strongly protects the rights of minorities.

Nepal remained closed to foreigners until the early 1950s. The first evangelists in Nepal were Nepalis who had been converted while living in India, and then moved into Nepal. When Western missionaries were first allowed in, in the mid 1950s, they were strictly prohibited from evangelism, and confined to working in the areas of health and development. This remains true today. Evangelism remains very effectively in the hands of Nepali Christians. Before 1990, it was illegal for a Nepali to be Christian. Many pastors spent months or even years in prison for the crime of converting others; Nepalis were also imprisoned for being converted. After Democracy was declared in 1990 and the constitution of 1990 stated that one could practice the religion of one’s ancestors, it became legal to be a Christian (by birth). However conversion is illegal.

In India, by the 1970s, most mission hospitals started by mainline denominations had been turned over to national church partners. In Nepal, Christian hospitals are still run by expatriate organizations. However, the situation for expatriate missionaries has become quite precarious for a number of reasons, including adverse government policies, civil unrest in Nepal and declining trends in the sending out of missionaries by traditional Western mission organisations.

How does this impact on the sustainability of mission hospitals?
A number of studies have come out in the last few years concerning the factors that determine the sustainability of mission hospitals³. Some of the important factors mentioned include vision and resources (both manpower and funding)⁴.

Lack of vision: The Nepali church today concentrates on evangelism, paying little attention to broader aspects of Christian ministries. In part this is because the church in Nepal is quite young. But the long history of persecution, when the church was virtually underground, meant that there was little opportunity for Nepali Christians to develop and experience broader aspects of the Gospel work. The few government-approved overseas Christian mission agencies could run schools, hospitals and projects, but Nepali Christians could not run ‘Christian’ institutions since being Christian was illegal. And because of government restrictions as well as the desire of mission agencies not to interfere with the development of the Nepali church, the work of the overseas mission agencies remained quite isolated from the Nepali church. The net effect of this situation is that today, the vast majority of Nepali Christians and the Nepali church have only a nascent concept of holistic ministry. Recently, Nepali Christian social development activities and organisations are beginning to emerge. And in the past year, a Nepali Christian development organization has taken on the management of a government district hospital.

Lack of manpower: In the mission hospitals in Nepal, Christian employees are in the minority. For example, in United Mission to Nepal (UMN) hospitals, which are the oldest mission hospitals, less than ten percent of the staff are Christians⁵. In general, Nepali Christians do not consider health professions as ‘Christian’ work. Nepali pastors who spent time in prison for their faith are widely respected; their profession is admired, and the impression is given that the only type of Christian work is being a pastor. This is superimposed upon the problem that there are relatively few highly educated professionals in Nepal. Before the 1950s, education was intentionally limited to the very elite and privileged. Higher education has only really developed in the last twenty years.

In contrast, in India, there are two Protestant Christian medical colleges, both over 100 years old. There are many nursing schools, including many founded by Christians. The majority of mission hospital staff are Christian. Although staffing mission hospitals with doctors is not easy, especially in more remote rural areas, mission hospitals and mission hospital organisations that have good relationships with the evangelical community are able to recruit and retain committed senior staff.⁶

Lack of resources: In Nepal, most of the general mission hospitals were not founded by a single Western church denomination.⁷ A consequence of this is that the hospitals do not have a particular parent denomination that feels some sense of ownership for a particular hospital. This is very different from India where each hospital belonged historically to some Western denomination and a significant proportion of them even today continue to receive some support from the parent denomination. The lack of association with a particular denomination will make the hospitals in Nepal particularly vulnerable when the expatriate missionaries, who often generate overseas interest and support, leave.
Unlike in India where the government is not interested in partnering with mission hospitals, in Nepal, one mission hospital has been run as a joint venture district hospital with the government for more than 20 years. Another mission hospital has acted as a de facto district hospital since it was established nearly 40 years ago. The government provides minimal support (supplies, vaccines, etc.). And recently, the management of another government district hospital has been undertaken by a Nepali Christian organization. Although funding and other support from the government is not as forthcoming as it should be, this may be the most sustainable way to proceed.

Conclusion: Although both India and Nepal are predominantly Hindu countries with a similar small proportion of Christians, the situation with respect to sustainability of mission hospitals is quite different. This is largely due to the very different history of Christianity in each country, one that took place in a British colony and the other in a Hindu kingdom. In Nepal, lack of wholistic vision, lack of Christian health workers, and poor potential for overseas funding make it unlikely that the mission hospitals would be sustainable if handed over to Nepali Christians, at least in the near future. However, unlike in India, the hospitals in Nepal are much more likely to be taken over as government hospitals.