<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

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Is free health care possible in Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179b9c7e80680e02c286jpeg.jpg" alt="" width="1400" height="905"/><figcaption>IN GOOD HANDS: Community Health Worker Bhajan Kunwar checks patient Namsara Tamrakar at her home in Chandika village of Achham. Pics: Marty Logan and Srawan Shrestha</figcaption></figure>Rounding a steep curve on the road to the district capital of Mangalsen a startling set of modular structures comes into view. The modern buildings look out of place in this scenic, but underserved, region of western Nepal.The construction is part of a $4 million expansion of <a href="http://archive.nepalitimes.com/news.php?id=17650#.WreWXNRua70">Bayalpata Hospital</a>, a unique medical facility that is a model for public-private partnership to improve medical care in Nepal’s remote interior.Inside the ward, orthopaedic surgeon Mandeep Pathak is examining an elderly man with a swollen knee. Clearly visible on an x-ray monitor is a short pin inserted by a general practitioner a few weeks ago, after the patient fell and broke his kneecap.https://www.youtube.com/watch?v=SuWvlDGasEAIn the same room with the surgeon today is Community Medical Assistant (CMA) Khagendra Pant, who is wrapping plaster around the arm of a small boy. Thanks to training at the hospital, Pant was able to diagnose the boy’s injury as a clean fracture that did not require an operation.Such training means Bayalpata now has to refer just 10-20% of orthopaedic cases to hospitals in Dhangadi and Nepalganj, compared to nearly 70% two years ago.“I am proud to say that all the basic trauma care can now be done by general practitioners. Plus they can diagnose cases and decide which need to be referred to outside centres,” says Pathak.Training is integral to Bayalpata’s mission, says Director of Medical Education <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Bikash Gauchan</a>: his hospital has continuing medical education for clinicians, and on the job training for future nurses and other staff. General practitioners from various centres learn rural surgery at Bayalpata while mid-level staff come to improve their clinical knowledge.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179e9c7e80680e02c287jpeg.jpg" alt="" width="1400" height="650"><figcaption> </figcaption></figure>For some <a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">patients who travel many days</a> to reach Bayalpata, access to basic surgery here means avoiding an expensive trip to the city. People whose limbs were fractured as long as three years ago delayed treatment until surgery was available at the hospital because they couldn’t afford the trip to a city hospital.Treatment at Bayalpata and at another hospital in Dolakha run by the non-profit Possible, is <a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">free</a>. The group believes healthcare is a fundamental human right protected by Nepal’s Constitution, and should have no cost at point of delivery.Possible is funded by donations and Nepal government grants, which will grow as its hospitals attain clinical targets, such as the percentage of women who give birth in a facility with a trained clinician. Operating expenses last year were $4.8 million, of which 9% came from the government.Arrivals are registered in the hospital’s Electronic Health Record (EHR), which puts patients’ information at the fingertips of clinicians throughout the hospital, and eliminates bulky paper records.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a19c7e80680e02c288jpeg.jpg" alt="" width="1400" height="823"><figcaption> </figcaption></figure>One patient already on the EHR is Namsara Tamrakar. Sitting cross-legged on a raised, wooden platform outside her home in Chandika village (left), the elderly woman shows visiting hospital staff that she knows how to use her inhaler, but it is empty.Three years ago, a doctor at Bayalpata diagnosed her with chronic obstructive pulmonary disease and prescribed medicine via inhaler. Now Community Health Worker Bhajan Kunwar (see box, left) visits regularly to follow up. Like others, Tamrakar’s house has a small blue metal tag on an outside wall with a unique household ID. The houses are also geo-tagged.Kunwar’s visit is guided by CommCare, a software developed by Dimagi and customised by Possible that includes counselling information and checklists for each patient. Plans are to integrate CommCare with the EHR so that field followups are immediately reflected in the hospital’s system. Eventually, Bayalpata’s EHR will be linked to a national data system.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a49c7e80680e02c289jpeg.jpg" alt="" width="1400" height="1024"><figcaption> </figcaption></figure>Kunwar takes Tamrakar’s blood pressure: 120 by 80. The woman is happy to hear the news and to see Kunwar again: “She comes, does a check-up, and tells me what sickness I have, and if it is getting better or worse. She insists I go to Bayalpata for a follow-up.”The hospital's <a href="http://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">community health program</a> focuses on maternal and child health as well as non-communicable diseases such as hypertension, diabetes and respiratory ailments. Possible employs 56 community health workers looking after more than 80,000 people in Achham and Dolakha. It is planning to more than quadruple that number next year.Bayalpata Hospital started in 2009, when the group <a href="http://archive.nepalitimes.com/article/nation/Crowding-it-out,1003">Nyaya Health</a> (now Possible) took over an abandoned government facility. Then it had five beds and treated up to 12,000 patients a year. Last year, Possible saw 86,000 patients at Bayalpata: the goal is to treat 150,000 people annually after the new wards, emergency room, administration building, a dormitory and remaining small houses for on-call staff are added.“Our integrated, hospital-to-home approach will be a model for Nepal, and beyond,” explains Gauchan, “and we will be proving that in a resource-limited setting, health care expansion, providing universal health coverage to people is possible.”But is the Bayalpata model really replicable? Skeptics say that two hospitals could have been built for the cost of the new buildings, which feature rammed earth technology, solar energy and rainwater collection, and that only substantial donor support made the expansion possible.Gauchan admits that the initial investment may seem high but says it will be more cost-effective in the long run.He adds: “The existing infrastructure for rural health care is way less than the minimum needed to address the emerging burden of non-communicable diseases and road accidents as well as infectious diseases. That is why we are investing in a very robust infrastructure.”<h2>Community spirit</h2>In 2011, Bhajan Kunwar (pictured above) was living an “Ok” life with her husband Purna and children in Bhageswor village of Achham when her sister-in-law Shavitra asked for a favour.Shavitra had been hearing rumours that her husband, who was working in India, was having an affair or had even remarried. Would Purna take her to India to find out? Purna agreed, and brother and sister set off with a friend. En route, Purna received a phone call from Shavitra’s husband warning them not to come, or there would be trouble.They continued anyway, and after crossing the border got on a train. That night, a group of men, perhaps including police, boarded the train and took Purna away. He later called Shavitra’s husband to say he had been kidnapped and would be killed unless help came quickly.Police found Purna’s body the next morning, on the roadside in Ahmednagar, east of Mumbai. It looked like he had been run over, but Bhajan believes he was murdered.Widowed at 25 and with two small children, Bhajan spent the mourning period worrying about how she would afford to send the children to school, and if her mother-in-law and community would accept her becoming the breadwinner for her husband’s four younger brothers and sisters and their families. (Her father-in-law had died earlier).That month, Bayalpata Hospital had a vacancy for a community health worker for the area. Bhajan was hired and six years later, still visits on foot the more than 700 households in her catchment area, checking that patients are taking their medicines, and much more (see main article).“This hospital made me strong,” she tells us. "Before I didn’t know anyone in my village and I didn’t know so many things.” Now with a college certificate, Bhajan advises young women to get educated before they get married. “I tell them ‘if I can do it, you can do it too’. I believe in myself and don’t care what others say about me. If you are true and honest, no harm will come to you.”Bhajan says she will never forget her husband. “But I have to live for my children, and control my mind and my heart. If I am strong, they can have a regular life. The hospital is now my husband, I cannot imagine leaving it.”Marty Logan in Achham<h2>Operating remotely</h2>When nine-year-old Samir Tamang was bitten by a dog on his way to school in Rayale village of Kavre last week, he had to take a two-and-a-half hour long bus ride to Kathmandu with his grandfather Suk Bahadur Tamang, for a rabies vaccination at Teku Hospital.Samir missed school and his grandfather, who works as a driver in Kathmandu, had to ask for leave from his employers.“We are relatively close to the capital, but imagine what it must be like for people living in remote parts of Nepal where there are no roads,” says Suk Bahadur.Indeed, despite the spread of basic health care in Nepal, emergency treatment and procedures like mending broken bones or caesarean sections are not yet available in rural areas. This means families have to sell property or borrow from moneylenders to be able to afford treatment in the cities. Studies have shown that many Nepali families are driven to poverty if relatives are referred to private hospitals.Unmet surgical needs in remote districts remain a major public health issue in Nepal, according to a recent study in 39 remote area hospitals commissioned by the Nick Simons Institute (NSI).One day this week, an informal survey of patients at the government-run Bir and Teaching Hospitals in Kathmandu showed that a majority of the patients were from remote districts, some as far away as Piuthan and Jajarkot.The NSI study shows that except for caesarean sections in Dolakha, Lamjung and Panchthar, very few government hospitals elsewhere were able to do simple operations of the abdominal cavity, or even mend broken bones.Nepal’s surgery rate falls well below the Lancet Commission target of 5,000 operations per 100,000 population. If the goal is to have a surgical facility within two-hour travel distance for patients, at present only a third of the population can reach an orthopaedic surgeon, and only 22% have access to abdominal surgery.However, the survey reaffirms that the presence of a medical general practitioner (MDGPs who can perform caesarean sections and other relatively simple surgical procedures) can change this. District hospitals with resident MDGPs can eliminate the need for patients to make expensive and extended trips to the cities for treatment.The minimum personnel at a district hospital should include an MDGP, obstretrics doctor, anaesthesia assistant, staff nurse and biomedical technician. However, Nepal’s density of hospitals with such staffing is very low (0.4-3.1 per 100,000) as against the Lancet Commission target of 20 per 100,000 population.“In the long run we need specialists but placing three of them in each district hospital will take a long time. For the next 5-10 years, MDGPs will be the answer to solve surgical problems throughout the country,” explains Anil Shrestha, NSI’s Executive Director.The study recommends an MDGP-led generalist surgical team with proper staff, drugs and equipment to upgrade emergency surgical care in all district hospitals.Adds Shrestha: “The government has to strengthen strategically located district hospitals and make them functional to take care of surgical needs throughout the year. It is entirely possible to do.”Sonia Awale in KavreRead also:<a href="https://www.nepalitimes.com/editorial/poor-health/">Poor health</a>, Editorial <a href="http://archive.nepalitimes.com/news.php?id=17650#.Wrydky5ubIV">Resurrection Accham</a>,  Paavan Mathema<a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">Boy walked eight days to treat broken arm</a>,  Tsering Dolker Gurung<a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">Free-for-all health</a>,  Duncan Maru and Roshan Bista

Marty Logan

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State of the art rural hospital

Nepal showed inconsistent performance at the T20 World Cup 2026 in Mumbai with flashes of brilliance, but ultimately snatched defeat from the jaws of victory. The <a href="https://nepalitimes.com/news/rhinos-hit-the-ground-running">near-win against England</a>, a test cricket team by an associate country, in the opening game showed promise and suggested that Nepal’s cricket was on the cusp of glory. The Nepal Premier League and a flawless performance in the qualifiers had raised hopes that perhaps the Rhinos could progress out of the group stage. However, subsequent losses against newcomers Italy and the West Indies were harsh reality checks about the true state of the game: there is a lot of catching up to do in the present, and structural changes to put in place to win big in the future. Head Coach Stuart Law summed it all up quite harshly: “To go from that high to then go to an extreme low four days later, that’s not showing mental toughness.” He was worried about the distraction of social media and lack of focus among players: “When you’re in cricket, do your cricket. It’s a difficult one for me because I’m a social media dinosaur, I don’t understand it. You don’t have to keep showing your face if we’re winning games.” Finally a late-night win against Scotland on Tuesday redeemed some of Nepal’s pride. A strong opening partnership, yet another rugged Dipendra Singh Airee innings and Sompal Kami’s vindictive 3 for 25 helped Nepal beat Scotland in their last group game at the T20 World Cup.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_6ca369f6aefc8b653c2572467f050e96b029c96b71fed5fb4213898c7d469325.jpg" data-media-id="editor_1" data-image-id="20260218010220_6ca369f6aefc8b653c2572467f050e96b029c96b71fed5fb4213898c7d469325" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  There was nothing riding on the game but honour, it means at least that Nepal do not crash out on zero. The game ebbed and flowed. Scotland started well and looked set to score 200 before collapsing in the end at 170. The Nepal batting effort also started out well, but in the middle overs after some wickets had fallen, it looked like the team was whimpering out again. Boundaries dried up, the run rate creeped up to almost 13, before Airee and Jha woke up and took charge and got to 171 with a few balls to spare. The dhaka topi crowd in the stands loved it. A big part of the reason Nepal’s performance was so much better against England than in the other games was the mentality going in. Against England, Nepal were clear underdogs and could play freely. Even a nasty defeat would have been forgiven. Against newcomers Italy, these roles were flipped. Fans and perhaps the players underestimated Italy, a nation much better known for its football culture. But it had put together a smart, experienced team made up of Italian cricketers with South African, Australian, English, Indian, Pakistani and Sri Lankan heritage. And Nepal may have won a series against West Indies last year, but against the full strength Caribbean squad they were easily beaten.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_dc27adaa2102b493f940a97f9572769e695c2c1c41c8558fc4c23657cc1c3261.jpg" data-media-id="editor_2" data-image-id="20260218010220_dc27adaa2102b493f940a97f9572769e695c2c1c41c8558fc4c23657cc1c3261" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="T20 World Cup Nepal"></figure>  Another key difference is that Nepal was batting second against England. Against Italy and the West Indies, having to set a target rather than chase it, there was miserable batting failure. The front of the order — openers Kushal Bhurtel and Aasif Sheikh, captain Rohit Poudel — did not pace themselves well. They started much too slow, not able to take advantage of the first six powerplay overs. Airee’s 58 and Sompal Kami’s 26 off 11 against the West Indies were the only innings of any note. The middle order of Bam, Jha, Aarif Sheikh was not much better. Nepal really struggled with the ball too in that game, taking the one wicket against the West Indies and none against Italy. Of course, it is a huge ask of your bowling attack to defend anything below 150 in the modern T20 game. There were questionable tactical choices. Early wickets are essential when defending a low score. But key wicket taker Sandeep Lamichhane was not brought on until the middle overs, when the opponents had made too many runs to feel any fear. So they took him on and he had a really poor tournament, going for a lot of runs.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_b0301b854ddf235e1bcb84e8ed58060a68c8f3f13d3bb5a7596e1f51184e0d03.jpg" data-media-id="editor_3" data-image-id="20260218010220_b0301b854ddf235e1bcb84e8ed58060a68c8f3f13d3bb5a7596e1f51184e0d03" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  To captain Poudel’s credit, he acknowledged the bad showing against Italy: “It was not a 123 all-out wicket. We are professionals and not turning up for the game was disappointing.” Coach Law thinks that Nepal is going to get to the next step. If the team is ambitious, and hopes to compete at the elite level, then it cannot celebrate a loss against England. If it wants to win consistently, it has to shed the ‘Cardiac Kids’ nickname. It is better to win than to be fun to watch but lose. The T20 game is so brisk and so it is often won in the margins. Good catching and fielding can create momentum and save a team the 5, 10 runs that win the game. Nepal were uncharacteristically poor in the field against Italy and West Indies, often fumbling and leaking boundaries. Airee didn’t get any of his usual run-outs either. Nepal lost cheap wickets through run-outs and stumpings. All these unforced errors right through the match add up on the scoreboard.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_1630c283f277631dfbddd3d7f29b930b124bde97c8f6a411cc2e1d089e452f45.jpg" data-media-id="editor_4" data-image-id="20260218010220_1630c283f277631dfbddd3d7f29b930b124bde97c8f6a411cc2e1d089e452f45" data-rendition-name="original" width="1366" height="2048" loading="lazy" alt="T20 World Cup Nepal"></figure>  SKILL SET Mentality is important but sport performance ultimately comes down to skill. There looked to be a large gap, and perhaps one of the reasons is because the Nepal team is so full of all-rounders. Airee’s two-way performance is undeniable, but Bhurtel, Paudel and Karan KC do plenty of both too and they do not do it super well very often. If the team wants to get consistent, it must have consistent performers with the bat and ball. That calls for some of these players to focus completely on one skill over the other. You do not see openers bowling so much in the top teams as Bhurtel does. The main reason for this skill gap, and one of the hardest parts about being an associate nation, is how little cricket the members of the team play compared to the test nations. Said Stuart Law: “The longer format is where you learn how to play the game. The shorter formats are where you have your fun. We need some sort of multi-day games.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260218010220_652ef3ba6fceab394a94c18cabd322dca8ba4a1266557660064339de9169c91d.jpg" data-media-id="editor_5" data-image-id="20260218010220_652ef3ba6fceab394a94c18cabd322dca8ba4a1266557660064339de9169c91d" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="T20 World Cup Nepal"></figure>  The contrast in experience showed during the Italy game. Most of the members of the Italy team were well into their thirties, had played a high volume of domestic cricket and were more self-assured. So, while the young Nepali team were more athletic, they seemed to lack the skill and experience to know what to do when things were going wrong. The Italians seemed to go about their game with a lot more self assurance. In the long run, this means setting up grassroot structures, getting kids into formal training when young, and setting up a longer format domestic league. In the short term, CAAN could organise frequent series with other associate nations, and individual athletes could go play long form club cricket abroad. Surely some team in the world has to have a spot for a player like Airee, for example. It has been Airee’s tournament. Scores of 44 v England, 58 v West Indies, and now a match-winning 50 against Scotland that gives the travelling Nepali support something to cheer for. The tournament could have been a lot more, but it is wholesome to end on a win.

Nepal goes in and out of T20

After his critically acclaimed 2023 book of essays सुन्यताको मुल्य on the state of women and children in the <a href="https://nepalitimes.com/banner/the-karnali">Karnali</a>, paediatrician and writer Nawaraj KC has come out with a next one, Swasparsh. The new book is almost a sequel to the first one, with real-life stories drawn from his medical practice and social engagement. Both are powerful accounts of suffering, resilience, and the search for human dignity in Nepal’s most remote and underserved districts. The book opens with deeply disturbing yet real incidents of the suicide of a Grade 2 student. A &nbsp;frantic mother rushes in with a son who had already written a suicide note but was saved at the last moment. There is a desperate call from a young woman threatening to jump into the Karnali River.&nbsp; We meet children carrying immense trauma: a toddler who refuses to eat after losing her mother, and another child who stops speaking after experiencing sexual abuse within the family. The emotional climax comes when KC himself falls into depression after being violently attacked by a drug addict patient, leaving him with a serious head injury.&nbsp; But this is not a book of only sad stories of deprivation and poverty. It is how people who find themselves in the worst circumstances struggle to overcome what life has thrown their way, and triumph in the end. By just surviving against all odds, people emerge stronger, often with a renewed commitment to helping others. As a paediatrician working out of his native Surkhet in Karnali Province, KC's work brings him face-to-face with the human side of what a centralised government’s neglect and apathy can do to communities in <a href="https://nepalitimes.com/banner/no-dasain-in-kalikot">Nepal’s most far-flung region</a>. KC shows empathy not just to human beings in trouble, but also animals and underlines the importance of coexisting with the natural world. By helping others individuals ultimately help themselves. Although a paediatrician by profession, KC demonstrates a deep understanding of structural oppression, gender discrimination, caste hierarchy, class inequality, and regional marginalisation within the Nepali state.&nbsp; He also captures moments of tenderness, such as young couples supporting one another through hardship. How poverty can drive families to take heartbreaking decisions — like a patient forced to discontinue life-saving medicine in order to qualify for disability allowances needed to repay debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260217030252_ffd67815063cffe51a0310f10405a554f6094ba05564993f34086fe4b31543f6.jpg" data-media-id="editor_2" data-image-id="20260217030252_ffd67815063cffe51a0310f10405a554f6094ba05564993f34086fe4b31543f6" data-rendition-name="original" width="1646" height="2048" loading="lazy" alt="Swasparsha"> </figure>  A former teacher is forced to beg despite receiving treatment, exposing the failure of conventional development models that ignore sustainable livelihoods.&nbsp; Then there are inspirational stories like the one of Mandire, who ran away at age 12 to work as a labourer in India, suffered severe burns while unloading coal, and lost a hand. Despite this, his infectious smile and fortitude transformed him into a local symbol of hope both in India and Nepal.&nbsp; Even in old age, he is always smiling and helping others less fortunate.&nbsp; Through Mandire’s story, KC explores the science of the healing power of a smile, the positive psychology of a ‘mental gymnasium’ in which optimism is cultivated through conscious practice.&nbsp; For example, a young girl from the historically marginalised Badi community which faces deep social exclusion refuses to accept her circumstances, and grows into an advocate for other disadvantaged children. A devoted foster mother dedicates her life to raising orphans, empowering them despite her own hardships. One of the book’s strengths lies in its accessibility. In Nepali language, KC blends science, philosophy, and lived experience into everyday language that resonates with villagers and ordinary readers. He comes across not only as a doctor and healer, but also as a teacher, nature lover, and social activist. He tries to introduce greenery to a remote school, and how this transformed children’s learning experience. He reflects that his patients are his greatest teachers helping to expand knowledge beyond medicine and technology into the realms of humanity and ethics. I read Swasparsh after witnessing the recent GenZ movement. The book’s recurring calls to youth, appearing at the end of several chapters, has special relevance today. KC reminds young readers that hardship is part of everyday life, but within struggle lies the potential for healing and growth.&nbsp; He encourages self-reflection, self-healing, and cultivating a positive mindset. Above all, he asserts that humanity’s greatest gift is its own human capacity henceforth solutions to all problems lie within oneselves rather than outside forces. The GenZ movement represents an urban youth revolt against traditional political parties and state institutions that have failed to deliver opportunities and accountability. Rising unemployment, widespread corruption, and frustration with stagnant governance have fuelled demands for new political alternatives.&nbsp; With the 5 March election less than three weeks away, many young people hope that new forces will be capable of bringing systemic change. Yet whether these forces can truly meet their aspirations remains uncertain. Established political actors are reluctant to relinquish power, while emerging groups often lack organisational depth and historical experience. In many ways, these new political actors resemble the people of Karnali: resource-poor, And in the periphery of power, yet rich in commitment and determination. Drawing from Buddhist teachings that recognise suffering, understanding its causes, and seeking pathways to overcome it, KC indirectly inspires today’s youth. Every problem contains the seeds of its own solution, provided we learn to know ourselves, care for ourselves, and care for others. Ultimately, the title Swasparsh means self-healing, self-reflection, and self-confidence. At a time of political uncertainty and generational change, this book speaks directly to Nepal’s younger and the emerging alternative forces — reminding them that transformation begins from within.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026021704020_1d2a855730bc14acbea596cce7b3a00b20f85c79c3a7d8ca46274a15eb642f59.jpg" data-media-id="editor_3" data-image-id="2026021704020_1d2a855730bc14acbea596cce7b3a00b20f85c79c3a7d8ca46274a15eb642f59" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Swasparsha"> </figure>  Hisila Yami served as CA member, Minister of Physical Planning &amp; Works, Minister of Tourism &amp; Minister of Land Reform. At present, she is a member of Central Political Council in Pragatishil Loktantrik Party and is a lecturer in IOE Pulchok.

Essays on self-realisation and self-healing

Chronic winter drought and decades of unmanaged forest biomass have turned wildfires into a systemic risk for Nepal. We need to re-learn to convert fire fuel in forests into fertilizer for crops.&nbsp; On 11 January, a huge forest fire spread rapidly from China into the forests of Sindhupalchok, 40km northeast of Kathmandu. The newly-opened Tatopani border checkpoint was closed. Smoke from the fire spread across central Nepal, blocking the sun.&nbsp; The fire burnt itself out within a few days, but the border stayed closed for longer. Such wildfires were once rare in mid-winter, and traditionally peaked between March and May as temperatures rose ahead of pre-monsoon showers. What is unsettling is not just the early onset of the fires, but also their scale. This shift is not accidental, the pattern has been unfolding over years due to winter drought, weakening post-monsoon moisture, and the accumulation of dry forest biomass as Nepal’s forest area doubled in the past 30 years.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf.jpg" data-media-id="editor_0" data-image-id="2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf" data-rendition-name="original" width="2000" height="1055" loading="lazy" alt="Wildfire season NT"> <figcaption>A NASA FIRMS image of Nepal with red dots signifying fires in February 2025.</figcaption> </figure>  Together, these factors have made forests tinder dry in spring, just waiting for a spark. Nepal has experienced winter drought in eight of the past ten years (this winter was an exception). Winter rain and snow at higher elevations play a decisive role in maintaining surface moisture, recharging shallow aquifers, and keeping forest floors damp enough to resist ignition. When winter rains fail, forests dry out months earlier than usual. Satellite-based assessments show a steep decline in surface moisture across the middle mountains of Nepal, particularly in areas with dense forest cover but limited undergrowth management. Springs that once flowed year-round are now seasonal.&nbsp; More than half of the springs in the mid-hills have either dried up or show significantly reduced discharge, a trend closely linked to declining soil moisture and disrupted recharge zones. Dry soil does not just threaten water security — it helps the vegetation ignite. FUEL WITHOUT FUNCTION For decades, Nepal’s forests have been accumulating dry leaf litter, fallen branches, shrubs, and deadwood. Historically, this biomass was not considered waste because rural households regularly collected leaf litter for livestock bedding, which was later composted and returned to farms as fertilizer.&nbsp; Forest floors were therefore relatively clean while the mulch fertilized farms. That relationship has steadily eroded due to outmigration, changes in livestock systems, restrictions on access to community forests, and the growing availability of chemical fertilisers.&nbsp; Community forests across the country today are thick with dry twigs, branches and leaves — a highly combustible carpet. When prolonged drought dries this biomass, even a small spark from a herder’s intentional fire, a cigarette, or lightning strike can trigger massive fires.&nbsp; Under such conditions, the question is no longer whether fires will occur, but how intense and widespread they will be. Forest fires are often framed as an environmental issue concerning trees and wildlife. In reality, their impact extends far beyond forest boundaries.&nbsp; Smoke travels faster and further than flames. Fine particulate matter, especially harmful PM2.5, spreads across countries. In recent fire seasons, air quality monitors in Kathmandu have recorded air quality levels several times higher than WHO guidelines. The smoke adds to Kathmandu’s own pollution and lingers for days.&nbsp; Flights are cancelled or delayed in cities like Pokhara, and poor visibility blocks mountain views affecting tourism. Health facilities report spikes in respiratory complaints, particularly among children and the elderly. Just as wildfires have multi-sectoral causes, the impact of forest fires go beyond forests. One critical dimension remains largely invisible: the soil. The fires cause silent damage beneath the ash, and the emergency does not end when the flames subside. Beneath the surface, soil suffers long-term damage. Organic matter burns away, beneficial microorganisms die. The soil structure weakens, reducing the land’s ability to absorb and retain water. The scorched earth is more prone to erosion, increasing the risk of floods and landslides once the rains return.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2.jpg" data-media-id="editor_1" data-image-id="2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2" data-rendition-name="original" width="1717" height="2143" loading="lazy" alt="Wildfire season NT"> <figcaption>Wildfire risk map based on the validated Random Forest model (a) Overall reclassified wildfire risk map of Nepal, (b) District level wildfire risk, and (c) Municipality wildfire risk map.</figcaption> </figure>  In many of Nepal’s agricultural areas, soil organic matter levels are already below 2% -- lower than what is needed for resilient and productive farming. Repeated fires push these levels even lower, undermining soil fertility and forcing farmers to rely more heavily on chemical fertilisers, unleashing a vicious cycle of higher costs and food insecurity.&nbsp; Climate breakdown is often cited as the primary culprit, and rightly so. Rising temperatures and erratic rainfall have intensified fire risk. But fires in Nepal are increasingly the result of human intervention.&nbsp; The response of all three levels of government remains too little, and too reactive. Each year, resources are mobilised to extinguish fires once they have already spread. Far less attention is paid to managing the fuel load within forest undergrowth that makes such fires inevitable.&nbsp; Meanwhile, forestry and agriculture policies are not coordinated, missing opportunities to address shared challenges. Forest fires are not natural disasters, but predictable outcomes of governance choices. National plans and climate pledges set an ambitious target of raising soil organic matter to 4%. The science behind this goal is solid. Higher organic matter improves water retention, stabilises yields, reduces fertiliser dependence, and enhances long-term food security. What remains unclear is the pathway.&nbsp; Where will the organic inputs come from? How will they be processed and applied safely at scale? Without practical answers, the 4% target risks remaining aspirational rather than achievable. Forest undergrowth can be turned into fuel and fertiliser. Biochar is produced by heating organic biomass in a low-oxygen environment, converting it into a stable form of carbon that can be added to soil.&nbsp; When properly produced and applied, it improves soil structure, enhances water and nutrient retention, supports microbial activity, and locks carbon into the ground for decades. In Nepal biochar addresses two interconnected problems: reducing the accumulation of combustible biomass in forests, lowering fire risk, while simultaneously rebuilding depleted soils. In doing so, it restores the broken link between forest management and agriculture.&nbsp; Done well, biochar is not merely an environmental intervention. It is an economic one, with potential to create local employment, reduce farmers’ input costs, and support climate-smart agriculture. But biochar propagation depends on improved governance. If promoted as isolated pilots or short-term projects, it will fail. What is needed is institutional clarity: standards for production and safety, quality control mechanisms, farmer extension services, and coordination across local, provincial, and federal levels.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4.jpg" data-media-id="editor_2" data-image-id="2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4" data-rendition-name="original" width="1536" height="2048" loading="lazy" alt="Wildfire season NT"> <figcaption>Freshly prepared biochar under control tempature (350-600°C).</figcaption> </figure>  Community forest user groups could manage biomass collection. Local governments then support safe, decentralised production units. Agricultural extension services guide farmers on application, linked to soil testing and monitoring. Such an approach would reduce fire risk, improve soil health, and generate rural livelihoods.&nbsp; Poorly produced biochar or contaminated feedstock can harm soils and human health. Without training, standards, and oversight, good intentions can backfire. Nepal needs to move beyond fire-fighting to fire prevention and confront the structural causes that make them a growing risk. It is not just a technical choice – it is one that demands political will from newly-elected leaders after March. &nbsp;&nbsp; Ngamindra Dahal is a hydrometeorologist with the Nepal Water Conservation Foundation specialising on climate and water management issues.&nbsp;

RED ALERT: Get ready for the wildfire season

There is a growing tendency to frame Nepal’s current political turmoil primarily through the language of Foreign Hands.
Across talk circuits and commentary today, Nepal’s unfolding crisis is increasingly being explained through external influence —foreign powers, hidden backers, geopolitical plots.
In a tense regional environment, this framing is understandable, but it also risks becoming a convenient shortcut. By looking outward first, it subtly shifts attention away from the harder, less comfortable work political parties and institutions have long postponed: internal reform, accountability, and rule-bound governance.
Three collapses in three decades and seven constitutions in as many decades should force us to pause for self-reflection. Add to this nearly thirty changes of government in just as many years.&nbsp;
Nepal’s democratic century, which began in 1950, has been marked by repeated conflicts, transitions, and crises. Not all of these can be explained by — or blamed on — &nbsp;forces from outside. This persistent finger pointing pattern indicates structural weaknesses at home.
Long before the September GenZ uprising, many observers (including myself) had been warning that Nepal was approaching a tipping point.&nbsp;
The concern was not foreign interference, but accumulated internal fragility: weak checks and balances, cartel-like party arrangements, politicised constitutional bodies, episodic accountability, and the near absence of credible, nonpartisan civic watchdogs.&nbsp;
Together, these produced a system operating at the edge of collapse. In such systems, small triggers — a protest, a ban, a spark — can produce cascading effects far beyond their immediate cause.
Explaining this rupture mainly through foreign influence can feel reassuring, but it ultimately absolves domestic actors of responsibility. External pressures do exist, but they become decisive only when internal institutions are already hollowed out and exposed.&nbsp;
When institutions are weak and compromised, outside forces stop dealing with the state as an institution and begin negotiating directly with individual political powerbrokers. At that point, sovereignty erodes quietly — not through invasion, but through leverage.
This is why the current obsession with identifying external hands risks missing the deeper lesson. The more revealing symptom may not be foreign maneuvering, but the ease with which, for example, militant cadres, informal networks, and extra-institutional actors are able to step in and exert influence, right under our nose during this election cycle. This is just the tip of the ever fragile institutional iceberg that needs tending.
CADRE MACHINES
As some have recently noted, these 'cadre machines' are not causes of the crisis so much as indicators of a broken system — filling a vacuum left by institutional decay.
Nepal’s deeper challenge, therefore, is not denying or ignoring outside influence. It is rebuilding the internal capacity that makes such influence less consequential: credible institutions, internal party democracy, transparent rules, and steady and independent civic oversight that operates beyond election cycles. Without this foundation, every crisis will continue to invite external interpretation — and external leverage.
Several recent essays on my Nepal Unplugged newsletter may be of interest to some: why Nepal’s current crisis is better understood through internal institutional fragility than through the language of 'foreign hands'. &nbsp;&nbsp;
Alok K. Bohara, PhD, is Emeritus Professor of Economics at the University of New Mexico, and writes his newsletter <a href="https://substack.com/@nepalunplugged">Nepal Unplugged</a> as an independent observer on Nepal’s socio-economic and political landscape. &nbsp;

accham

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State of the art rural hospital

Nepal goes in and out of T20

Essays on self-realisation and self-healing

RED ALERT: Get ready for the wildfire season

Foreign hands, or homegrown failure?