<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e29c7e80680e0c031ejpeg.jpg" alt="" width="1086" height="724"/><figcaption>Charikot Hospital. Photo: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s medical industrial complex has modernised healthcare in the country, but it has also pushed treatment out of reach of most citizens.Collusion between politicians and medical magnates has made it so expensive to become a doctor that it has set off a chain reaction to make hospital treatment unaffordable.Meanwhile, government hospitals are <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/">under-funded, under-staffed and under-motivated</a>. Most medical personnel in district hospitals and health posts moonlight in private clinics, and patient treatment is substandard.Desperate families have to sell property, jewelry and other assets <a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">to afford private treatment</a>, pushing even some middle-class families below the poverty line.Read more: <a href="https://www.nepalitimes.com/banner/in-a-healthy-state/">In a healthy state</a>, Nepali TimesBut there are notable examples of government hospitals that are running well because of various models of partnership with non-profits, foundations and charities. They prove that affordable high quality healthcare is possible, and those hospitals need not be so expensive to run.There is <a href="https://archive.nepalitimes.com/news.php?id=18362#.YrQjS-xByrc">Dhulikhel Hospital</a> which has a tiny registration fee, treatment is low cost, an insurance scheme pays for most treatment, and patients are charged according to their capacity to pay. Despite being a government hospital, Dhulikhel has upheld a consistently high standard of care and treatment.United Mission to Nepal has run a hospital in Tansen for over 60 years, a community hospital in Okhaldhunga, and was till recently managing Patan Hospital, providing high quality care at low cost to patients.Other public-private partnership institutions that could be models to be replicated across Nepal include:<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e59c7e80680e0c031fjpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure><h3>Bayalpata Hospital</h3>After <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Bayalpata Hospital</a> was established in Achham 20 years ago, for many years it did not have a single doctor. Treatment was so poor that even emergency cases had to be taken on a grueling 12 hour drive down to Dhangadi.In those days HIV tagged along with the migrant workers returning from India, and there was a full-blown AIDS and TB epidemic in Achham and other district in Far Western Nepal. The mortality rate, already very high among women and children, soared.In 2009, Nepali and American medical students inspired by the community health model of <a href="https://www.nepalitimes.com/latest/paul-farmer-on-my-mind/">Paul Farmer</a> set up Nyaya Health Nepal (formerly Possible) taking over  Bayalpata under a public-private partnership with the government.Since then, Bayalpata Hospital has upgraded its facilities (left) and <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">treated nearly 1.5 million patients for free</a>, some of them for complicated caesarian and orthopedic surgeries.Read also: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P KalauneeUp to 100,000 patients from Achham and surrounding districts come to Bayalpata because they get free treatment there, and many families have saved themselves from sinking into poverty.Bayalpata also runs a network of community health centres with an Electronic Health Record (EHR) system that digitally keeps track of all patients in the catchment area. The presence of just this one hospital has improved the health parameters of surrounding districts, bringing down the maternal and child mortality rates. Achham once had the highest maternal mortality rate in Nepal, today institutional deliveries make up 90% of total deliveries, and very few women die at childbirth.“We have a simple objective: to show that providing free and high quality treatment to the most underserved area of the country is possible at a very low cost,” explains Srijana Devkota of Nyaya Health Nepal.Once <a href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">fully funded by international foundations</a> to run hospitals in Bayalpata and Charikot, NHN now provides free medical treatment in Achham for just Rs200 million a year, of which half now comes from the Sudurpaschim Province and local municipality.+977 - 4100517<a href="https://www.nyayahealthnepal.org/">https://www.nyayahealthnepal.org/</a><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222e89c7e80680e0c0320jpeg.jpg" alt="" width="750" height="401"><figcaption> </figcaption></figure><h3>Spinal Injury Rehabilitation Centre</h3>The <a href="https://www.facebook.com/SpinalNepal/">Spinal Injury Rehabilitation Centre</a> (SIRC) in Banepa is a public-private partnership  providing treatment and rehabilitation to people with spinal injuries. It was started by journalist and civil rights activist Kanak Mani Dixit after his miraculous survival and recovery in a trekking accident in 2000 along the Annapurna Circuit that damaged his spinal cord.SIRC now <a href="https://www.nepalitimes.com/here-now/injured-use-internet-to-reach-physiotherapists/">helps rehabilitate up to 100 spinally injured patients</a> a year, and the numbers are going up every year due to injuries sustained in highway accidents and falls from trees and cliffs. The facility was located in Banepa because of its proximity to highways and nearby trauma centres. The hospital has also been providing community treatment and tele-rehabilitation services for follow-ups.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">POOR HEALTH MAKES NEPALIS POORER</a>, EditorialThe hospital has medical officers, urologists, physiotherapists, occupational therapists, nursing care, prosthetics, orthotics, psychologists and consultants. Those who cannot afford to pay are still treated for free, others are charged the same rate as Bir Hospital.“Because patients often have to stay for more than five months, it may be difficult for them to afford the cost, so we charge them according to their capacity to pay,” says SIRC’s Raju Dhakal.SIRC’s annual running cost is Rs50 million, of which most comes from grants by non-profits and other fund-raising activities. The government also chips in with a budget for the physical construction and equipment as well as occasional allocations to cover budget shortfalls.infosirc@wlink.com.np, spinalnepal@gmail.com<a href="https://www.sirc.org.np/">https://www.sirc.org.np/</a><h3>Charikot Primary Health Centre</h3>The 2015 earthquake damaged <a href="https://www.nepalitimes.com/latest/unique-hospital-handover-in-dolakha/">Charikot Primary Health Centre</a> along with 98% of the medical facilities in Dolakha district. But the disaster was a blessing in disguise for the Charikot centre. It was rebuilt and upgraded to a full-scale 50-bed hospital and managed first by Médecins Sans Frontières and then by the non-profit Nyaya Health Nepal (NHN). Residents of Dolakha did not have to make expensive journeys to Kathmandu because medical treatment was available for free at Charikot.Read also: <a href="https://www.nepalitimes.com/opinion/dangers-of-privatising-health-insurance-in-nepal/">Dangers of privatising health insurance in Nepal</a>, Gaj B Gurung and Sushil KoiralaIn 2020, NHN handed over management of the hospital to Bagmati Province and Bhimeshwor Municipality which now run the facility with low cost treatment for up to 300 patients a day. The Charikot experiment has been hailed as a model for successful transfer by a private non-profit to the local government, and it has been running well despite the presence of two private hospitals in Charikot.“It has been a seamless handover from Nyaya Health to the government, and the level of care and treatment is the same,” says chief physician Binod Dangal. “We perform caesarean sections, orthopedics, telemedicine, free check-ups for the elderly, children and pregnant women, mental health counselling, and chronic illness monitoring.”+977 49 421125<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222ea9c7e80680e0c0321jpeg.jpg" alt="" width="1080" height="608"><figcaption> </figcaption></figure><h3>Sagarmatha Chaudhary Eye Hospital</h3>For the past 30 years, the <a href="http://archive.nepalitimes.com/news.php?id=10071#.YrQlROxByrc">Sagarmatha Chaudhary Eye Hospital</a> in Lahan of Siraha district has been providing the cheapest cataract surgery in the world for just Rs1,200 per operation.Thirty years ago when the hospital started, it had only 12 beds. It now treats 470,000 people every year with patients coming in from as far away as southern India and Bangladesh, and they pay the same amount as Nepalis. Just in the last three years, the eye hospital has treated 321,000 foreign nationals.“It is possible to provide the services at an affordable cost because we are a non-profit, and have an economy of scale,” explains Abhishek Roshan of Sagarmatha Chaudhary Eye Hospital.Read also: <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe hospital has <a href="http://archive.nepalitimes.com/news.php?id=10071#.YrQlROxByrc">also set up 15 eye care centres throughout the district, and takes treatment directly to the people</a> so they do not have to make the journey to Lahan. It has a separate department for paediatric services, care for newborn babies with vision problems. In 2021 alone, it performed 1,170 eye surgeries on children.Apart from providing treatment of retina, cornea, glaucoma, oculoplasty, the hospital also serves as an international research centre, collaborating with institutions like The London School of Hygiene and Tropical Medicine.The hospital subsidises its eye treatment for patients with revenue from its agribusiness ventures. A part of the hospital’s land is dedicated to fish farming, and an orchard for litchi and mangoes, as well as a bamboo grove.“Income from those ventures help us keep the cost of treatment down,” says Roshan. The hospital is also supported by Christian Blind Mission (CBM), the European Commission and Arvis.+977-33- 560080https://www.erec-p.org/sagarmathaRead more: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale

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Taking wealth out of health

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219c9c7e80680e0c02c6jpeg.jpg" alt="" width="1000" height="662"/>This year’s health budget kept the contribution to health insurance of the previous year's allocation of Rs7.5 billion. However, the plan to hand over the institutional management of health insurance programs to the private sector through the Ministry of Finance defeats the fundamental goal of the health security.This is not entirely surprising, of course, because the Health Ministry had passed a <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">narrow and poorly thought model of health security</a> for Nepal, and there were already concerns that it would eventually be handed over to the private sector and traded as a commodity.A private company can contribute to a health insurance program. But can they really contribute to national public health security, understand equity, expand <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">access to the poorest and the most marginalised</a> population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">National health insurance not as easy</a>, Sonia AwaleThe private sector has a role in contributing to achieving Universal Health Coverage by mainly serving the affluent. The poor neither can afford private health insurance nor access expensive private hospitals. Even if they are admitted to hospitals, they have to bear <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">catastrophic expenses</a> pushing them into the vicious cycle of poverty.The private insurance companies only pool the resource, they do not share the risk for those who cannot afford to pay the premium. It will be naïve to assume that such companies could be easily maneuvered to deliver services as a fair-price approach. There are around 20 registered private health insurance companies and 366 private hospitals in Nepal, and some are <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling health insurance at exorbitant premiums</a> many times higher than the current premium cap.There are six national health security indexes: prevent, detect, response, health, norms, and risk. During the pandemic, insurance companies got richer by <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling fake insurance schemes</a> while the hospital profits bulged through expensive Covid treatment. Very few hospitals treated Covid patients with a humanitarian approach. None of their technical advancements helped effectively prevent, detect, and respond to the pandemic.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219f9c7e80680e0c02c7jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The current health insurance program has identified the elderly, completely disabled, leprosy, Multi-Drug Resistant TB patients, people living with HIV, and ultra-poor as target populations to waive their premium. Though not adequate, this is an equity approach.But none of these target populations are <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">eligible for private health insurance</a>, or they will have to pay a much higher premium. It will be unwise to assume that these companies will change overnight and be equitable. They are powerful enough to influence government policy and have the power to bend them to suit their commercial interests.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">Poor health makes Nepalis poorer</a>, EditorialInstead, the government should <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">strengthen the Health Insurance Board</a> and explore ways to integrate health security with the broader social security scheme. In the short term, there are urgent but straightforward reforms like recruiting adequate and skilled human resources, strengthening the organisational systems, revising the design of service purchase strategy and equity, and gradually, having effective providers/purchasers split for better implementation.Ultimately, the program will benefit by forming a broader and more robust social security structure, co-incidentally introduced at the same time by the government. It would be able to absorb costs by pooling tax-based health care contributions and merging subsidies given to the treatment of cancer, renal failure, and other chorionic diseases under one integrated umbrella.But the current government does not appear serious about <a href="https://www.nepalitimes.com/opinion/health-insurance-must-be-an-election-agenda/">reforming health insurance</a>, and simply does not understand the fundamental principles of health security. Health insurance is not just limited to providing health care, but is a part of broader health security.Read also:  <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe idea that health security can be strengthened by passing the buck to the private sector amounts to abandoning the constitutional commitment to provide health care, not as a service but as a citizen's fundamental right. The Nepal government is a signatory to achieving the health targets of the Sustainable Development Goals.As argued by Nepali Congress leader Gagan Thapa, who is one of the pioneers who <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">pushed health insurance</a> in Nepal, they contribute to strengthening the health system, strive for healthy populations, cushion the poor and provide them access to health services. It is a vehicle for mobilising adequate health resources, enhancing health security, and ultimately achieving Universal Health Coverage.These goals cannot be met by trading the people's health as mere commodities.Gaj Gurung has a PhD in public health from Chulalongkorn University and Sushil Koirala is a public health expert. Both are based in Bangkok.Read more: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P Kalaunee

Dangers of privatising health insurance in Nepal

In 2013, while writing <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Flu,294">a weekly health column</a> in this paper, I explored the potential for <a href="https://www.cdc.gov/coronavirus/mers/index.html" target="_blank" rel="noopener">MERS </a>(Middle Eastern Respiratory Syndrome) to spread among Nepalis working with camels in the Gulf states. Despite all the dire predictions of how that coronavirus could be brought back to Nepal and spread in the population, it is still a mystery why there was no MERS outbreak here. Viruses do have their own predilections.This time, although <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">Nepal officially has had only one person diagnosed</a> with the novel coronavirus (COVID-19) who later recovered, it is utterly foolhardy to think that we may escape this pandemic. In Italy, there were only four cases in 20 February, but three days later it soared to 400 cases. That virulence is what is new about this novel coronavirus.Even if Nepal does not have a surge of cases now, there is every likelihood that we will have to deal with an outbreak next winter. In addition how COVID-19 will interact with a summer dengue outbreak like last year in Kathmandu is anyone’s guess. It is important to be prepared with preventive aspects.Read also: <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">This is a test</a>, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79239c7e80680e0646e5jpeg.jpg" alt="" width="960" height="640"/><figcaption>An Army personnel demonstrates how to wear protective gear while treating possible COVID-19 patients in Nepal. All Photos: BIKRAM RAI</figcaption></figure>Masks for the general public are more for self-assurance than anything else. People who are coughing and have symptoms should wear masks. But widespread use of masks for the general public may only deplete the limited supply of masks where they are actually needed in hospitals. The most important prevention is <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" target="_blank" rel="noopener">washing hands </a>properly with soap and water 5 to 6 times per day and avoid touching the face. Keeping a reasonable distance from one another is also important. The elderly need to be especially careful.One of the most crucially helpful decisions that the Chinese government took in December 2019 after the novel coronavirus struck Wuhan was to rapidly share the molecular structure of the virus (its genomic sequence) with the world. This made it possible for drug manufacturing companies like <a href="https://www.modernatx.com/" target="_blank" rel="noopener">Moderna</a>, a biotechnology company based in the US, to start working on a vaccine.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleThe first human trial against COVID-19 will start later on this month. This is incredibly fast because in earlier times, it would take at least six years before a vaccine was developed. Although an effective vaccine is the best defence against COVID-19, what can be done for prevention in Nepal here and now is more important.First, the good news. It is now well known that about 80% of COVID-19 victims will have mild symptoms not requiring hospital admission. Of the rest, 15% will be severe and 5% may be critical, possibly requiring ventilators in an intensive care unit. Even if only 0.5% of patients from South Asia’s population of 1.8 billion require ventilators, it is easy to imagine the tragic scale of this potential  emergency.The Wuhan data from Chinese doctors also revealed that it was the elderly (mostly male) that took the brunt of the disease and that children were not symptomatic, even though they may be infected by the virus. The findings also showed that about 1% of the patients who suffer from  COVID-19 die.This is the stark difference between COVID-19 and other causes of influenza where the death rate is only 0.1%. That is, COVID-19 kills ten times more people, and they are mostly above 60 years old. Although 1% may sound small, actual numbers will be numbing when large populations are infected.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79249c7e80680e0646e6jpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Besides vaccines, there are also drug studies going on to fight COVID-19. One such medicine is called <a href="https://www.kaletra.com/" target="_blank" rel="noopener">Kaletra</a>, commonly used for HIV patients. Many other drug trials (including the antimalarial drug cholroquin) are going on.The incubation period (the time from infection to symptoms) was also studied in Wuhan and forms the basis of the quarantine period of 14 days. The average incubation period is five days but may be up to 12 days. To be on the safe side a two-week quarantine is recommended, after which it is unlikely that the symptoms will manifest.Unlike some western countries, China, Singapore, Taiwan, and South Korea practiced widespread contact tracing to control the disease. If someone was diagnosed with COVID-19, the health professionals took a detailed history of  who their contacts (including family and friends) were, and followed up to see if they developed symptoms. Contact tracing helped stem the spread of the disease in these countries.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

What is novel about the novel coronavirus?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79289c7e80680e0646e7jpeg.jpg" alt="" width="960" height="640"/><figcaption>A quarantine zone at Nepal Army's headquarters in Tundikhel. Photo: BIKRAM RAI</figcaption></figure>By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the <a style="background-color: #ffffff; font-size: 16px; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/editorial/fear-goes-viral/" target="_blank" rel="noopener">fear of infection</a>. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.Nepal is now <a href="https://www.nepalitimes.com/opinion/global-thinking-and-local-action-on-coronavirus/" target="_blank" rel="noopener">so closely intertwined with globalisation</a> through migration, tourism and trade that its <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">already-fragile economy has been badly hit</a> even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone -- since they are lower down in the economic ladder, they have a shorter distance to fall.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, EditorialDespite Nepal’s surprisingly <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener">dramatic improvements in mother-child survival </a>over the past two decades, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">the public health system here is in crisis</a>. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.Nepalis are still afflicted by easily preventable water-borne diseases like <a href="https://archive.nepalitimes.com/news.php?id=16988#.XnMUhagzbSF" target="_blank" rel="noopener">typhoid and diarrhoea</a>, vector-borne infections like malaria, encephalitis or dengue, and illnesses like <a href="https://www.nepalitimes.com/banner/nepal-tb-cases-grossly-underestimated/" target="_blank" rel="noopener">tuberculosis </a>and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">remoter parts of Nepal</a> are still dying of simple infections.Read also: <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener">A shot in the arm for vaccines in Nepal</a>, Sonia AwaleOn top of this, urbanising Nepal now also has the added burden of <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">non-communicable afflictions</a> like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.For example, a study by the BPKIHS in Dharan showed that while the national average for <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">Type 2 diabetes </a>prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032" target="_blank" rel="noopener">ignoring risk factors and not diagnosing non-communicable diseases</a> can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener">blamed on climate change</a>. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">a possible COVID-19 outbreak</a>.Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">accessible and affordable healthcare</a> for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected <a href="http://archive.nepalitimes.com/news.php?id=19560" target="_blank" rel="noopener">medical education</a>, putting it out of reach of deserving poorer students.Read also: <a href="https://www.nepalitimes.com/editorial/when-panic-goes-viral/" target="_blank" rel="noopener">When panic goes viral</a>, EditorialInto this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.

This is a test

Nepal won the first two matches, clinching the T20 series in the UAE, making history: this is the country’s first ever win, and series win, against a Test-playing country.&nbsp; On Tuesday night, Nepal lost the last game by 10 wickets. The West Indies easily met Nepal’s 122 runs in 19.5 overs. Despite that, Nepal had beaten the two-time T20 World Champions which is currently number 6 in T20 rankings. It is important to note that the West Indies are fielding a significantly weaker and younger team than they could. Caribbean heavy hitters Nicholas Pooran, Andre Russell and Shimron Hetmyer are currently resting or playing in domestic leagues. But that does not take away from the fact that, after two narrow misses against South Africa and Bangladesh at the 2024 T20 World Cup, Nepal has now beaten a Test-Playing nation, and done so convincingly.&nbsp; Nepal won the first match of the series on 27 September by 19 runs. Batting first after winning the toss, Nepal put up 148 for 8 after losing openers Kushal Bhurtel and Aasif Sheikh early.&nbsp; Rohit Paudel’s 38 and Kushal Malla’s 30 steadied the innings, and 148 was a reasonable target to defend on the tricky Sharjah pitch. The young Windies dropped a series of catches.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251001031052_5f24273f6da2f52f6414b7ecc485938a4c726431bfa7c2ba435bded3debe9f5a.jpg" data-media-id="editor_0" data-image-id="20251001031052_5f24273f6da2f52f6414b7ecc485938a4c726431bfa7c2ba435bded3debe9f5a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Nepal defeats West Indies NT 1"> </figure>  Nepal’s fielding, in contrast, was excellent as it held the West Indies to 129 for 8. Dipendra Singh Airee and Kushal Bhurtel both had run outs, and the team held on to tricky catches throughout.&nbsp; The last ball of the match, with it already won, saw Bhurtel catch Fabian Allen off of Airee’s bowling, throw the ball in the air before stepping outside the boundary, before jumping back in to complete the catch legally.&nbsp; Head coach Stuart Law, former Australian Cricketer, was pleased with the performance. “We deserved it, we played a really good game of cricket. I thought our fielding in the first 15-17 overs was outstanding,” he said, predicting, “the West Indies will be hurt, they’re a proud nation. They’ll come out red-hot on Monday, so we got to be better than tonight.”&nbsp; Bhurtel was ecstatic at having beaten the two-time T20 World Champions. He pointed to the team’s versatility as a big strength. “We have a lot of players who can both bat and bowl. Gulsan (Jha) and Kushal Malla did not bowl at all, and Lalit (Rajbhansi) did not bowl out all of his overs.” And the team still used seven bowlers.&nbsp; If the first match was a surprise, then the second match was a shock. Nepal put up 173 for 6, with Aasif Sheikh hitting 68 not out and Sundeep Jora 63, the two putting up a hundred run fourth wicket partnership.&nbsp; They then bowled out the West Indies for a humiliating 83, with Mohammad Aadil Alam taking 4 for 24 and Kushal Bhurtel 3 for 16.&nbsp; There was more excellence in the field, with the Nepali team taking seven catches, many of them very tricky ones right on the edge of the ropes. This second win sealed the series victory, also a first for Nepali cricket. The margin of victory and the team’s overall dominance were both very obvious.&nbsp; Nepalis in the UAE showed up at the Sharjah Stadium in full support for the Rhinos, wearing jerseys, flags, and dhaka topis, raucously cheering on the team’s performance.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251001031052_217ceb7078e9c253f8db6fec57911eb8e56822e3fc20d520d39e06f475fd6d65.jpg" data-media-id="editor_1" data-image-id="20251001031052_217ceb7078e9c253f8db6fec57911eb8e56822e3fc20d520d39e06f475fd6d65" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Nepal defeats West Indies NT 1"> </figure>  Fresh on their minds must have been recent protests back home. The Cricket Association of Nepal dedicated the series to those who lost their lives. Captain Rohit Paudel also dedicated his man of the match award from the first T20 to the 74 people killed last month in Nepal.&nbsp; “Since last one month has not been that great for us, so slowly we are getting better. It is great to give a little happiness to the people of Nepal,” said Paudel.&nbsp; Leg-spinner Sandeep Lamichhane was notably absent from both matches, having excused himself from the squad for personal reasons.&nbsp; “It is what it is,” said coach Law. “we are a very competitive team and someone has to stand up in his place.”&nbsp; The wins also open the possibilities for further series, with countries such as Bangladesh, Pakistan or Zimbabwe.&nbsp; CHASING TESTS  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251001031048_70fed823c34d91dfefc078cb5786c2ea04ad70387fbf09424a5304b926cc3e3c.jpg" data-media-id="editor_2" data-image-id="20251001031048_70fed823c34d91dfefc078cb5786c2ea04ad70387fbf09424a5304b926cc3e3c" data-rendition-name="original" width="1600" height="995" loading="lazy" alt="Nepal defeats West Indies"> </figure>  In international cricket, a ‘Test-playing nation’ is a country that is authorised to play Test Matches by the central governing body, the International Cricket Council (ICC). Test Matches are the longest format of the sport, lasting up to five days, and are the most prestigious.&nbsp; Currently, this exclusive group is made up of Australia, Bangladesh, England, India, Ireland, New Zealand, Pakistan, South Africa, Sri Lanka, West Indies, Zimbabwe, and Afghanistan.&nbsp; Nepal has a ways to go. To become a Test-playing nation, it must first become a full member of the ICC. To do this, they must consistently qualify for ODI and T20 world cups over eight years, and have at least two ICC-accredited venues for hosting matches — currently only the Tribhuvan University Cricket Ground qualifies.&nbsp; Nepal must also have significant youth development infrastructure, a good domestic setup, and a recognised governing body that is financially stable and not corrupt.&nbsp; With the current development of stadiums across Nepal and innovations such as the Nepal Premier League, and performances such as these, Nepal seems firmly on the way.&nbsp;

2-1 for Nepal against The Windies

Nepal is still reeling from the short but violent GenZ moment, and the reverberations are being felt around the world.&nbsp;
As news from the killings and rampage from Nepal on 8-9 September spread through the wire services and social media, in the Philippines, East Timor and even faraway Peru, banners on the streets last week referred to ‘learning lessons from Nepal’. In Ladakh last week, <a href="https://www.aljazeera.com/news/2025/9/25/bloodiest-day-how-gen-z-protest-wave-hit-indias-ladakh-killing-four">protesters set fire to the ruling BJP party office</a> and four people were killed in police firing.&nbsp;
Nepal’s GenZ was praised by <a href="https://www.nytimes.com/2025/09/19/opinion/asia-protest-youth-nepal-bangladesh.html">international commentators</a> for rising up against chronic corruption and impunity, and for achieving the fastest regime change in history. But the youth were also blamed for the arson and vandalism even though the groups said they had no part in it — most &nbsp;foreign media also did not highlight enough the infiltration by radical groups.
“We were not expecting the protests to turn so violent and deadly. On the second day, things escalated so quickly it became difficult to keep track. We were rushing on the groud and making calls to confirm what was happening,” recalls Paavan Mathema of Agence France-Presse (AFP) in Nepal.
The GenZ protest this month was a lesson on the mechanics of social media. Hashtags like #youthagainstcorruption and #nepobaby from Indonesia inspired Nepal’s youth to take to the streets, but events here in turn triggered protests elsewhere. The international news agencies and mainstream global tv channels were not as important in this information cross-pollination.
The movement was organised online and spread quickly in no time, but it was disinformation and fake news that spread faster than facts. The over-simplification by international media was because it had to explain 30 years of political evolution in a country that they mostly ignored in the past, this sometimes tended to be misleading.&nbsp;
While the Oli government’s social media ban of 26 platforms starting 5 September poured oil on the fire that had already been lit by a disparate group of desperate youth, their outrage over decades of corruption and impunity was reaching a breaking point. There was extreme disenchantment with serial politicians recycling themselves in power.&nbsp;
“The ban on social media definitely triggered the protest, but we put a high priority on accuracy and speed during reporting in such times,” explains the Nepal correspondent for Associated Press (AP) news agency in Nepal Binaj Gurubacharya. “Our own safety also becomes a prime concern in times like these, but should not be at an expense of accuracy.”
CRISIS REPORTING
But headlines everywhere including in The New York Times, The Guardian and others that used wire service content initially highlighted the social media ban as the main reason for the protest. They were soon called out by protesters, while <a href="https://institute.aljazeera.net/en/ajr/article/3358" target="_blank">Al Jazeera</a> and its <a href="https://institute.aljazeera.net/en" target="_blank">Media Institute </a>were applauded for more nuanced coverage.
Another positive example of international media supplementing the stories by local journalists was <a href="https://www.france24.com/en/" target="_blank">France 24’</a>s detailed <a href="https://www.france24.com/en/asia-pacific/20250915-nepal-police-protests-violence-kathmandu" target="_blank">forensic analysis</a> of the security forces firing live ammunition at protesters at Parliament on 8 September.&nbsp;
What really went far and wide around the world were dramatic YouTube videos about the violence, and memes on social media. <a href="https://nepalitimes.com/here-now/the-accidental-journalist" target="_blank">A British tourist</a> who filmed street protests did the work of an on-the-ground journalist and got millions of views globally for some of <a href="https://www.youtube.com/watch?v=Slq6zWu9o9w" target="_blank">his YouTube videos</a>.&nbsp;
But some of the misinformation or fake news on social media was also picked up by the mainstream press, like the <a href="https://timesofindia.indiatimes.com/world/south-asia/nepal-violence-ex-pm-khanals-wife-dies-after-house-torched-president-urges-calm-dialogue/articleshow/123791004.cms">wrongly reported death of former Prime Minister Jhalanath Khanal’s wife</a> in an arson attack on their home. A video of the Finance Minister Bishnu Poudel being <a href="https://www.ndtv.com/world-news/video-nepal-finance-minister-chased-through-street-kicked-attacked-9243749">chased and beaten</a> by protesters also turned out to be someone else.&nbsp;
Some international outlets, mainly in India, also fell prey to a fake video that K P Oli had fled to Dubai. Even this newspaper’s online edition had to correct it after wrongly reporting it without verification.&nbsp;
Indian tv channels which did &nbsp;extensive coverage of events in Nepal, with many Nepalis relying on them and believing their content — especially during the protests when Nepal’s main channels went off air as they were being attacked.
All this got out of hand, and protesters in the week after the violence started ridiculing and harassing Indian tv correspondents as they tried to interview talking heads outside the charred Parliament building, or on the streets.
<a href="https://www.newslaundry.com/2025/09/09/foreign-hand-gen-z-data-addiction-5-ways-indian-media-missed-the-nepal-story">Indian media</a> were also the first to accuse US involvement in sparking a ‘colour revolution’ in Nepal. They later claimed that former Nepal Electricity Authority (NEA) chief and now Energy Minister Kulman Ghising and even Kathmandu Mayor Balen Shah have been appointed interim prime minister in Nepal. These were rumours in Nepal, but were reported as news.&nbsp;
“Fact checking is crucial while covering such movements, and since we are telling an important story about Nepal to the world, double checking becomes important as it sets the international narrative,” says Mathema.
“We were constantly double checking numbers and information with concerned authorities and parties to make sure we were accurate, especially as misinformation was rampant,” she adds.
Apart from Indian media, international news agencies got reinforcements of reporters, photojournalists and editors from the region, and other foreign correspondents also flew in when Kathmandu airport was opened after 48 hours.
Adds Mathema: “Sometimes foreign reporters can give a fresh perspective or an angle which we could not see or cover. So their inputs are always helpful.”
In the aftermath of the violence, there were plenty of jokes and memes, clips of protesters dancing, in weird poses and performing martial arts, showcasing the light hearted side of the protests while also <a href="https://nepalitimes.com/here-now/nepal-s-meme-revolution">reaffirming the resilience</a> of people able to bounce back from something so traumatic.
The GenZ clean-up campaigns, neighbourhoods helping restore burnt out police stations and local people’s emotional reaction to the burnt out hulks of government buildings at the city centre also <a href="https://www.scmp.com/week-asia/people/article/3325635/nepals-gen-z-protesters-lead-clean-campaign-after-violent-clashes">made news</a>.
“After the protests, people were quick to gather and clean up public spaces and paint police stations. This is a scene which may not be so common in other countries with similar violence,” adds Gurubacharya. “So it became an important story to also tell the world.”&nbsp;
In less than two days, the world saw a dramatic toppling of a democratic government. With the interim government led by former chief justice Sushila Karki, there is much hope. She has expanded her ministerial cabinet, and the election has been announced for 5 March 2026 but between then and now, a lot remains uncertain.&nbsp;
And Nepal will continue to be watched by national and international media alike until then and after. AP’s Gurubacharya sums it up: “For now, we are taking it one day at a time.”

International spotlight on Nepal

From the echo chambers of social media to neighborhood tea shops, the hot topic two weeks after the GenZ revolt toppled Nepal’s government is whether the country should now have a directly elected prime minister. Although this has been proposed before as a way to end the instability in heads of government chosen by the biggest party or coalition in Parliament, it has found supporters and critics in the aftermath of the protests. As democratic as it sounds, a directly elected executive is not that simple.&nbsp; Nepal’s 2015 Constitution does not allow it, but for a young generation impatient for change, this demand raises critical social, political and constitutional questions. Nepal has seen a multiplicity of systems in the past 45 years: from a partyless absolute monarchy to a constitutional one, a parliamentary democracy and then a federal republic. But they have repeatedly failed to bring stability, good governance or an end to corruption in Nepal. But even though lately they have ensured civil liberties, the public was losing hope for the future, especially the young who could air and amplify their outrage on social media. Unbridled corruption and ideologically mismatched fragile coalitions acting with impunity, led many to conclude that a directly elected prime minister would ensure stability and accountability. ‘We have repeatedly trusted the same political parties, but they have repeatedly broken that trust, so it is no longer possible to trust that system anymore,’ says Miraj Dhungana, popular for the TikTok videos asking young people to go out into the streets to rally against corruption, and seen by many as the ‘original’ representative of Gen Z.&nbsp; In interviews he has stated that it has become necessary for Nepal to have a directly elected executive head through constitutional amendment. Dhungana himself did not participate in the protests after his meeting with pro-monarchist businessman Durga Prasai on 7 September sparked controversy that he as a lackey. Binod Deuba Thakuri of the Nepal Student Union who also participated in the GenZ protests thinks Nepal is institutionally not ready for directly elected prime minister: “Our democracy is not mature yet, our institutions are not strong, and we are vulnerable to social media induced populism.”&nbsp; CONSTITUTION AMENDMENT Amending the Constitution would also open a pandora’s box, with other demands, and should be left to the next legislative body, he adds. In her address to the nation on Friday, Prime Minister Sushila Karki who is a former chief justice also clarified that her interim government does not have the mandate to amend the Constitution to make way for a directly elected head of government, and it should be up to the new legislature and government after the 5 March election.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250919130956_799b2d43dccca73b3bff96e435efc0752203117b2cb219d0073994c0e6f2ee25.jpg" data-media-id="editor_0" data-image-id="20250919130956_799b2d43dccca73b3bff96e435efc0752203117b2cb219d0073994c0e6f2ee25" data-rendition-name="original" width="4160" height="2774" loading="lazy" alt="Constitution Day NT"> <figcaption>Constitution Day address by Prime Minister Sushila Karki on 19th September earlier this month.</figcaption> </figure>  The demand for a directly elected executive head was first raised by Maoist leader Pushpa Kamal Dahal after the 2006 ceasefire. He proposed himself as Nepal’s first executive president ahead of the 2008 Constituent Assembly elections. While the UML did not strongly oppose the idea, the Nepali Congress (NC) stuck to a parliamentary framework. The 2015 Constitution ultimately clinched it for the current parliamentary system. The Constitution stipulates that the process of selecting a prime minister is based on parliamentary strength: the President appoints the leader of the party with a majority in the House of Representatives, or, in the absence of such a majority, a member who can demonstrate majority support. If these efforts fail, provisions exist for coalition or minority governments, and ultimately for the dissolution of the House and fresh elections. The Constitution currently makes no provision for a directly elected prime minister, which means that any attempt to introduce a directly elected executive would first require the careful design of a democratic mechanism to amend the Constitution and set out the procedures for such an election.&nbsp; “There is no legal legitimacy to have the directly elected executive head of the country in the March election, except if political legitimacy surpasses legality but that would mean a new constitution,” explains senior advocate Surendra Kumar Mahato. “Many other institutional arrangements like the appointment of the judiciary, the role of the president, and other check and balance mechanisms would need to be restructured.” Mahato says: “Nepal’s Constitution itself is not at fault — it is the political actors, who have failed to uphold good governance within its framework. Changing systems does not ensure better governance.”&nbsp; Changing the Constitution also needs a broad political consensus, the institutional capacity of the state must be carefully considered to ensure such a new system can function effectively in practice and not simply in theory. Empowering an executive head through direct elections should not come at the expense of accountability or parliamentary oversight, and there should be checks and balances in place. LESSONS FROM ABROAD Sri Lanka’s 2022 Agralaya was fuelled by the anger that the directly executive head turned out to be an authoritarian who backslides on democracy. Under Sri Lanka’s 1978 Constitution, the country adopted a directly elected executive presidency with sweeping powers over the cabinet, appointments, dismissal of parliament, and control over key institutions.&nbsp; Over the years, President Mahinda Rajapaksa removed term limits via the 18th Amendment in 2010, centralised appointment powers, including judges and heads of independent commissions, and used constitutional changes such as the 20th Amendment (2020) to reverse safeguards that limited presidential authority, thereby subordinating the legislature, weakening oversight, and enabling authoritarian control.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250914060932_a96e1046d0b148982b33f2dcbe56f349dc0c20a087e358360eb2dddcfe0b5072.jpg" data-media-id="editor_1" data-image-id="20250914060932_a96e1046d0b148982b33f2dcbe56f349dc0c20a087e358360eb2dddcfe0b5072" data-rendition-name="original" width="4640" height="2610" loading="lazy" alt="GenZ and Aragalaya"> <figcaption>Anti-government protest in Sri Lanka on 13 April 2022 in front of the Presidential Secretariat. Photo: WIKIPEDIA</figcaption> </figure>  Nepal’s multiparty framework upholds an institutional balance where both the governing party and the opposition have defined roles. This parliamentary setup prevents power from being overly concentrated in one individual and ensures accountability through parliament and competing parties. Beyond the neighbourhood, the United States has a directly elected executive system. Donald Trump exemplifies how direct electoral mandate can fracture institutional check mechanisms. He has leveraged his power to attack judges, frame political opponents, turn legal defeats into rallying points for his supporters, often using pliant media platforms to reinforce the idea that institutional checks impeded the popular will. In Nepal, there is a risk that a directly elected prime minister could bring up a populist media savvy messiah who could use public grievances to get to power and consolidate it. Social media can be mobilised and easily saturated with posts to fuel a political narrative of choice.&nbsp; In the past, former prime minister K P Oli’s ‘digital army’ has been lobbied on his behalf on social media. Even without an ‘IT sena’, it is not unusual for governments to collaborate with social media platforms as seen in the US and India.&nbsp; In Nepal, a directly elected prime minister would raise the stakes, turning the battle for votes into a battle for attention online, where a leader who wins the algorithm also wins the elections, just as Kathmandu Mayor Balen Shah demonstrated in 2022 with support from groups like MRR and RONB. The Balen Phenomenon started in social media trickled to the ballot box.&nbsp; The digital space mas ensure that it is not trendy to dislike Balen. Comments that are critical of the Kathmandu Metropolitan City’s treatment of street vendors or of the mayor himself are met with backlash from supporters. Or, if the comments did not get any likes, the algorithms filtered them out as ‘not relevant’.&nbsp; The conversation of Shah often centred on his emotive responses and sentiments, generating strong engagement online. Meanwhile, policy debates received comparatively less attention.&nbsp; “Choosing a leader directly through an election means that we are vulnerable to populism and undermining of the democratic process, accountable institutions,” says Thaukri. Political activist Pradip Gyawali admits that the GenZ revolt was an example of how social media is a powerful tool to organise and disseminate information. But there are risks posed by disinformation and fake news online.&nbsp; “More media and political literacy among the people before the election in March is crucial to control the damage social media could do to influence voter behaviour,” he says.&nbsp; Beyond social media, online news increasingly relies on sensational, click-driven headlines to attract readers in a competitive digital market. A recent survey showed that 82.6% of GenZ (16- 24) rely on Facebook for news and 51.4% on YouTube.&nbsp; Nepali people with higher education seemed to engage with news more (99.1%) than illiterate individuals at 52.1%. Byte-sized headline-only journalism is leaving readers to their own devices, and vulnerable to media infiltration by IT cells.&nbsp; With social media actively shaping the course of elections, and news consumption, debates about changing the Constitution or the system of governance yet again may not ensure the demands for corruption free governance is met. Instead, strengthening media and political literacy among voters is key to prepare for the elections in March. Ayusha Chalise is a communication and development scholar specialising in how politics is experienced in the digital space.

Nepal's democracy keeps doubting itself

The word for ‘development’ in Nepali is bikas. The world for destruction is binas. &nbsp; The two words not only rhyme, but replacing just one consonant gives it an opposite meaning. It also demonstrates how easily what we think is <a href="https://nepalitimes.com/editorial/development-destruction-yt3t1yhu">‘Development’ can be destructive</a>.&nbsp; University libraries in Nepal and around the world are stacked with hundreds of books dissecting ‘development’. They can be divided broadly into at least two types: some authors define development as a moral imperative to improve living standards of people in the underserved parts of the world, mostly in the Global South.&nbsp; Others critique development either as being an ‘industry’, or as a continuation of the western colonial project that imposes dependency and corruption, perpetuates the donor-recipient hierarchy, and ends up disempowering intended beneficiaries. Somewhere in between are books by experts who have tried to find a middle path with concepts like ‘sustainable human development’, ‘people’s participation’ or ‘public-private partnership’. But even the staunchest proponents of traditional development models will admit that all is not well, somewhere along the line we lost our way. Peter Sutoris and Uma Pradhan have dared to take the bull by the horns to find a new path to ‘reimagine’ development, and explore new templates to confront a world wracked by interconnected crises of conflict, inequality, environmental decay and climate breakdown. Their book Reimagining Development: Bold Directions Towards a Thriving World lays out a roadmap for countries like Nepal as they try to fix what went wrong. Billions of dollars were poured into Nepal’s ‘development’ over the past seven decades, but the country is littered with the carcasses of failures like the rusted abandoned tractors from the Rapti Valley Development Project 65 years ago. To be sure, there have been catalytic success stories along the way. It is not a coincidence that whatever has worked well in Nepal since 1990 has the word ‘community’ in it — things fall into place when local groups are given ownership to decide what they need, and allowed to decide what they need to do.&nbsp; Some examples in the book include <a href="https://nepalitimes.com/banner/reviving-nepals-community-forestry-success-story">Nepal’s community forestry project</a>, which Sutoris and Pradhan cite as an example of the kind of possibilities needed to reimagine development for a ‘thriving world’. Local communities were handed control to manage their natural resources, revive traditional conservation practices, and assert command over their own destiny. Nepal’s community forestry program together with the Local Self Governance Act that decentralised power to elected local bodies in the 1990s was the best example of how development can be a political act to ensure an equitable future, while conserving nature. Sutoris and Pradhan write: ‘Substantial evidence from Nepal indicates that community forestry enhances forest protection and regeneration … Village Development Committees that had adopted community forestry recorded a 77% increase in forested area, compared to a 13% increase in the villages without community forest.’&nbsp; Peter Sutoris was born in the former Czechoslovakia that saw the 1968 Prague Spring uprising and the Velvet Revolution of 1989. Uma Pradhan is from Nepal, which has witnessed successive People’s Movements in 1980, 1990, 2006 and earlier this month in 2025. &nbsp; ‘It was perhaps because of these experiences of witnessing the remaking of the world in the wake of the end of the Cold War that we come to this book with a strong belief that even the most rigid collective trajectories can and do change,’ the authors write in their introduction. Their book has three parts. The first one dissects the Development Industry and the model of perpetual ‘growth’. (Interestingly, the word ‘growth’ is used in medicine to signify malignancy.) The authors propose re-centering the stories of beneficiaries and their lived experiences which have been pushed to the margins in ‘project’ design of mainstream Development with a capital ‘D’. &nbsp; The book defines development with a lowercase ‘d’ as a more democratic bottom-up approach. Capital ‘D’ Development on the other hand involves ‘developers’ wanting to ‘develop’ societies, replicating the wasteful, unsustainable growth path of the industrialised countries. &nbsp; The book’s second section examines the tension between sweeping international concepts of development, and how it is not quite relevant to the reality of rural areas of countries like Nepal. The prevailing notion that development ‘aid’ flows mostly from cash rich countries to cash poor ones ignores the fact that it mostly takes from the poor in rich countries to give to the rich in poor countries. After all, the Global South also includes the underserved parts of the Global North.&nbsp; RETHINKING PROGRESS The Development Industry does ‘develop’ certain segments of the economy, just not so much the sections it is supposed to uplift. The <a href="https://nepalitimes.com/here-now/usnoaid">cancellation of USAID</a> this year vacated hundreds of rented offices and houses in Kathmandu, consultants and contractors became jobless, and even Nepal’s domestic airlines lost business.&nbsp; The third part of this book imagines what ‘A Thriving World’ can look like if we listened more to indigenous communities and their knowledge of the stewardship of nature, adopted best practices about inclusive and decentralised decision-making, and explores examples of ‘degrowth’ and ‘postgrowth’ to address unsustainable consumerist, extractivist economics, and the climate crisis. Sutoris and Pradhan admit that these concepts are not new. Practitioners have questioned the top-down model for decades, but their book Reimagining Development takes a fresh, non-conventional approach to bridging the best of the ‘old’ development discourse with a ‘new’ imagining that transcends entrenched positions. The authors cite Buddhist mindfulness techniques, the concept of ‘radical humility’ and the idea of deep time to zoom out for a fresh perspective on a novel development paradigm to ‘think about humanity’s position in the world’. ‘Ultimately, this book is likely to disappoint both the proponents and critics of development,’ the authors admit. ‘The proponents might view the arguments we put forward as too esoteric and not attuned to what can realistically be achieved. The critics might be dismayed by our &nbsp;unwillingness to dispose of the concept of development altogether and by our attempts to give credit to the Development establishment where credit is due. Our aim, however, is not to please either camp.’ The authors do not want to throw the baby out with the bathwater. However, the obsolete way of forcing soft states to adopt the path of linear modernisation and infinite growth so they can ‘graduate’ to a higher per capita income bracket must be rethought. Alternative models are available to confront the momentous crises facing people and the planet.&nbsp; Nepal’s <a href="https://nepalitimes.com/here-now/nepal-s-historic-youth-dissensus">GenZ protesters this month rose up</a> against corruption and bad governance. But underlying it was a failure of the development path that the country has chosen, which contributed to wanton destruction of ecosystems, the unequal allocation of &nbsp;benefits, and corruption that ensured both over- and under-development.&nbsp; Nepal’s young idealists may not have been able to articulate it in the language of academic discourse, but on social media platforms they have discussed a post-development era to reexamine and reimagine development, accountability, embedded ethnocentric hegemony, and an in-built structural inequality in the system.&nbsp; These lines from Sutoris and Pradhan’s book could almost be word-for-word from the GenZ manifesto: ‘Development encompasses not only financial prosperity but social justice, environmental sustainability, and the more plural development pathways that respect the world’s diverse cultural, historical, political, and social contexts.’&nbsp; Indeed, instant global connectivity through social media platforms has meant that socio-political movements elsewhere in the world impacted on young Nepalis, just as the events in Nepal this month are now influencing youth globally.&nbsp; These lines from Reimagining Development were written before the September Uprising in Nepal, but were a warning of things to come: ‘The current moment feels different. Perhaps due to the global nature of many of the contemporary movements facilitated by social networks, perhaps due to the movements’ sheer scale, or perhaps as a result of the multitude of challenges faced by the world, the feeling in the air seems to be that accumulated critiques of Development are more pressing than ever. If development is to remain a historical moment, it must reinvent itself and finally listen to the voices from below.’ &nbsp; Kunda Dixit is the author of Dateline Earth: Journalism As If the Planet Mattered, and publisher of Nepali Times.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025092704094_b795907f8fa9a5ec67508e683e7a65737c6c237ca5482425bcbe5ee6254bb3f0.jpg" data-media-id="editor_4" data-image-id="2025092704094_b795907f8fa9a5ec67508e683e7a65737c6c237ca5482425bcbe5ee6254bb3f0" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Development book details"> </figure>

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