<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107161116/6369215c9c7e80680e03a0c9jpeg.jpg" alt="" width="1500" height="1046"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Imagine a large warehouse at Biratnagar airport that flies out on cargo planes tons of <a href="https://www.nepalitimes.com/here-now/chiampagne/" target="_blank" rel="noopener">high value tea</a>, <a href="https://nepalitimes.atavist.com/the-kingdom-of-cardamom" target="_blank" rel="noopener">cardamom</a>, nettle fibre products, rice, lentils and expensive aromatic oils and herbs to Bhutan, Bangladesh, Burma and Thailand. Imagine a train station at Mechi Nagar bringing tourists on their way to Tibet and Kathmandu on holiday.The <a href="https://www.nepalitimes.com/banner/bimstec-facelift/" target="_blank" rel="noopener">BIMSTEC Summit</a> last week in Kathmandu got a lot of flak. People complained that it was inappopriate to talk about regional connectivity when Kathmandu’s own roads were in ruins. Yet, the sub-regional grouping’s emphasis on connecting South Asia with Southeast Asia has a lot of potential.The distance between member countries is only in the mind. And even within Nepal it will be Province 1 that can be the gateway to future trade and multi- dimensional cooperation in roads and energy.What dampens this enthusiasm is the language of <a href="https://www.nepalitimes.com/editorial/sorry-state/" target="_blank" rel="noopener">BIMSTEC</a> bureaucrats that are not really actionable but just meant to keep politicians talking, the administration and security agencies baffled, the expensive venues occupied, and in the end nothing tangible ever comes out for the people who were stuck in long traffic jams and had to endure humiliation in the name of VIP security. The document is written by people who have no intention of doing anything, and is signed by Heads of Government whose political lifespan is so ephemeral that they just want to maintain the status quo.This lethal combination keeps our part of the world from growing economically. Let us take the three points in the Kathmandu declaration that talk about establishing the BIMSTEC development fund, the point about continuing to talk about creating a BIMSTEC free trade zone, and ending poverty by 2030.Could not the language in the resolution read: ‘We will create a BIMSTEC free trade zone across the member countries within one year, increasing the volume of trade by X% per year and; Y% of this will go to set up a development fund contributing to ending poverty.’ As the Beatles song goes, ‘You may think I am a dreamer, but I am not the only one…’In the true spirit of <a href="https://archive.nepalitimes.com/regular-columns/Analysis/how-decentralised-is-federalism,776" target="_blank" rel="noopener">devolution and federalism</a>, Province 1 could start working with Bhutan, Bangladesh, the states of Sikkim, West Bengal and Bihar of India to create a free trade zone in food, tourism and energy, without waiting for the central governments. The Chief Minister of Province 1, which is closest to the Bay of Bengal, could take the lead on behalf of Nepal and maybe even host the next <a href="https://archive.nepalitimes.com/article/nation/connecting-Bangladesh-China-India-Nepal,2966" target="_blank" rel="noopener">BIMSTEC</a> meeting there in three years to report back.In a part of the world where a country’s currency used by more than a billion people can be banned a few minutes before midnight, do not tell us we cannot start trading, allocating a percent of the revenue to a development fund and end poverty.Such actionable declarations could also make them much shorter. Could someone also tell us how much the Kathmandu meeting cost? <a href="https://www.nepalitimes.com/opinion/hugging-hogs/" target="_blank" rel="noopener">How much did the fencing around Tin Kune cost?</a> The people of BIMSTEC countries are not impressed by the number of expensive cars that are needed to take politicians from the airport to their hotels and their grand banquets.Why do they need helicopters in the sky to escort motorcades, when the guest could have been in the helicopter. Why do our politicians need a car and security to travel from their suites to meeting venues only 50m away?Nepal desperately needs access to the larger market that BIMSTEC has to offer. Aid will dry up sooner or later, free trade is more tangible and sustainable. It can raise productivity, quality and competitiveness will be the big variables. Industry, businesses and farmers will all have to roll up their sleeves. There could be real opportunity here.Anil Chitrakar is President of Siddharthinc

Anil Chitrakar

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Actionable Summits

A day after Rabi Lamichhane and Balen Shah <a href="https://nepalitimes.com/news/old-vs-new-in-nepal-in-2026-z6l4fgrd">came together to form an electoral alliance</a>, Kulman Ghising has also joined forces with the two leaders, merging his Ujyalo Nepal Party with the RSP.&nbsp; Following last-minute negotiations before Monday’s midnight deadline for parties to file their list of candidates for the Proportional Representation (PR) seats, Lamichhane and Ujyalo Nepal chair Anup Kumar Upadhyay signed a seven-point agreement to unify the two parties, with Balen Shah as witness.&nbsp; Per the deal, Ghising will be the vice-chair of the RSP, joining DP Aryal and Swarnim Wagle as the party’s seconds-in-command. The earlier agreement between Lamichhane and Shah retained Lamichhane as RSP chief, and promised Shah prime ministership if the party wins a majority in Parliament in March.&nbsp; Ghising’s team reportedly has a 17% share on the list of PR candidates filed by the RSP at the Election Commission. Balen has also fielded his own picks, and together the party has the likes of cricketer Gyandenra Malla, actress Reema Biswokarma, rights activist Mohna Ansari, climate activist Tashi Lhazom, and singer Prakash Saput as PR candidates. Ghising had held multiple rounds of talks with the RSP chair and the Kathmandu Mayor to discuss possible collaborations, but had failed to reach a power-sharing agreement. On Monday, Ghising had met with Lamichhane heeding a last-ditch effort from GenZ leaders, in particular Sudan Gurung, as they tried for the final time to get the interim Minister on board with Lamichhane and Shah before the PR list submission deadline.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7.jpg" data-media-id="editor_1" data-image-id="2025123004128_99e23ae7b6a042e71d271e3e74f7527086a7bb55779e6781bc9e7b711c8303e7" data-rendition-name="original" width="1595" height="1087" loading="lazy" alt="Sudan Kulman Balen"> <figcaption>Photo: SUDAN GURUNG / FACEBOOK</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7.jpg" data-media-id="editor_2" data-image-id="2025123004128_d9f530704ab4c6e27eebf51f8e9fb55fed1d4281c99d089d06455cc7448bfda7" data-rendition-name="original" width="1026" height="1084" loading="lazy" alt="Balen and Sudan NT"> <figcaption>Photo: BALEN SHAH / FACEBOOK</figcaption> </figure>  The three are now set to make a formidable team to challenge mainstream parties at the polls. News of this alliance has been welcome to Nepalis who are looking for any alternatives to break the stronghold of the Oli-Deuba-Dahal trio over Nepali politics in recent history.&nbsp; But they will also carry each other’s baggage.&nbsp; Lamichhane, who was jailed for defrauding cooperatives depositors last year, was welcomed back as RSP party chair with open arms after he was released on bail last week. And while he has maintained his base of loyal supporters, he was subject to widespread criticism after he walked out of detention amid the jailbreak during the September protests, prompting his eventual voluntary return to prison.&nbsp; His party’s silencing and expulsion of critics within the RSP has also drawn direct comparison with the leadership structure of Nepal’s mainstream parties. Prominent leaders like Sumana Shrestha have left the party over disagreements with leadership.&nbsp; Meanwhile, Balen’s impassioned campaign resonated with Nepalis disillusioned with establishment leaders during the 2022 election and made him mayor of Kathmandu. The mayor’s direct, no-holds-barred style of communication and commentary has attained him much support beyond his constituency.&nbsp; But his unyielding, often unempathetic leadership style and policies— like his dismissal of street vendors and informal businesses during his drive to free up Kathmandu’s footpaths— have also earned him detractors. His recent outburst on social media in November that included expletives against both of Nepal’s neighbours and the US, as well as Nepal’s three main parties and the RSP was also widely criticised.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2.jpg" data-media-id="editor_3" data-image-id="20251230041212_fc2088daf32bac93541ebf25ca07725d75a721ae83440749ac8fa09d8fe308f2" data-rendition-name="original" width="890" height="1255" loading="lazy" alt="Agreement NT"> <figcaption>The seven-point agreement between RSP and Ujyalo Nepal Party.</figcaption> </figure>  Ghising, credited with ending Nepal’s prolonged load-shedding during his tenure as the chief of Nepal Electricity Authority, has a reputation of getting the job done. His public goodwill earned him a seat on Prime Minister Sushila Karki’s interim Cabinet following the youth protest.&nbsp; But he has also been under scrutiny for funds misappropriation as well as controversial power purchase agreements during his tenure as NEA chief. Ghising had foregone the leadership position at his Ujyalo party, preferring to play the role of patron until closer to the election date, but was nonetheless criticised for his political and electoral aspirations while being a member of the transitional government. It now remains to be seen if and when Ghising will step away from his position in the interim Cabinet and begin campaigning with his new partners.&nbsp; As it stands, the involvement of prominent GenZ figures in bringing together Ghising, Shah, and Lamichhane has established youth leaders as major players in Nepal’s post-September political landscape. These leaders will have significant pull with young and first-time voters. But not all young leaders are impressed with this new triumvirate. Some have pointed out that the unity between these three leaders is no different from the political opportunism and quid-pro-quo power-sharing culture established and followed by Nepal’s mainstream leadership for the last three decades which culminated into the GenZ movement of September.

Kulman follows Balen to RSP

Koreana Coffee Guff begins with a scene where Narayan Wagle, the editor-turned-farmer, appears in reverse cameo, as a character in a novel. He has just landed at Incheon in the dead of winter.&nbsp; The opening premise reminds one of Tolstoy’s saying about how stories begin either when someone goes on a journey, or when a stranger comes to town. ‘The winds of each city are its original inheritance, shaped by its local language, its specific topography and the buffets of the airborne wings of birds and airplanes,’ Wagle writes.&nbsp; The author is both on a journey and a stranger to the town. The word ‘stranger’ might need to be redefined here, as he has visited Korea several times before. But if every journey is new, then he is a stranger of sorts — stranger to the people he meets for the first time in the book, stranger to the reader who will encounter him for the first time like I did in high school reading the English translation of his 2005 Madan Puraskar winning novel Palpasa Cafe.&nbsp; Koreana is non-fiction, and was first published in 2017 in Nepali, and recently rendered into English by Prawin Adhikari, who specialises in translating Nepali works into English in such a way that they do not read like translations at all.&nbsp; Even so, I turned to a few chapters from the original text, curious to see how ideas have morphed. Take Wagle’s journey to Ansan Mountain. It is the same mountain, but something different happens in the two languages. The inexplicable feeling is that the translation has to conquer the mountain itself. At its best, the book gives the reader a peek into Wagle’s mind, his internal monologues, his writing ideas, his thoughts on the people around him, his deep yearning and respect for nature, his exploration of Seoul and Korea, where he is attending the Asian Literary Creative Writing Workshop in 2017.&nbsp; BACK TO THE LAND ‘All cities appear the same everywhere,’ he writes of Seoul, speaking of how ‘development’ has masked the original charm of a city rebuilt after war. In recent years, Wagle has moved on from being the editor of Kantipur, to activism, and has now returned to his ancestral land in Tanahu to farm.&nbsp; Clues to this metamorphosis can be detected in this book, which was written nearly ten years ago and before his transition. Wagle used to write a column called Coffee Guff, and the book carries that conversational style.&nbsp; But not all monologues land. Thoughts rooted in a specific time and space like the hike to Ansan where the author reflects on buildings, birds, and trees feel connected with a context and background. Then there are those that bring in a new metaphor, a new reflection, a new connection in almost each new sentence which make it difficult to follow the author’s stream of consciousness.&nbsp; Halfway into the book, we finally meet the writers who have come from different parts of Asia for the workshop. Not speaking a common language, the writers have to rely on interpreters and Google, which turns their exchanges into quirky moments of laughter.&nbsp; Writers are an important part of the book, the lens through which Wagle invites us to see the world. Poets Manjul from Nepal and Shiva Ryu from Korea make guest appearances. Through two Korean writers who share the surname Kim, we get a glimpse into Korean history and society, and how writing is intertwined with politics.&nbsp; This Korea is different from the Kpop idols and skincare routine that has dominated recent imagination of the divided peninsular nation. Wagle writes, ‘Literature attempts to unite, politics impedes it. They are being continuously thwarted by the conflicts ongoing in the nation’s politics.’&nbsp; One of the Kims is Kim Min-jung (김민정), author of The World’s Most Expensive Novel, that explores what it means to be a writer in Korea.&nbsp; Reading Koreana feels like a hike through a jungle. If one is able to move past the tangled and stretched monologues, the book can hold moments of awe and wonder. But there is always a desire for a clearer trail to follow. &nbsp;&nbsp; Narayan Wagle’s characteristic witticism is there aplenty, his observations are astute. Writers exploring their craft and readers curious of what is churning inside Wagle’s mind will find treats -- sometimes well-crafted, other times to be searched between the lines. &nbsp; Alfa M Shakya is a writer, researcher, and podcaster. She runs and hosts ‘How’d You Create That?’, an art podcast about the creative process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5.jpg" data-media-id="editor_0" data-image-id="20251230071252_5503c9fb08d62adb328d8f817b353604429559d3d9c6542edf3663c3f8c554e5" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Korean coffee guff English translation review"> </figure>

Coffee guff from Korea

From stone spouts to cast-iron mains, Nepal’s water system and its struggle to provide safe water tells a larger story of power, disease, dependency — and lessons for the future. From 1823 to 1891, the Nepali state made just two notable interventions in Kathmandu’s drinking water system. The first was when Prime Minister Bhimsen Thapa commissioned a stone pout (hiti) to tap groundwater within the valley’s traditional supply system. The second came nearly 70 years later with Nepal’s first industrial-era water system, the Bir Water Works in 1891 under Prime Minister Bir Shumsher Rana. Linking these two milestones was the spectre of cholera. From the 19th century on there were seven global cholera pandemics. <a href="https://www.sciencedirect.com/science/article/pii/S0264410X19309995#bb0325" target="_blank">Originating in Asia</a>, the disease reached Europe and the Americas, the Vibrio cholera bacillus breeding in poor sanitation wherever it found it. The first wave erupted in 1817, followed by others in 1829, 1852, 1863, 1881, 1889 and, finally, in 1961, the seventh pandemic which still lingers on. London, the epicentre of the Industrial Revolution, was repeatedly stricken. In Britain ‘miasma’ foul air was blamed. &nbsp;In Nepal, cholera was seen as divine damnation. By the late 19th century, as Nepal’s relationship with Britain deepened, the Bir Water Works was inaugurated in 1891 as a defence against cholera. Whether cholera also shaped Bhimsen Thapa’s decision in 1823 is less clear. Contemporary records note the commissioning of Sundhara, but do not refer to the cholera epidemic raging at the time. The silence itself is telling: Nepal’s elites were ruling in the shadow of the disease. Bhimsen Thapa first resided in Thapathali Palace, which was built in 1802 by Nain Singh Thapa, father of Mathabarsingh Thapa, who would briefly become prime minister in the 1840s. In 1806, Bhimsen Thapa moved to Bagh Durbar, a new complex on the western edge of Tundikhel. Historians are vague about the water supply in the residences of the nobility, but wells and water hauled from rivers, ponds, canals, and other sources were likely the primary sources. A small hiti north of Bagh Durbar, near today’s Sun Dhara, may have supplied the palace. In 1823, Bhimsen Thapa had it enlarged, making it the last and largest state-built hiti in Kathmandu. Even as Bhimsen Thapa was involved in palace intrigues and border conflicts, Britain was engineering pipelines. By the late 18th century, Sir Thomas Simpson had invented the bell-and-spigot joint, making long-distance pipes viable. Fluid dynamics, dealing with pumps, pipes, and filters, was becoming a foundational discipline. In Kathmandu, the scourge continued. Cholera struck Kathmandu repeatedly, in 1862, 1867, 1872, 1874 and 1875. The 1872 epidemic, <a href="https://nepalitimes.com/news/kathmandu-in-the-time-of-cholera" target="_blank">according to historian Tom Robertson</a>, claimed between 200 and 250 lives a day. On average, cholera killed between 1,200 and 1,500 people annually in Kathmandu Valley, an enormous toll for its small population. The summer of 1885 was especially calamitous: a cholera epidemic ravaged Kathmandu and its periphery from the beginning of June until late August. The disease even breached the royal palace, reportedly killing 23 people, mostly young girls. Records show that 909 people received treatment at the British Residency dispensary, and estimates suggest that as many as 10,000 people perished in a city of 50,000. In November that year, Bir Shumsher seized power in a coup. He inherited not only a premiership but a Valley ridden with disease. Cholera was endemic, and it was accompanied by typhoid, smallpox, goitre, syphilis, and chronic dyspepsia. The The British Residency dispensary at Lainchaur was inadequate. “In a poor country like ours, wealth means health,” Bir Shumsher remarked, an unusually pragmatic admission that epidemics were not divine punishment but structural afflictions of urban life. He soon pledged to expand health care. In 1889, he opened Bir Hospital and staffed it with Indian doctors to treat cholera, typhoid, smallpox, and other prevalent illnesses. PIPED WATER Bir Shumsher also recognised the need for safe drinking water. Between 1866 and 1872, he had served as Nepal’s ambassador in Calcutta, and he must have seen water mains already in operation there, and a filtration plant inaugurated in 1870. Madras had installed such a system as early as 1800, Bombay constructed the Vihar and Tulsi reservoirs in the mid-19th century. In Kathmandu British Residency personalities such as George Gimlette must have urged Bir’s government to quicken the construction of the hospital and water system, yet the archival traces of such exchanges still await historical scrutiny. By the late 19th century, the British had developed a technological ecosystem for water supply, intakes, pipes, fittings, reservoirs, and trained engineers. Bir Shumsher appealed to the British Government in India for engineering assistance. A British engineer named Mr Feigneur surveyed Kathmandu to prepare maps, and estimated the volume of water that could be brought from the Rudramati River. In 1889, a more experienced engineer, Lockhart Matthew Sinclair arrived. He was a Scotsman educated at Wellington College and the Royal Indian Engineering College, with prior experience in constructing waterworks in Jubbulpore and the Viceregal Palace in Shimla. Appointed State Engineer of Nepal (1889–1892), Sinclair reviewed Feigneur’s plans, updated them, and chose the Bishnumati River as the source of the city’s drinking water. Sinclair’s design included a reservoir at Panipokhari, at 1,330m elevation and 30m above &nbsp;Tundikhel, thereby enabling gravity-fed distribution in pipes. With a capacity of 7,327 cubic metres, the reservoir could store nine days of supply.&nbsp; The system was designed to serve about 70,000 residents through both private connections and public standpipes. The reservoir was a single-compartment tank with an arched brick roof covered in earth and turf. Its brick walls were bonded with lime mortar and aggregate, and its floor was dressed with fly stone. Work on the valley’s water supply began in 1888, three years after Bir Shumsher seized power. The following year, Bir Hospital and the Bir Water Works took shape. The project involved some 40km of imported cast-iron pipes, weighing 1.866 million kg and inscribed with the marks of Scottish foundries ‘Ally and McLean’ and ‘Glasgow’. Construction required 620,000 man-days of labour and cost over Rs600,000. Transport costs inflated prices: <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">a load of cement</a> costing Rs10 in Calcutta was worth Rs33 by the time it reached Kathmandu. Bir Water Works was inaugurated in September 1891, six years after the cholera epidemic. Water flowed out of 131 taps, including eight in Lainchaur, six in the royal palace, eleven in the prime minister’s palace, sixteen around Tundikhel, thirteen in Thapathali, seven in Thamel, and two in Naxal. The system’s designation, the term ‘works’ , echoes the Chelsea, Calcutta, and Glasgow Water Works, underlining its industrial pedigree. Water was also supplied to Phora Durbar, Bir Shumsher’s palace of music and dance whose fountains sprayed rose-scented water in a display of opulence. The <a href="https://commons-nepal.com/the-first-kaldhara-in-" target="_blank">Bir Dhara Works</a> was more than an engineering scheme: it was Nepal’s first modern public-health intervention. Safer drinking water curbed waterborne disease, and the number of cholera outbreaks declined, but were not eliminated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254.png" data-media-id="editor_4" data-image-id="20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254" data-rendition-name="original" width="865" height="535" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971.jpg" data-media-id="editor_5" data-image-id="20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971" data-rendition-name="original" width="2791" height="3859" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>  “Now we have water to fight cholera, and I believe cholera will no longer prevail. After four years of piped water, the benefits have been greater than expected,” Bir Shumsher said in a proclamation. Despite this, the prevalence of poor sanitation, open defecation, cramped housing, and malnutrition meant that typhoid, smallpox, and dyspepsia remained endemic. The Bir Dhara system marked Kathmandu’s transition from reliance on wells, rivers, springs, and hiti to piped water, operating for several decades and laying the foundation for the expansion of drinking water services across the country in the late twentieth century. <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">Extensions followed in Patan</a> under Chandra Shumsher, and Bhim Shumsher later added the Tri Bhim Dhara. Piped water systems were subsequently constructed in towns such as Kirtipur, Bhaktapur, Dhankuta, Pokhara, Dhulikhel, and Jajarkot which itself saw a deadly cholera outbreak in 2009.&nbsp; CHOLERA METAPHOR In 1933, Nepal’s first water bureaucracy, the Pani Goswara, was established, formalising state involvement in urban water supply. Yet even till the late 20th century, households continue to rely on a mix of sources, including public water networks, private vendors, rooftop storage tanks, borewells, wells, hiti, and household filtration. The lack of reliable water supply places disproportionate financial, physical, and psychological burdens on low-income households, underscoring how decades of infrastructure expansion have not translated into universal, reliable service. during challenges in governance, investment priorities, and regulation. Bir Shumsher also attempted to introduce <a href="https://www.ukaalo.com/news/cholera-in-kathmandu-1958/" target="_blank">basic hygiene measures</a>, such as pit latrines with squatting slabs. However, there is no record of these facilities being built in his palaces, later built palaces, or elsewhere. Sanitation conditions remained poor for both the elite and the general population. Open defecation or the use of crude pit latrines without proper waste disposal was common. With no drainage or sewer systems, human waste accumulated near homes, contributing to the spread of waterborne diseases. In 2019, Nepal declared itself ‘open defecation free’, a policy milestone, but this achievement masks the persistence of deeper problems. Urban areas generate some 867 million litres of wastewater daily, yet only 7% of it is treated before being discharged. Sewage flows untreated into rivers and streams, spreading cholera, typhoid, dysentery, and other diseases, particularly among children and vulnerable communities. Safe disposal of faecal sludge continues to be a major struggle for many communities and local governments. Besides Jajarkot, Godavari in Kathmandu Valley had a localised outbreak in 2024. This year, Birganj was struck by a cholera outbreak caused by a lethal combination of unreliable water supply, groundwater overpumping, poor drainage and hygiene, and unsafe waste disposal. And Nepal’s peacekeepers deployed after the earthquake in Haiti in 2010 were blamed for spreading cholera that ultimately killed 30,000 people in the Caribbean nation. The Bir Water Works was more than a reservoir and pipes. It was Nepal’s first brush with modernity, mediated through engineering and haunted by cholera. More than 134 years on, cholera remains a threat and a reminder of Nepal’s challenges in water and sanitation governance. The issue is not merely ensuring access to safe water but also building public trust that quality essential services can be delivered equitably, sustainably, and with resilience. Ajaya Dixit is a Kathmandu-based researcher exploring Nepal’s water history since the mid-eighteenth century to inform ethical water and river management in a changing climate.

Life in a time of cholera

Nepal has made dramatic progress in expanding health services, yet millions of people still do not fully benefit from their Constitution-ensured right to basic medical service. Many of those deprived of accessible and affordable healthcare are in remote far-flung areas of the country, but increasingly they are also among the urban poor who have migrated to the cities and live in the margins. In both areas there are gaps in service quality, health workforce availability, and governance capacity. Out of pocket expenses for medical treatment of a family member can push families into absolute poverty and debt. The 2025 WHO–World Bank Global Monitoring Report on Universal Health Coverage underlines this challenge -- financial hardship from health spending remains a major barrier to equity, even where medical coverage has improved. In Nepal, rising demand for better and more affordable healthcare and workforce shortages due to outmigration of medical personnel and other factors mean that the government is unable to bridge these gaps through public provision alone. Well-governed and accountable public-private partnerships (PPPs) aligned with national priorities offer <a href="https://archive.nepalitimes.com/article/nation/Crowding-it-out,1003" target="_blank">a practical pathway from policy commitment to real-world impact</a>. The experience of the non-profit Nyaya Health Nepal (NHN) in partnership with the Sudurpaschim Province is an example of where this has worked well. Through <a href="https://nepalitimes.com/banner/altruistic-healthcare-models-in-nepal" target="_blank">public ownership and non-profit management</a>, <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=17s" target="_blank">Bayalpata Hospital</a> in Achham and <a href="https://nepalitimes.com/news/unique-hospital-handover-in-dolakha" target="_blank">Charikot Hospital in Dolakha</a> strengthened service delivery, supply chains, health workforce management, and digital health systems, while keeping all services free at the point of care.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  NHN managed Charikot from 2016-2020 and handed it over to Bagmati Province, and Bayalpata was handed over to Sudurpachim after 17 years in August 2025. These partnerships reduced out-of-pocket spending, improved trust in public facilities, and directly addressed financial concerns of citizens. The WHO–World Bank Global Monitoring Report emphasised that universal health coverage requires strengthening primary health care, providing free services at the point of care, and protecting families from financial hardship. Public–nonprofit partnerships like NHN and others in Nepal provide a model to directly address these challenges. By improving access to quality care, supporting local health workers, and keeping services free, these partnerships help reduce health costs for families, build trust in local health facilities, and narrow the gap between rural and urban health services, <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">turning </a><a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">policy commitments into real improvements for communities.</a> The experience of <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata and Charikot hospitals</a> show that effective PPPs are governance-driven, not market-led. Clear agreements, transparent data sharing, performance-based management, and strong government oversight guaranteed that public institutions were strengthened rather than sidelined. Bayalpata and Charikot successfully transitioned leadership and full management to Sudurpaschim and Bagmati provincial governments, proving that public-private partnerships can build lasting government capacity, not dependency.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8.jpg" data-media-id="editor_8" data-image-id="20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8" data-rendition-name="original" width="1570" height="940" loading="lazy" alt="Charikot hospital"> <figcaption>Charikot hospital in Dolakha.</figcaption> </figure>  This model combined facility-level operational flexibility with public stewardship, and tackled long-standing weaknesses in Nepal’s health system, from workforce retention to evidence-based decision-making. Scaling such models through a national, gap-focused partnership framework is now an urgent opportunity. Replicating Bayalpata model partnerships in selected hospitals and primary health care centers could rapidly advance the three pillars of universal healthcare: equitable access, quality services, and financial risk protection. Institutionalising public-private partnerships within the Ministry of Health and Population and &nbsp;linking it to national health insurance reforms could help fulfil the promise of Article 35 of the Constitution guaranteeing basic healthcare to all citizens. For development partners and donors, this could represent a high-impact, evidence-informed investment aligned with the WHO–World Bank call to reduce financial hardship while strengthening healthcare systems. If Nepal is serious about leaving no one behind, strategic public–non-profit partnerships must move from the margins to the mainstream of health system reform. By <a href="https://nepalitimes.com/opinion/is-free-health-care-possible-in-nepal" target="_blank">scaling the NHN model</a> at Bayalpata and Charikot nationwide, Nepal can build a resilient, equitable health system where every community regardless of location or income has access to quality care, financial protection, and the opportunity to succeed. Investing in well-governed PPP models is not only essential to protect the health of the Nepali people but also to safeguard the country’s economic stability and long-term resilience. &nbsp; Srijana Devkota is Director of Program and Partnerships at <a href="https://nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal</a> (NHN). <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">Watch a video of Bayalpata Hospital.</a> <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=_gSoClqwmI-ecSxh" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>

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