<figure><img width="2048" height="1282" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1af9c7e80680e083e61jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>With the <a href="https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/">pre-winter resurgence of Covid-19</a> around the world and in Nepal, pressure is mounting on governments to procure vaccines to protect their populations.
Last week, the <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government set up a committee</a> of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them. But Nepal is far behind other countries, which have already ‘booked’ their future supplies.
On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">VAX POPULI</a>, Sonia Awale
However, there is no effective strategy to ensure vaccines for all as distribution in Nepal comes with the challenge of taking it to poor and remote corners of the country. Experts fear that even when the vaccines become available, the campaign will be plagued by the same socio-economic inequities that afflict the medical sector.
“We need to immediately start identifying vulnerable groups like <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a>, <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> or those with comorbidities to prioritise for immunisation,” says Bikash Gauchan, a physician at Bayalpata Hospital in the under-served western district of Achham.
“We also need to set up proper cold chain facilities across the country as soon as possible and have a well thought out distribution plan so that when the vaccine does arrive, we can hit the ground running,” he adds.
The silver lining is that Nepal already has a successful <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">childhood immunisation</a> network that has successfully mobilised <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and they can deliver vaccines to the homes of the elderly who cannot make it to clinics. Monitoring the follow-up second dose for some of the vaccines will be crucial, although Nepal’s health system has experience with maintaining a cold chain for other campaigns.
<a href="https://www.nepalitimes.com/latest/nepali-diaspora-hit-by-covid-surge/">Nepali diaspora hit by Covid surge</a>, Nepali Times
Despite recent breakthroughs in trials (see box) public health experts stress the importance of exploring vaccine supply options closer to home. As of now, 11 vaccines developed in several parts of the world are in the third phase of <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener noreferrer">clinical trials</a> with many of them expected to be as effective.
Neighbouring China and India are at the forefront. And Nepal should have begun its ‘vaccine diplomacy’ much before this to secure its supply of shots.
There is also the uncertainty of vaccine efficacy depending on the strain: the same vaccine could be highly effective against people in the West but not as much in South Asia where people suffer from chronic malnutrition and multiple infections.
“For a working vaccine to be made within a year is an amazing victory for science but we also need to know that these vaccines are designed for their population. So I’d want to know more about the vaccines in India and China,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Particularly China, as it was where the pandemic started but <a href="https://www.nepalitimes.com/latest/what-nepal-can-learn-from-china-about-covid-19/" target="_blank" rel="noopener noreferrer">has since controlled it effectively</a> unlike rest of the world.”
<a href="https://www.nepalitimes.com/opinion/the-truth-about-the-chloroquine-scam/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Buddha Basnyat</a> of the Patan Academy of Health Sciences agrees. He says: “China looks at the reality in our backyard. So a more suitable vaccine for us could come from the Chinese, particularly because they have a track record of having developed better vaccine for this part of the world.”
Indeed, the JEVAX made by the researchers in Chengdu is now the most widely used jab against Japanese Encephalitis because it’s more cost effective compared to its western vaccines.
Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.
In India, The Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.
Similarly, researchers at the Indian Institute of Science have designed a protein-based heat-tolerant vaccine that can stay stable for a month at 37°C, and could endure temperatures as high as 100°C if freeze dried, a feature that could be a game changer for mass vaccination campaigns in lower and middle income countries in Asia and Africa.
The other factor to consider will be the duration of the immunity after each vaccine shot, as well reinfection groups and if antibodies developed in the first episode helps fight the mutated forms of the virus.
With Covid-19 crisis continuing to spread rapidly across Nepal and at 10 fatalities per million population (same as Pakistan and much higher than China’s 3), it is not too early to start dialogue with Gavi, the vaccine alliance, COVAX and agencies like the World Bank and World Health Organisation to help procure the most cost effective approach to vaccines most suitable to Nepal’s conditions.
Alternatively, many pharmaceutical companies will want to play the field in order to boost their profile. In fact, embassies and foreign donors are already hard at work pushing for trails and deals.
“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”
In all this excitement, Nepal’s health authorities must also keep an eye on the plight of infected people and many more to come as <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">they wait for a vaccine</a>. The results of current treatment regimens ranging from plasma therapy to administering Remdesivir have been patchy. And as scientists study the long-term impact of Covid-19 on patients even after they recover, making an optimal use of resources becomes even more significant.
So far, the government has been faulted for squandering months of lockdown, not carrying out sufficient tests and contact tracing, not increasing hospital capacity and equipment, and letting the people fend for themselves.  
The result is that Nepal is <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">suffering a sustained surge</a>, with more than 1,400 new cases a day, over 60% of them in Kathmandu Valley alone and a quarter of those tested coming out positive. There is also a surge in symptomatic patients, even among those without pre-existing conditions, and those sick enough to require ICU and ventilator.
Even when the government does act, the <a href="https://www.nepalitimes.com/latest/coronavirus-coordination-committee-doesnt-coordinate/" target="_blank" rel="noopener noreferrer">priorities seem to be misplaced</a>. For instance, health experts say the emphasis in the past months should have been on high flow oxygen therapy or High Dependency Units rather than Intensive Care Units in hospitals.
“It would have been cheaper, it does not require highly trained staff or sophisticated equipment, and it would have freed up the ICUs for the really critical patients,” adds Pun, who himself is at the Health Ministry, and this possibly means his advice is not being taken.
Insiders say it will likely take upwards of six months for the first vaccines to arrive in Nepal, and there will be a rush by the rich, the powerful and those with political connections to get their shots. The marginalised, poor, those in remote areas will be the last to get their injections, unless the government has fair and effective rules in place and implements them.
Till then, there is little else to do than <a href="https://www.nepalitimes.com/opinion/silver-linings-in-the-covid-cloud/" target="_blank" rel="noopener noreferrer">keep masking up this winter, avoid large gatherings, keep distance and wash hands regularly</a>.
Says <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a>: “The mask is the best vaccine we have at the moment. These safety measures have largely reduced hospitalisation due to other infections in 2020, masks in particular will also protect us from winter pollution in the coming months.”<h2>The Vaccine Race</h2>The global resurgence of Covid-19 in the northern winter has coincided with breaking news every day of successful new vaccine trials.First the Russians announced a vaccine in September that is 92% potent against SARS-CoV-2.  Last week Pfizer unveiled a 90% effective vaccine, which on Wednesday was upgraded to 95% efficacy without side effects. Moderna was next with an efficacy of 95%, and not needing extreme refrigeration. More companies in China, India and Europe are conducting their own trials.Public health experts have hailed the developments, but warn that vaccines will not be universally available till late 2021 and even so will not provide full protection. They suggest continuing with masking up, keeping distance and avoiding crowded indoor places.Pfizer and its German partner BioNTech’s mRNA-based vaccine came out declaring over 90% effectiveness but only at -70°C ultra cold chain which will be a challenge even for countries with the best health facilities in the world.Massachusetts-based Moderna’s RNA shot has 94.5% efficacy, seems to also prevent severe infections and remains stable in medical and home refrigerators for up to 30 days, in freezers (-20°C) for up to six months, and at room temperature for up to 12 hours.Even so, poorer countries are unlikely to get coronavirus vaccine any time soon. Even the biggest pharmaceutical multinationals can only manufacture a limited quantity of the vaccine over the next year.Pfizer has capped its production at 1.4 billion for 2021, 80% of which has already been booked through advance purchase agreement by the US, UK, EU, Canada and Japan. Moderna expects to manufacture 20 million doses this year and up to one billion in 2021.On the other hand, <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">Russian’s Sputnik V</a> has been overshadowed by new developments, and due to lack of sufficient data to back up its claim of 92% efficacy. Although geopolitical rivalry with the West has given it negative publicity, some health agencies have not ruled it out.

Sonia Awale

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When will Nepal’s Covid vaccine turn come?

The series Nepal Made profiles Nepali products and the people who make them possible While premium beauty product outlets were closing during the Covid-19 pandemic, two young women gambled on setting up a new skin and haircare brand with natural ingredients mostly sourced from Nepal and suited for the Nepali complexion. Arushree Sharma Khatiwada and Megha Agarwal were batchmates in school before they left for studies abroad, returning to set up Avani Nepal after year-long rigorous research into ayurveda-based cosmetic products. Avani in Sanskrit means ‘earth’, and as the name suggests it is committed to bringing all natural, pure and authentic range of beauty solutions.&nbsp; “We found a gap in the Nepali market demand for cosmetics, which is why we decided on a brand sourced from all-natural Himalayan herbs that are not used or explored properly,” says co-founder Khatiwada.&nbsp; Nepal is a treasure trove for medicinal plants and those with therapeutic properties. After all, legend has it that Hanuman flew right across the subcontinent from Sri Lanka to the Himalaya to find a rare medicinal plant to save the life of Lord Ram, who was wounded in battle. When he could not find the specific plant, he tore off a whole mountain and brought it down. Read also: <a href="https://nepalitimes.com/multimedia/looking-good-by-doing-good">Looking good by doing good</a>, Sudiksha Tuladhar  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0.jpg" data-media-id="editor_1" data-image-id="20260314120356_32323fd084540236fe4edb3b98286c131d67c73310279c8038510da1e1ae1bc0" data-rendition-name="original" width="3024" height="2012" loading="lazy" alt="Avani"> </figure>  Medicinal plants in Nepal range from yarsagumba to jatamasi and 500 other species traditionally used in the Ayurveda as well as now in the wellness industry. Avani is also trying to experiment hibiscus, Himalayan honey and other plants to eventually launch an export drive. Running a business in Nepal is no easy task, especially for small scale locally crafted products but in a few years, Avani has ammased loyal customer base and have many repeat customers. “While it was tricky initially, we were determined to launch our products with the best quality ingredients and in an affordable price range,” says Khatiwada. Following a worldwide trend and emulating the method used by Korean cosmetic brands, Avani has deployed celebrities and influencers to increase its outreach through tikTok , Facebook and YouTube. &nbsp;Actresses Barsha Shiwakoti and Shilpa Maskey and makeup artists like Lemi have reviewed their products favourably. Sutainability is a big part of the brand, and Avani uses glass bottles, cardboard boxes, paper bags for all its products. Plastic use is cut to a minimum, and where used is recycled.&nbsp; “Many people think that sustainable brands are expensive, we want to bust that myth,” Khatiwada told us. “We focus on being eco-friendly using ethically sourced materials that are paraben, silicon, and cruelty free.”&nbsp; Read also: <a href="https://nepalitimes.com/here-now/proud-to-wear-dolpo">Proud to wear DOLPO</a>, Vishad Raj Onta  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49.jpg" data-media-id="editor_3" data-image-id="20260314120356_da0d7d4082a9aa51c96ecbcb8a2e7a5bc60e27de202fb339a522036aa3f50b49" data-rendition-name="original" width="1048" height="1280" loading="lazy" alt="Avani"> </figure>  Avani has expanded its business to get a toehold in Nepal’s tourism and wellness industry, and the products are carried by spas in leading hotels and resorts in Kathmandu and Pokhara such as the Terraces, Marriott, and Kavya resort, and is in talk with the Hideaway Resort in Pokhara.&nbsp; The skin and haircare brand that initially started with 10 products has since expanded its line to 60 with goods placed in more than 100 stores across Kathmandu. Plans are in the works to expand to India, China and in Japan partnering with Okada. Avani Nepal’s founders say that they support empowerment through employment and training opportunities for women at the company. Khatiwada herself has been engaged with organisations such as Nepal Women Chamber of Commerce, and Nepal Youth Entrepreneur Forum. Additional support from the government such as the provision of lower excise duties has helped but guidance for export and other business regulations is as crucial. Such an environment would also foster opportunities for the youth who are otherwise moving away for jobs or study abroad. “While everyone is trying to go abroad, opportunities can be created here in Nepal itself, with adequate support from the government,” says Khatiwada. “In the meantime, we are eyeing for long term benefits. We are trying to create a legacy for cosmetic brands in Nepal.” Read also: <a href="https://nepalitimes.com/here-now/java-in-the-himalaya-y1ilc21h">Java in the Himalaya</a>, Vishad Raj Onta

Redefining the criteria for beauty

- High Court employee Amrita KC fulfilled her duties as a polling officer in Nepalganj on election day, with her six-month-old daughter held in her arms.&nbsp; - The same morning in Kathmandu-1, RSP candidate Ranju Neupane appeared at the polling station to cast her vote with her 10-day-old baby. The next day, she became the first candidate declared a winner by the Election Commission. Her party won a supermajority and will now be tasked with reforms in governance, development, the economy, and service delivery. At least four of the winning RSP candidates are doctors, and the party must fulfil its campaign promise of improving healthcare access across Nepal. Among the lowest-ranking region for healthcare indicators in Nepal is Madhes Province. Across the districts of Madhes and Karnali, where maternal and neonatal health outcomes remain poorer than in the rest of the nation, local governments in collaboration with non-profits, have financed and facilitated the operation of birthing centres where <a href="https://nepalitimes.com/here-now/nepal-haemorrhaging-nurses">nurses are lifelines</a> for pregnant women, new mothers, and newborn babies.&nbsp; At the Inarwari birthing centre in Rautahat district, nurse midwife Manisha Kushwaha gently applies ultrasound gel on the abdomen of 28-year-old Robina Khatun who is having a sonogram in the first trimester.&nbsp; Kushwaha glides the transducer over Khatun’s belly before pronouncing her baby healthy. She will later send the ultrasound machine for the municipality’s monthly mobile sonogram program in a neighbouring village.&nbsp; Ministry of Health and Population guidelines recommend that pregnant people make eight antenatal care (ANC) visits to health posts before their delivery date. Expecting mothers are also provided Rs800 for the eight visits and travel costs according to geographical region. In Baudhimai, the local government provides more incentives: 10 eggs for non-vegetarian and protein powder for vegetarian mothers-to-be per visit. The municipality also provides free ambulance service for pregnant women, and conducts a monthly mobile sonogram program across all communities.&nbsp; The initiatives of local governments, health officials, non-profits, and volunteers have meant that institutional deliveries here have increased drastically. In Rautahat, institutional deliveries have increased from 50% to 68% in four years, according to figures from the non-profit One Heart Worldwide that works to improve <a href="https://nepalitimes.com/here-now/nepal-lagging-in-safe-motherhood">maternal and neonatal health</a> outcomes arcoss Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020352_a3f66142aa6a0333b78d82cd5520b1818633a580885232c10625572e014b1b15.png" data-media-id="editor_2" data-image-id="20260314020352_a3f66142aa6a0333b78d82cd5520b1818633a580885232c10625572e014b1b15" data-rendition-name="original" width="1034" height="650" loading="lazy" alt="Motherhood in Madhes"> </figure>  “Home deliveries have completely stopped in Inarwari, and women are increasingly accessing ante-natal and post-natal care, as well as family planning measures,” says Manisha Kushwaha. “Women and families here are now more aware of maternal and neonatal healthcare.” One of them is Noor Jahan Khatun, who had her first baby at home and gave birth to her second child at the local birthing centre despite wanting another home birth. When the due date for her third child came around, she walked to the health post herself.&nbsp; “I realised it is much better to give birth at the hospital,” Noor, who is pregnant with her fourth child, told us. “They have everything we need in case of complications.” The nursing staff at the birthing centre, as well as other centres in the municipality also periodically review their training in the birthing simulation room set up on the premises of the Inarwari birthing centre so that they retain their training and continue to hone their skills. Over in Sarlahi’s Sundarpur in Chakraghatta Rural Municipality, a state-of-the-art birthing centre now stands adjacent to the derelict old structure from which nurses previously had to provide services.&nbsp; The new and improved maternity ward was built last year with Rs2.4 million from the municipality and a Rs2 million from <a href="https://nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives">One Heart Worldwide</a> under a cost-sharing public-private partnership formula.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_4e7f71b535541d56d267baa6f2656faf008b7e98cc16da0042253f4c0db3eeb7.jpg" data-media-id="editor_4" data-image-id="20260312120328_4e7f71b535541d56d267baa6f2656faf008b7e98cc16da0042253f4c0db3eeb7" data-rendition-name="original" width="3000" height="2000" loading="lazy" alt="maternal health"> <figcaption>Sundarpur birthing centre in Sarlahi built through the collaboration of the local government and One Heart Worldwide.</figcaption> </figure>  Chief nurse Sunita Rai has been stationed here for the last six years, and looks at the old building. “I remember when we had to deliver babies while ankle-deep in flood water during monsoon,” recalls Rai. “This new facility and the equipment have improved service.”&nbsp; Since the start of the fiscal year, the six-nurse team at Sundarpur has delivered more than 140 babies. One day last month, a national holiday, the centre was quieter than usual, with just two women waiting for delivery.&nbsp; But fewer-than-usual patients does not mean there is no work to be done. In the afternoon, nurses make the rounds of the community to conduct post-natal care visits, and to keep track of how the new mothers and babies in the village are doing. This is important because neonatal mortality of babies within the first month of birth is still high. “For the people in this village we are both the doctor and the nurse,” Rai says matter-of-factly as she walks towards the village to see a new mother.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020352_24b9e04295150a8a64ff56f457e3faebd84eaa22a3e3521499ac17c23ec48027.jpg" data-media-id="editor_5" data-image-id="20260314020352_24b9e04295150a8a64ff56f457e3faebd84eaa22a3e3521499ac17c23ec48027" data-rendition-name="original" width="790" height="542" loading="lazy" alt="Motherhood in Madhes"> </figure>  In Sarlahi's Laxmipur Kodraha, Kanchan Rai makes her own rounds, calling out to several young children playing in the pale afternoon sun. Rai has been stationed in Laxmipur for 10 years and delivered most of those children playing outside herself. A beloved member of the community, Rai is greeted by several women and invited in for tea and snacks as she walks by. The Laxmipur birthing centre has seen major renovations to make it more spacious, better equipped, and hygienic. Mothers now have more privacy, especially from men who in the past would simply barge in wanting to know which woman from the village was about to give birth.&nbsp; “We deliver 400 babies on average every year,” Rai says. “There have been zero home births in this village for the last five years, and women are increasingly accessing maternal healthcare and family planning services.” Institutional deliveries in Sarlahi have gone up from 37% to 71% over the past five years.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020348_983e3b652b38cee4a1d977742e0211dd85c1ab8085f961876dde1ada78c7c2ac.jpg" data-media-id="editor_6" data-image-id="20260314020348_983e3b652b38cee4a1d977742e0211dd85c1ab8085f961876dde1ada78c7c2ac" data-rendition-name="original" width="359" height="329" loading="lazy" alt="Motherhood in Madhes"> </figure>  Pregnant women who require C-sections, or those who experience complications during pregnancies, are referred to the nearest provincial hospitals in Gaur or Malangwa. “Community-based awareness programs about going for hospital visits have helped reduce home deliveries, and counselling sessions provided to new mothers at provincial hospitals have contributed to better maternal and neonatal health outcomes,” says Sachin Yadav, obstetrician-gynaecologist at Malangwa Provincial Hospital. SAFE MOTHERHOOD Newborns with birth asphyxia, tachycardia, meconium aspiration syndrome and other complications are admitted to the special newborn care unit at the Gaur Provincial Hospital. But Apsana Khatun, chief nurse at the hospital’s maternal and neonatal unit says: “We have not been able to provide neo-natal care as effectively because we do not have an NICU.”&nbsp; Provincial hospitals provide life-saving services, but remain underfunded and in need of life-saving equipment. At the Gaur Hospital, Rukmini Kumari Shah gently rocks her three-day-old son, who was admitted to the special newborn care unit due to birth asphyxia and dehydration.&nbsp; “I have not even been able to think of a name for him,” says the 25-year-old. “My other two children were born normal but I worry for this one.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_2736dbc7660fdb60d928df22b387d084a244607126567e5cbf37235177d1ac3c.jpg" data-media-id="editor_7" data-image-id="20260312120328_2736dbc7660fdb60d928df22b387d084a244607126567e5cbf37235177d1ac3c" data-rendition-name="original" width="3000" height="2000" loading="lazy" alt="maternal health"> <figcaption>Gaur Provincial Hospital.</figcaption> </figure>  This is where the election pledge of the RSP will be tested. Will the new government cut through the bureaucracy, corruption and resource constraints to provide life-saving services to mothers and babies in places like Rautahat and Sarlahi? There has been no maternal mortality at the Malangwa Provincial Hospital for the last two years, but the hospital has had neonatal deaths. “We need more spacious waiting areas and training for maternal and neonatal healthcare workers,” says Sachin Yadav. “Without that we are unable to serve our patients and have to send them to Kathmandu or Birganj.” In Baudhimai village, patient numbers have increased by 140% in the last three years, but the federal government slashed the health budget by 60%. The government across three levels is supposed to provide 98 types of essential medicine free of cost at primary healthcare centres, but the federal and provincial governments often fail to make their share of the drugs available.&nbsp; “Federal and especially provincial governments have been irresponsible when it comes to investing in local healthcare,” says Baudhimai mayor Pradeep Kumar Yadav. Health workers and institutions continue to work without being paid or funded when the budget remains frozen for months at a time. “It does not matter to a patient when the fiscal year begins,” says Sachin Yadav at the Malangwa Provincial Hospital. “Maternal deaths do not wait for the budget to be released.” And despite budget constraints, political posturing still continues. At local levels, officials build multiple birthing centres in each ward when one would suffice, and these buildings remain empty.&nbsp; Politics also plays a significant role in whether or not local officials are willing to agree when health officials try to refer pregnancy-related complications to better-equipped facilities. And while services have improved due to the efforts of dedicated healthcare officials, they are transferred from one place to another at the whim of governments that come and go, which means staff turnover in these institutions is very high, affecting consistent service delivery. &nbsp; Yadav has been at Malangwa for three years— during which yearly institutional deliveries have gone from 2,000 to 3,200 and C-section births have gone from 150 to 700. He had just begun to hit his stride at the hospital when he received transfer letters to another hospital.&nbsp; So far, he has managed to hold on to his position in Malangwa, but he does not know how long he will be able to delay the transfer. &nbsp;&nbsp; <h2>Tackling patriarchy</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260312120328_7df47f32c19a10cd59efbd7e2639a1b719bd4f6ca50bfa24189c8ecc65f21d09.jpg" data-media-id="editor_8" data-image-id="20260312120328_7df47f32c19a10cd59efbd7e2639a1b719bd4f6ca50bfa24189c8ecc65f21d09" data-rendition-name="original" width="1850" height="3000" loading="lazy" alt="maternal health"> </figure>  Nepal has made dramatic progress in reducing the maternal mortality rate (MMR) from 539 per 100,000 births to 142 over the past 30 years. But that is the national average. MMR is still high in parts of Nepal where access to healthcare and adoption of health services are not as extensive. One reason is that despite birthing centres and awareness of pre- and post-natal healthcare, s<a href="https://nepalitimes.com/here-now/the-slaughter-of-our-daughters">ocio-cultural norms in a patriarchal society</a> also mean that female literacy remains low, and the rate of underage marriage is high.&nbsp; Rautahat has the lowest literacy rate in Nepal, and the lowest female literacy rate. This has a direct correlation with its its fertility and maternal mortality rates. Gaur Hospital continues to see maternal and intrauterine fetal death (IUFD) deaths due to a lack of ANC visits by patients. In the absence of education and information, socio-cultural misconceptions still persist. Women refuse to take essential pre-natal medication like folic acid because they think it will affect their babies’ complexion, and do not eat enough fruits because they believe it will cause fetal pneumonia.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260314020348_2ce41f5b625cb005b9477861d0c208e806601ce7eaa804d525030282675e3856.jpg" data-media-id="editor_10" data-image-id="20260314020348_2ce41f5b625cb005b9477861d0c208e806601ce7eaa804d525030282675e3856" data-rendition-name="original" width="377" height="367" loading="lazy" alt="Motherhood in Madhes"> </figure>  Women are also expected to get through their pregnancies without going for health check ups in keeping with the tradition of their mothers and mothers-in-law enduring pregnancy and childbirth at home without access to healthcare. Maternal and neonatal health outcomes are also affected by child marriage, as well as the patriarchy-enforced preference of a male child in the family.&nbsp; At Gaur Provincial Hospital, 25-year-old Asha Kumari stands with her hands braced against the hospital bed as she is gripped by a contraction. Her eldest child is already 12, and she is at the hospital to have her fifth baby.&nbsp; “She had already had two children by the time she was 18,” explains her mother, who is here with Asha’s mother-in-law. &nbsp; Officials worry that reporting instances of child marriage might mean that women no longer trust health workers and hospitals, and stop accessing healthcare altogether. They insist that investment in maternal health needs to be accompanied by socio-cultural interventions. <div class="embed-block"><div><div style="left: 0; width: 100%; height: 0; position: relative; padding-bottom: 56.25%;"><iframe src="https://cdn.iframe.ly/api/iframe?url=https%3A%2F%2Fwww.youtube.com%2Fembed%2FtVA--CRk3nM%3Fsi%3DJtFs6cwqOhJua9NI&key=87ca3314a9fa775b5c3a7726100694b0" style="top: 0; left: 0; width: 100%; height: 100%; position: absolute; border: 0;" allowfullscreen scrolling="no" allow="accelerometer *; clipboard-write *; encrypted-media *; gyroscope *; picture-in-picture *; web-share *;"></iframe></div></div></div>

Motherhood in the Madhes

Nepal’s new political wave has been described in many ways: a generational shift, a technocratic shift, a shift in ideas, and a shift in political behaviour. Young leaders now sit in Parliament, many with international education and policy experience.
But amid this excitement, a quieter truth risks getting lost: this political transformation is also the ascent of people who, until recently, were the grassroots themselves.
For the first time, many of the people now sitting in government are not distant elites. They are people I have marched with, argued with, worked with, and been inspired by for more than a decade.
They are people who once stood ankle‑deep in floodwaters, not in front of press conferences. As optimism rises around the new government, we must not forget that the climate crisis has not slowed down. 
The monsoon is at our doorstep again. And if the disasters from previous years taught us anything, it is that climate impacts do not wait for political transitions. And our mountains and rivers do not care who sits in Singha Darbar.
What is different this time is who holds power.
During the <a href="https://nepalitimes.com/opinion/flood-of-despair" target="_blank">September 2024 floods in Kathmandu</a>, the first responders were not the state or development machinery. It was ordinary young people. A loosely formed WhatsApp network coordinated everything from dispatching mountain bikers to landslide‑stranded areas, to pooling relief supplies, to delivering materials to army bases for airlifting. These were citizens acting out of necessity, not mandate.
Many from that very network are now part of the government. As I have argued before in Nepali Times, top‑down climate responses in Nepal have always been too little, too late, and too disconnected from lived experience. The only proven path is bottom‑up, community-led adaptation where those who face the risks daily shape the solutions. 
International research backs this: community-based adaptation has been central to success stories from Bangladesh’s cyclone shelters to Vietnam’s mangrove restoration to the Philippines’ barangay disaster committees. The world has repeatedly learned that resilience grows from the ground up, not the top down.
RARE MOMENT
Nepal now has a rare political moment where people with lived experience of crisis sit in positions of authority. The real test is whether this lived experience becomes policy and immediate action.
The expectation should not be that these new leaders deliver because of their degrees. It should be because they remember where they come from and use their privilege to strengthen and fund local institutions, networks and people who kept this country functioning long before governments did.
The monsoon that starts in June will test the government’s commitment to governing from the bottom up. Will these new leaders govern the way they once volunteered — listening first, acting fast, improvising where needed, and involving those closest to the danger? Or will the weight of the state push them back toward the familiar comfort of top‑down plans and consultant reports?
The challenges are complex. <a href="https://nepalitimes.com/opinion/comment/a-pre-monsoon-deja-vu" target="_blank">Climate change is driving displacement</a>, deepening poverty, and exacerbating gendered vulnerabilities. Climate adaptation, therefore, needs cross-sectoral solutions that understand how these issues intersect.
Long-term transformation is essential. Our major cities like Kathmandu desperately need a future where rivers are protected instead of mined, where an urban forest cools our heat‑trapping city, and where mobility focuses on sustainability, not just shiny EVs. Our mountain villages and terai lowlands deserve a community resilient to climate impacts, with livelihoods protected.
These require years of work. But immediate, life-saving measures cannot wait.
Will the government finally rein in the sand mining and quarrying upstream of the Rosi and Nakkhu Khola? Will someone sit down with the communities on the riverbanks and listen to the early warning signs they’ve learned through pain? Will climate adaptation be prioritised amidst political noise and competing crises?
Or will we find ourselves, yet again, mourning damage that could have been prevented? I have been inspired by many of the individuals now in government — they questioned old hierarchies, challenged worn‑out norms, and believed that things could be done differently. 
But while the faces in Parliament have changed, the bureaucracy has not. Development organisations and civil society groups have not. And those systems are slow: too slow for the speed at which our climate is changing.
So something has to give. And that shift must begin with remembering where this political movement came from: the grassroots. Those now in power must not forget the urgency they once carried in their bones. They cannot forget the feeling of wading into murky floodwater, holding a bag of rice over their heads. 
And it is our responsibility — mine <a href="https://nepalitimes.com/news/turning-green-policies-into-greenbacks" target="_blank">as a writer</a>, yours as a reader, and ours as citizens — to remind them. The real spark for <a href="https://nepalitimes.com/opinion/measuring-climate-impact-on-culture-and-heritage" target="_blank">climate action</a> comes from personal stories of loss, fear, survival, and solidarity. And suddenly, those stories are no longer outside the halls of government. They are inside.
The question is no longer whether our leaders understand the stakes. They do. They lived it. The real question, as the skies grow heavier again, is this: What will we do with this moment?
<a href="https://nepalitimes.com/opinion/comment/a-pre-monsoon-deja-vu">Rastra Raj Bhandari</a> is a co-founder and fellow at the Himalayan Water Project, where he leads the research on climate finance opportunities for the Himalaya. He contributes regularly to Nepali Times on climate change.

Soon, the monsoon

Sometimes, we need to take a step back to realise what a tectonic movement Nepali politics witnessed this month.
In a region and world ruled by elected authoritarians, Nepalis &nbsp;went to the ballot box freely to express a collective will for change.
These faces in this group photo of the RSP’s 180 freshly-minted MPs at the ballroom of the Royal Tulip Hotel on Wednesday is symbolic of what Nepal has come through.&nbsp;
The ship of state righted itself after the September Storm, installing an interim government that held an election within six months in which voters banished obsolete politicians and their parties into oblivion.
Nepalis, fed up with the inept kakistocracy of the past three decades, took the country into a post-ideological phase — replacing Marxists, Maoists and monarchists &nbsp;with a belief in a new governing culture that rewards delivery and accountability. And they have trusted the RSP to carry it through.
Nepal’s history has never been linear, it jerks ahead in lurches. The polity also tends to take one step forward and two steps back, so the public’s great expectations is tempered by a sense of cautious optimism and guarded pessimism.
This could be the great leap forward that Nepalis have waited for and deserve, but it could also be a Gramscian interregnum in which the old is dead and the new is not yet born. We will have to wait to see whether this transitional period will also see ‘morbid symptoms’.
As disruptor-in-chief, it was the Balendra Shah ‘wave’ or ‘craze’ that propelled the RSP to power. The former Kathmandu mayor needed a party platform, and the RSP’s tainted leader Rabi Lamichhane required a booster. Nepal's voters were looking for a saviour.
Personality-wise Shah and Lamichhane are poles apart: one is Type B and the other Type A. One is enigmatic, the other phlegmatic. But yin and yang do also tend to complement each other.&nbsp;
Kathmandu’s chattering class is already making self-fulfilling prophecies about the two falling out, and are fishing for hints that they already have. Shah’s absence from the RSP’s orientation this week was taken as a clue.&nbsp;
Closing the two-day tutorial on Wednesday, Lamichhane delivered a fiery 30-minute speech that laid out the RSP’s main agenda: to function differently from the old parties, serve the people, avoid middlemen, become true lawmakers without taking the law into their own hands.&nbsp;
“The old political parties contributed to history, we will build the future with a new political contract with citizens,” he said, trying to rise over past controversies and his abrasive rhetoric to sound statesmanlike.&nbsp;
GIVE AND TAKE
Lamichhane is said to be in touch with the reclusive Shah to announce a compact cabinet next week. Its composition will be an indication of how much give-and-take there was, and whether the criteria for selecting ministers is competence or loyalty.
Will RSP ministers behave like rulers or service providers? The new government will dive right into the economic fallout of the West Asia war with soaring fuel &nbsp;prices, inflation and uncertainty about remittance inflows.
On Thursday, Gagan Thapa resigned as NC chair, taking moral responsibility for the party’s election loss. The UML’s unrepentant K P Oli does not share the same sentiment about who is responsible for his own party’s historic downfall.&nbsp;
NCP chair Pushpa Kamal Dahal, who was luckier than his cross-party cohort, is now a comparative relic in a Parliament largely comprised of freshmen and sophomore lawmakers.
But the NC, UML and NCP still control provincial and most municipal governments. The old parties could try to make things difficult for the RSP at the centre, but it is also an opportunity for them to clean up their act ahead of local elections next year.&nbsp;
Another test for the RSP will be dealing with a heavily-politicised klepto-bureaucracy which has to frontend its policy decisions. &nbsp;

global-vaccine

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Redefining the criteria for beauty

Motherhood in the Madhes

Soon, the monsoon

People’s power