<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222d29c7e80680e0c0318jpeg.jpg" alt="" width="1400" height="905"/><figcaption>Photo: NEPALI TIMES ARCHIVE</figcaption></figure>Every year, half a million Nepalis fall below the poverty line paying for expensive medical care. Another three million face financial burden, unable to pay hospital bills even after selling their assets. This is over 10% of Nepal’s population.Nepal might have taken dramatic strides in reducing maternal mortality and childhood malnutrition in the last decades, but it is lagging behind in assuring accessible and affordable healthcare for its people.This is a crime, it goes against the Constitution which guarantees basic health care for all Nepalis. Like other social sectors including education, healthcare is either over-commercialised or offers substandard service.Public health is just not the priority of the government, especially when it comes to the poorest and most neglected sections of society. The state’s investment in healthcare is inadequate, and the budget allocation for the health sector is considerably lower than the global average of 10% of GDP, and is less than most developing countries.Read more: <a href="https://www.nepalitimes.com/here-now/grassroots-democracy-promotes-good-health/">Grassroots democracy promotes good health</a>, Sagar BudhathokiEven the budget that is set aside for healthcare is mostly spent on shoddy infrastructure, or procuring unnecessary and expensive equipment that is never used. There is little left for trained medical personnel and retaining them in remote area hospitals.Nepalis are sick because they are poor, and they are getting poorer because they are sicker. Most families that cannot afford treatment in private institutions have to sell property or borrow from loan sharks to pay medical bills.Private hospitals and clinics operate on free market principles, and need a return on investment. The most lucrative business in Nepal today is medical education, and the sky high fees in those colleges perpetuate the cycle of over-priced medical treatment.Read more: <a href="https://archive.nepalitimes.com/news.php?id=18362#.YrLw3-xBzDI">Do hospitals have to be so expensive?</a> Elipha PradhanangaHealthcare should not be guided by the free market, and as long as the state does not take responsibility for the wellbeing of its citizens we will never achieve equity.Medical care cannot be a commodity, patients are not customers.Primary health care (PCH) is free in government hospitals in Nepal, and is paid for through taxes. Specialised medical care is best covered by insurance so the cost is not passed on to patients and their families. But in Nepal, primary health care is too basic, government hospitals are crowded and understaffed, and private hospitals are out of reach of most.A welfare state with a social safety net pays for free healthcare through taxes, or insurance. Tax revenue goes for other sectors besides health, but medical insurance is targeted for specifically for health.Countries like Bhutan, Cuba and Sri Lanka show that it is indeed possible to achieve free universal healthcare. Nepal itself has public-private partnership models like Bayalpata Hospital. Replicating these examples requires political will, and a national vision.Read more: <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/">This is how to upgrade Nepal’s rural health</a>, Sewa BhattaraiOur salvation may lie in national health insurance that is mandatory and where the premium is based on a family’s capacity to pay. Nepal introduced its national insurance scheme in 2017, and the premium is now Rs3,500 per year per family for a benefit package of Rs100,000. But this does not even pay for an ambulance to a city hospital.Late reimbursement to care providers is chronic, and hospitals now want to pull out from the national insurance program. Patients are cannot access timely treatment, and  are dropping out.To correct this mistake, the government is making another blunder: hand over management of health insurance programs to the private sector.The state is giving up on health insurance without even trying, abandoning citizens and leaving them at the mercy of profiteers.Letting the private sector manage health insurance defeats its very purpose: providing equitable and affordable medical care for those most in need and to prevent them from falling into the poverty trap.A better alternative is to work within the existing health insurance program by upgrading its features including the revaluation of the premium and benefits, bringing in private institutions for research and technical know-how, and digitisation of reimbursement for care providers.There are ways the Nepali state can fulfil its constitutional obligation to ensure healthcare for all, and deliver on promises not kept. It just has not tried hard enough.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 KalauneeSonia Awale

Sonia Awale

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In a healthy state

<figure><img width="1400" height="663" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814110/636a52fe9c7e80680e052328jpeg.jpg" alt=""/><figcaption>Photo: PRAKASH SINGH</figcaption></figure>Last month Kalpana BK delivered a healthy newborn baby on the way to <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a>, but her placenta did not come out spontaneously. As a female community health volunteer, she was usually the one providing support for women before, during and after they give birth. But when the road to the hospital was blocked for nearly 10 hours by a landslide (above) she became <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">the emergency</a>, bleeding massively and was increasingly short of breath.Luckily, once she finally made it to the hospital near Sanfebagar, Kalpana BK’s retained placenta was removed and she was transfused with blood. Today she is recovering from her life-threatening post-partum haemorrhage. More recently at Bayalpata, a surgical team was preparing to perform an emergency caesarean section to save both the mother and foetus. But the surgery was delayed for 20 minutes because of lack of water needed for the surgical team to scrub in, protecting the patient and her baby against infections. The delay significantly heightened the risk that the two lives would be lost, not saved.Across Nepal, <a href="https://www.nepalitimes.com/opinion/nepals-silent-emergency-springs-going-dry/" target="_blank" rel="noopener">traditional springs are going dry</a>, and hospitals are also affected. Without adequate water, staff at health facilities are finding it increasingly difficult to maintain cleanliness and best practices for preventing infections. When this happens, hospital-acquired infections are likely to rise. <figure><img width="1500" height="712" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110814110/636a53019c7e80680e052329jpeg.jpg" alt=""><figcaption> </figcaption></figure>Due to a combination of factors, such as <a href="https://www.nepalitimes.com/opinion/where-is-the-monsoon-this-year/" target="_blank" rel="noopener">lower rainfall</a> and <a href="https://www.nepalitimes.com/opinion/turning-on-the-heat/" target="_blank" rel="noopener">rising temperatures</a> caused by <a href="https://www.nepalitimes.com/banner/weather-warning-for-climate-meeting/" target="_blank" rel="noopener">climate change</a>, rampant construction of poor-designed roads, <a href="https://www.nepalitimes.com/banner/who-now-owns-nepals-forests/" target="_blank" rel="noopener">deforestation</a>, overpopulation, overconsumption and inadequate maintenance of pipes and wells, Nepal’s mountains are suffering <a href="https://archive.nepalitimes.com/article/editorial/h20-shortage,3456" target="_blank" rel="noopener">water shortages</a>.Roads are supposed to improve access of patients to hospitals, but have themselves become killers in two ways. <a href="http://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Haphazard construction triggers landslides</a> that endanger lives, and roads are blocked, delaying patients like Kalpana BK from reaching hospitals in time. These two recent examples of a landslide and water shortage in Achham reflect the adverse impacts of worsening environmental conditions on our health system and their possibly devastating impact on people who are already ill and often vulnerable. So-called ‘natural disasters’ actually have a strong connection to human decision-making and are frequently caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">reckless road construction</a> that does not pay sufficient attention to environmental factors.Navin Bhatt, staff physician at Bayalpata Hospital, says environmental degradation can undermine health care delivery: “Deforestation is one of the causes of landslides, which lead to roads being blocked, hampering the transportation of people who are ill to the hospital. Rising temperatures are resulting in more <a href="https://www.nepalitimes.com/banner/hisss/" target="_blank" rel="noopener">snake bite</a> cases. The quality of healthcare services is affected by environmental pollution.” The urgency to recognise that health and the environment are strongly connected is growing worldwide. To raise awareness about the issue and motivate grassroots solutions to these problems, the World Health Organisation announced in its ‘Ten threats to Global Health in 2019’ that <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">air pollution</a> and <a href="https://www.nepalitimes.com/editorial/climate-climax/" target="_blank" rel="noopener">climate change</a> are the number one public health threats. Nepal Government officials at all levels, health workers, environmental experts and development partners need to collaborate with advocates for <a href="https://www.nepalitimes.com/banner/between-existence-and-extinction-in-nepal/" target="_blank" rel="noopener">ecological balance</a>. Only when we work hand-in-hand rather than in isolation, can we take tangible steps to prevent environmental damage and restore healthy and resilient ecosystems.   Bikash Gauchan is a doctor in Achham. Nathaniel Uchtmann is a medical doctor and lawyer.

Environmental destruction is a medical emergency

Samsung Nepal has opened pre-orders for the Galaxy A57 5G and A37 5G. Both phones run Samsung’s One UI 8.5, featuring AI capabilities like voice transcription, Circle to Search, and photo editing. They feature a 50MP triple-camera system, a Super AMOLED display, and six years of OS and security updates.

Galaxy A series

Know your Ministers

‘One early morning, we heard the ambassador’s wife cry out, “Ram, Ram, Ram!” A disaster has befallen Nepal!” She had heard on the radio that a fire had consumed Singha Durbar." This is not about the arson attack on 9 September 2025, but the one on 8 July, 1973. It started in the South Wing of the then single-largest building in all of Nepal. It took two days to bring the blaze under control, requiring the use of explosives to demolish one wing to protect the imposing western facade. As Bhekh Bahadur Thapa recalls in the English translation of his memoir A Life in Public Service: Nepal from Autocracy to Democracy, he was then on leave from the Nepal government serving with the IDRC in Ottawa.&nbsp; He had already served as Nepal’s Finance Secretary at age 25, went on to be Finance Minister and Governor of Nepal Rastra Bank. He was already younger than some of the GenZ ministers in Nepal’s present RSP government. Thapa, now 89, was at the launch of the book in February which was attended by former diplomats and bureaucrats. After speeches by panelists, there was a question from the audience about how Thapa had managed to be the diplomat he was, managing Nepal’s international relations on the world stage.&nbsp; Writer and journalist Akhilesh Upadhyay, who was moderating the panel, responded by going into the section of the book where we see Thapa as an ambassador to the US, playing tennis with White House officials, cultivating a network of contacts to project the identity and welfare of Nepal, and making it possible for a state visit by King Birendra to Ronald Reagan’s America. The book is full of anecdotes that suggest Thapa was a clever and strategic diplomat, always calm and unruffled, easily making friends in high places with his maturity and engaging sense of humour. Thapa’s memoir is heavy on details about Nepal’s administrative history during the years he was active in public service, serving as minister and ambassador under three kings: Mahendra, Birendra and Gyanendra, and alongside five prime ministers.&nbsp; Aside from an insider look on how certain treaties, development deals and research projects in Nepal came into fruition, Thapa goes into great detail about his personal and professional relationships with the kings, ministers, ambassadors, foreign leaders and politicians.&nbsp; As a reader, one is struck by the level of detail around the events that unfolded in Nepal over the years during Thapa’s tenure. Was Thapa recording a journal over the years of the events and the conversations that transpired, or were they committed to his phenomenal memory? Either way, the reader gets a glimpse of Nepal’s recent history from the early days of the Panchayat, through the People’s Movement and the democracy period, the Maoist insurgency, Royal Palace massacre of 2001, and Gyanendra’s coup of 2005.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4.jpg" data-media-id="editor_0" data-image-id="2026041204048_125dc8ae300a1e33124f394abe724d42727f83e067b0201d2008b58d60c459a4" data-rendition-name="original" width="1584" height="1000" loading="lazy" alt="How to win friends and influence nations NT"> </figure>  Not enough is said about the political parties of the time whose presence led to the way Nepal’s multiparty democracy came to be shaped. The book keeps its focus on the administration and the key figures around it, mostly those in the Panchayat era. Towards the second half of the book, we do start to hear about political parties, but not in great depth. Another figure whose presence in the book is conspicuously less prominent is that of his wife, Rita Thapa — the person who seems to have rescued him every time financial quandary or family care became a challenge. Yet, we do not see her as a full person. Perhaps because of the personal tragedies in his life, the children are also barely mentioned.&nbsp; The book is therefore less personal and more technical. Throughout, we learn about Thapa’s thinking as he navigated the world of diplomacy to win him the trust of those who mattered. There are tips here for a new generation of Nepali officials and diplomats about how much commitment and focus is needed to be good at one’s job and serve the national interest. This book adds to tomes that have been written on Nepal’s fragile relationship with India. ‘India has always wished for Nepal to remain dependent on it,’ writes Thapa, who served as Nepal’s ambassador to India and later in the Eminent Persons Group &nbsp;on Indo-Nepal relations that has been allowed to languish. The book has several insights into the Indo-Nepal trysts with diplomacy and agency.&nbsp; China’s role is also recorded, viewed through conversations during a visit to Beijing, but all that was before Nepal’s neighbour to the north emerged as a world economic and military power. The book also has such sudden instances of quirkiness and humour. For instance, we see a young Thapa in America explaining to a government official why he would like to return to Nepal instead of settling down in the US. “Because, Nepal is beautiful,” he said. The text is immaculate and does not read much like a translation, credit for which clearly goes to the team that put the edition together: translator Prawin Adhikari, &nbsp;Anagha Neelakanthan and Bhekh Thapa’s daughter, Manjushree. As Nepal enters a new era of governance and diplomacy, A Life in Public Service: Nepal from Autocracy to Democracy should be essential reading for students of political science, economics and foreign affairs who can gain a fresh perspective on the country’s trajectory.&nbsp; There are dozens of forgotten state secrets recorded in the book, but the reader must also remember this is a story told from one person’s perspective and there may be others.&nbsp; So, what really made Thapa the diplomat he was? I met him in 2004 at the Kantipur TV studio when he was serving as king Gyanendra’s foreign minister. He was there for a studio interview, and I was just done with my English newscast.&nbsp; He surprised me at the door: “Pratibha! I’ve been reading your articles in The Kathmandu Post. You must keep writing.” I thanked him, glad to have been noticed for my work by a stranger. That was perhaps one of the things that set Thapa apart — he excelled at staying close to those in power, while also noticing those who were not.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f.jpg" data-media-id="editor_1" data-image-id="20260412040412_213e706136a038ec9f5e2b8c6d7f7c1e9ceed9479e22fe2884872ad7bd20955f" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Book details"> </figure>

How to win friends and influence nations

Prime Minister Balendra Shah on Wednesday broke tradition and met with 17 foreign envoys collectively, a move that was a notable departure from how his predecessors operated.&nbsp;
Shah had already set himself apart by talking less, listening more, and delegating to trusted friends. But by meeting all ambassadors at one go in the presence of the Foreign Ministry, he signalled a paradigm shift in how he wants Nepal to be seen: no longer just balancing India and China, but as a country confident about its <a href="https://nepalitimes.com/opinion/guest-editorial/tripolar-contestation-over-nepal">strategic importance and place in the world</a>.
In just two weeks, the <a href="https://nepalitimes.com/news/rsp-dos-and-don-ts">RSP has sprung into action </a>on multiple fronts to implement its ambitious 100-point, 100-days action plan. It has taken short-term measures to mitigate the impact of the Gulf war, as well as medium- and long- term measures to streamline the bureaucracy. A few high-profile figures have been made examples of to drive the message home.
Earlier this week, the government recalled six politically appointed ambassadors, the most notable being long-serving Shankar Sharma from New Delhi. The Kathmandu District Court issued arrest warrants against former prime minister Sher Bahadur Deuba and his former foreign minister wife Arzu Rana on charges of money laundering and corruption.
Each ministry has been trying to clean up the accumulated rot from the past three decades: regulatory overhaul of microfinance, education, health and service delivery.&nbsp;
These actions widely disseminated campaign-style on YouTube and TikTok have made most Nepalis hopeful that the party they installed in power means business.
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BACKLASH
But such attempts to overhaul a long-entrenched political culture were bound to face backlash. In their impatience and enthusiasm to get things done, some of Prime Minister Shah’s ministers have over-reached.
It was common knowledge that government-paid advertising in the mainstream press was kickback-driven, but the PMO’s directive that official notices be published or broadcast only on state-run media has been denounced — especially as the media industry struggles to stay afloat.
More serious are some recent appointments by ministers of relatives and figures closely associated with the RSP to key positions. This has rankled because this party built its political plank on ending nepotism and graft.&nbsp;
News that Home Minister Sudan Gurung allegedly had not paid rent on leased land, which illegally encroached on the lake in Pokhara did not help. &nbsp;
Prime Minister Shah himself has come under scrutiny for appointing a kitchen cabinet full of male buddies from his time as Kathmandu mayor. To douse criticism he brought in as adviser investigative journalist Deepa Dahal, who has exposed corruption in high places of the previous coalitions.&nbsp;
Shah’s appointment of another political adviser Asim Shah to the head Constitution Amendment Task Force, is also seen as problematic. He is a filmmaker and former lawmaker, but does not have a background in constitutional law.&nbsp;
Even more controversial is the Cabinet’s decision to appoint RSP Chair Rabi Lamichhane’s legal counsel, Narayan Kandel, as Attorney General. Kandel used to be a UK permanent resident, and does not have as much experience practicing law in Nepal.&nbsp;
Kandel’s appointment drew flak and raised eyebrows, and with the pending legal cases against Lamichhane this appointment represents a flagrant conflict of interest.
Health Minister Nisha Mehta was also accused of favouritism after reappointing Junu Shrestha, wife of Labour Minister Dipak Kumar Shah, as member of the Health Insurance Board which had earlier suspended her. The Labour Minister’s rambling rant at the Board’s meeting on Tuesday has not helped the RSP’s image.&nbsp;
(UPDATE: On Thursday, Prime Minister Shah sacked the Labour Minister after the RSP found him in breach of the party's code of conduct and discipline. He served 14 days in the Cabinet, one of the shortest tenures for a minister in Nepal )
It is hard to know what <a href="https://nepalitimes.com/news/ball-in-balen-s-court">Balendra Shah is thinking</a>, and how Rabi Lamichhane is going to justify some of these moves. After all, making politics, governance, and bureaucracy a meritocracy has been the core tenet of the RSP, and it risks alienating its mainly youth base if these missteps persist.
But at least for now, most RSP supporters seem to be giving the party the benefit of doubt.

health-facilities

In a healthy state

Environmental destruction is a medical emergency

Galaxy A series

Know your Ministers

How to win friends and influence nations

Nepal’s new government springs into action