<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73eb9c7e80680e062365jpeg.jpg" alt="" width="1500" height="911"/><figcaption>Photo: NATIONAL TRAUMA CENTRE</figcaption></figure>Speeding along a narrow winding mountain road in Dhading, a heavily intoxicated truck driver lost control of the <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">vehicle</a> and it overturned, killing seven and severely injuring 34 passengers hitching a ride.This was a mass trauma incident that required immediate attention, but <a href="http://nationaltraumacenter.gov.np/" target="_blank" rel="noopener">Nepal’s only trauma care centre</a> was located in Kathmandu, 90km away via bumpy roads jammed with traffic.Read also: <a href="https://www.nepalitimes.com/?p=40249&amp;preview_nonce=aefd82ecbe&amp;preview=true" target="_blank" rel="noopener">injured use Internet to reach physiotherapists in Nepal</a>, Sonia AwaleMost passengers from the truck accident were taken to nearby hospitals in Dhading, but the 21 most critical patients were airlifted or driven in ambulances to the National Trauma Centre in Kathmandu.“It had already taken a while to bring the patients to the Trauma Centre, so we had to act quickly once they were here,’’ recalls Pramod Yadav, acting medical superintendent at the facility.The standard protocol for trauma care is the triage system -- determining the priority of treatment based on the severity of injury. Doctors at the National Trauma Centre quickly designated yellow, green and red codes to patients to ensure that those in critical condition were taken care of first, and fast.Read also: <a href="https://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Unblocking an artery</a>, Sanjeev SharmaOn-call doctors were contacted and began assessing the patient’s injuries. But without a functioning MRI and a faulty CT machine, some had to be sent to private clinics and later returned to the hospital.This is a recurring event for patients seeking immediate care at the government-run Trauma Centre where patients in critical condition have to be moved about from one facility to another for tests.“We cannot afford an MRI machine, it is very expensive to repair our CT machines, we have limited trolley beds and only 11 ICU beds when we need more than 50,” says Yadav. “We are requesting the government for Rs420 million to become a real trauma centre, especially since we are the only one in the country.”There were 60,000 severe trauma injuries in Nepal in the last year, a 3,000 increase from the previous year, and a whopping 27,000 over the year before that. Like with all government-run medical centres, the Trauma Centre lacks resources, is under-staffed, and is incapable of handling this exponential increase.“In the last two, three years, falls, physical assault, <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a>, sports injuries and <a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> have been the leading causes of trauma,” lists  Siddhartha Dhungana, the Medical Record Officer at the National Trauma Centre. “Head injuries and multi-organ failures have been the highest causes of death in these cases.”Most hospitals in Nepal, like the National Trauma Centre, follow the World Health Organisation’s trauma protocol. During a trauma case, medical personnel are contacted as soon as possible, patients are screened, their needs are identified and necessary care is given.Although the government has not developed a standard care protocol for trauma like it has for cancer patients, private hospitals have implemented and refined their own systems based on WHO guidelines.<a href="http://archive.nepalitimes.com/article/nation/politics-behind-epidemic-of-hospital-vandalism,3578" target="_blank" rel="noopener">Om Hospital</a>’s Continuing Medical Education Program is at the forefront of teaching trauma care to new doctors and providing courses on improved techniques to existing doctors.“We make sure that the ABCs of trauma care are followed strictly and that blood is readily available be it from our blood bank or staff-chain blood donors,” says Binod Adhikari of Om, which handles dozens of cases every day and has systems in place to coordinate between doctors, nurses and critical care anesthesiologists to provide emergency care to patients.<h2>Ambulance chasers</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73ee9c7e80680e062366jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Most of Nepal's ambulances are just jeeps with stretchers, with no life-support systems or medical attendants. It was only in 2011 that Nepal’s first emergency medical service was established. Supported by the Patan Academy of Health Sciences and the Stanford University School of Medicine, Nepal Ambulance Service (NAS) has since trained more than 100 emergency medical technicians (EMTs) and ambulance drivers and operates the <a href="http://archive.nepalitimes.com/news.php?id=18888#.XjvhpTIzaUk" target="_blank" rel="noopener">'Dial 102' service</a>. NAS operates mainly in Kathmandu Valley, Pokhara, Chitwan, Butwal and Bhairawa.“Before this, only few private hospitals had ambulances and they were used mainly for patient transfer rather than pre-hospital care,” says Hari Khadka, a paramedic at <a href="https://www.grandehospital.com/" target="_blank" rel="noopener">Grande International Hospital</a> and a member of the first EMT batch of NAS. “Ten years ago, there was simply no concept of pre-hospital care or paramedics in Nepal.”Now, many hospitals have their own EMS systems with mostly Type 3 ambulances that have first aid kits and basic medical supplies. <a href="https://www.nrcs.org/" target="_blank" rel="noopener">Nepal Red Cross Society</a> (NRCS) operates 283 ambulances nationwide. Although not every ambulance carries a paramedic, every driver has received first aid training.“We have five Type 2 ambulances and a paramedic in each vehicle,” says Bipul Neupane of NRCS. “We send these ambulances to patients who need basic life support systems.”But for patients needing critical care in remote areas, there is no recourse but expensive helicopter medical evacuation.Like Type 1 ambulances, some of these helicopters can have doctors, ventilators, advanced life support, and EMTs.“EMS has helped save many lives in Nepal but it isn’t always the best option considering the geography of Nepal and the condition of the roads,” says Sanjaya Karki, Head of the Emergency Department at <a href="https://www.nepalmediciti.com/" target="_blank" rel="noopener">Nepal Mediciti Hospital</a>. “Helicopter Emergency Medical Services ensure that we can get to critical patients as quickly as possible and provide the best pre-hospital care.”

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It’s an emergency: Nepal needs to improve trauma care

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

Is free health care possible in Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903869c7e80680e037cc9jpeg.jpg" alt="" width="1000" height="616"/><figcaption>Photo: SHRADDHA SABURI HEALTH SERVICE</figcaption></figure>As a married, working woman with a child, it was impossible for Jasmine Bajracharya to take days off to care for her ailing parents. T<a name="_GoBack"></a>hey needed physiotherapy, but her father refused to visit a hospital. So they had to get the physiotherapist at home. Both are recovering thanks to home treatment.<a href="https://doctorsonkall.com/">Doctors on Call Nepal</a>, which provided the service to Bajracharya’s parents, is one of many new home care services that have come up in Nepal as the population ages, and their offspring are either abroad or busy at work.“My father is very talkative, so I was worried that he might offend the doctor on call,” Bajracharya says, “but the whole experience turned out to be very useful both for my parents and me, because of good communication and coordination. Now I know I have someone to turn to if my parents need care again.”Home health care has also helped provide jobs in Nepal for staff nurses and caregivers who may have otherwise have <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/">migrated abroad</a>. In turn, as more and more young Nepalis go abroad to study or work, there is a growing demand for care givers who can take care of elderly parents at home, or take them to hospital for treatment.Another service provider is <a href="http://healthathome.com.np/">Health at Home</a> (see box) which was established in 2009 and has now grown into a nationwide network with units in Pokhara, Chitwan and Biratnagar besides Kathmandu.“In the West, every hospital has a home care unit. Its prospects in Nepal indicate that it is the future of medical care, which needs continuous innovation,” says founder Bishal Dhakal.Health at Home and others provide a range of services from nurses, doctors, physiotherapists and lab technicians on call to caretakers, travel support and appointment management. Many provide full doctoral supervision, while a few outsource nurses and caregivers only.The demand for care-givers is new in Nepal, and has grown exponentially to meet growing demand. Their work includes non-professional assistance which nurses do not perform, and some families prefer male health assistants.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903889c7e80680e037ccajpeg.jpg" alt="" width="640" height="808"><figcaption> </figcaption></figure><a href="http://healhomecare.com/">Heal Home Care</a> and <a href="http://www.sshealthservices.com/">Shraddha Saburi Health Service</a> outsource female nurses and caregivers, employing more than a hundred trained personnel each, and one-third of them have been hired by Nepalis living abroad who want their parents cared for.Along with an improvements in physical health, many doctors and clients have also felt that such a service has positive effects on the mindset of elderly people, who prefer not go to a hospital. A simple follow up call or a quick visit brightens up the mood of elderly people who are often lonely, anxious or depressed because of health issues and separation from children.While the increasing demand has led to the mushrooming of home care in Kathmandu, health experts are worried that the quality of care may go down and put the health of the elderly at risk.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/6369038b9c7e80680e037ccbjpeg.jpg" alt="" width="640" height="860"><figcaption> </figcaption></figure>Ramesh Kadel, Nepal’s first Geriatric Specialist, expresses concern over nurses trained in specialized care of the elderly. He says, “Service providers should keep hospitals and doctors in the loop. Our society is not fully geriatric friendly yet, and negligence of elderly people’s health is still prevalent, we need to be more aware and careful.”For the first time in world history, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">the population of people above 60 has exceeded that of children below 5</a>, and in 30 years more proper and holistic health care will be needed for the aging population.“There has been a lot of research and experiment on child health care, but proper research is lacking in the field of geriatrics. What will the future look like for today’s active population when they grow older?” asks <a href="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php%3Fid%3D6370&amp;sa=U&amp;ved=0ahUKEwiKmsT_-u7cAhXRfCsKHY9xDzsQFggHMAE&amp;client=internal-uds-cse&amp;cx=011870630917993763279:opm7uqsat-4&amp;usg=AOvVaw3bqUqf9aY11y1eBubOwlMC">Krishna Murari Gautam</a> of <a href="http://ageingnepal.org/">Aging Nepal</a>, which has started a week-long specialised training for care givers of elderly patients.Doctors on Call Nepal and Health at Home also have a guided selection procedure and orientation program for nurses and caregivers, and a systematic recording of their patients to maintain quality.<h2>Health care at more homes</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/6369038d9c7e80680e037cccjpeg.jpg" alt="" width="1000" height="662">Home care for the elderly is one of their social enterprises that run as a business, while providing a public service. The company <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/Doctor,344">Health at Home won the Surya Nepal Award in 2012</a> for the concept of a socially responsible business. It hasn’t looked back.Nine years later, Health at Home has grown into a nationwide network of home care service company with centres in Pokhara, Kathmandu, Patan, Chitwan and Biratnagar providing much-needed home care for Nepal’s rapidly-aging population. With young men and women migrating abroad for work and studies and a growing demand from their elderly parents for health care, Health at Home is planning to open four more centres.“When we started, it was a small idea. With innovation, the idea turned into an industry and today we look forward to be an influencer that provides global standard health facility in the comfort of patient’s own home,” explains founder Bishal Dhakal.As it grew, the company has corporatised its structure with four partners, and CEO Amit Shrestha. The idea is to serve people in their community by building care capacity through an accountable, transparent and predictable process.“The concept of home care ten years ago was just to send nurses home to take care of the elderly. We are trying to constantly innovate and meet demands from patients for specialised care,” says Dhakal.Shrestha says Health at Home is poised to be a global player in virtual health care. The company is partnering with Samsung to invent a virtual platform for data management of home care parameters. This means doctors and the health management team do not need to visit homes, and can monitor patients remotely, making visits only if intervention is required.“We want to redefine health care for the new generation with new technology,” says Shrestha.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714118/636903909c7e80680e037ccdjpeg.jpg" alt="" width="640" height="960"><figcaption> </figcaption></figure>Health at Home customers have requirements from postnatal to elderly care, patients with chronic diseases, the terminally ill, and dependent patients. The company ties up with hospitals like Mediciti, Nidan, Nepal Cancer Hospital, Sumeru and Green City, and insurance companies like MetLife, Reliance and Citizen Life and various diagnostic labs and pathologist.And there are additional services like Japanese massage therapy and nurse placements with home care specialization. So far, Health at Home has built up a reputation for reliable and personalised care that is responsive to the needs to patients.With Nepal’s population expected to reach 33 million by 2030 with nearly 15% of them above  65, there will be an ever-greater need for elderly care. Combined with out-migration of the young, this means the field is wide open for innovation and expansion in home care services.Read also: <a href="https://www.nepalitimes.com/banner/lets-talk-about-it/">Let’s talk about it</a>, Duksangh Sherpa<a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a href="http://archive.nepalitimes.com/article/nation/malnutrition-stunting-wasting,3603">Thought for food</a>, Marty Logan

Caring for those who cared

Nepal’s fertility rate is going down even though contraceptive use has not increased<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/636517189c7e80680e02c252jpeg.jpg" alt="" width="1400" height="933"/><figcaption>THE RIGHT SHOT: Health worker Januka Dhakal injects Depo-Provera on a woman at Rayale Health Post of Kavre district on Tuesday. With their husbands away, fewer women now want to use contraceptives. Sonia Awale</figcaption></figure>Sita Yonjan, 21, has a two-year-old daughter, and recently stopped using <a href="http://archive.nepalitimes.com/article/from-nepali-press/Ftnp-the-curse-of-the-contraceptive,493">contraceptives</a> even though she is not planning to have another child. She says she doesn’t need her birth control implant anymore because her husband went away to work in Qatar two months ago.Yonjan visited a health post in Rayale village of Kavre to remove the birth control implant that she had inserted last year. The tiny device prevents births for five years, and does not need to be removed even when users abstain from intercourse. But many Nepali men want their wives to stop using contraceptives when they leave for overseas work."My husband thinks I could sleep with anyone if I use contraceptives in his absence," Yonjan frankly admits.An estimated four million Nepali men of reproductive age <a href="http://archive.nepalitimes.com/article/nation/The-cycle-of-migration,3230">work abroad</a>, and their wives back home generally see no need for contraceptive implants, preferring to use short-term methods like condoms, pills and injectables when their husbands come home on leave. Like Yonjan, those using IUDs and implants remove them as soon as their husbands go away again.https://www.youtube.com/watch?v=8lXkqrDtUOUDemographers say this explains the riddle about why Nepal's fertility rate has been going down despite contraceptive prevalence rate remaining low.When Nepal conducted its first-ever nationwide health survey in 1996, only 26% women were using modern contraceptives. Within ten years, it had nearly doubled to 44%, but has leveled off since. The contraceptive prevalence rate actually declined to 43% in 2016, when the last National Demographic Health Survey (NDHS) was conducted. Even so, the fertility rate that measures the average number of children per couple has been going down -- from 4.6 in 1996 to 3.1 in 2006 and 2.3 in 2016 (see graphs, overleaf).Demographers were initially puzzled by the drop in the fertility rate despite contraceptive use rate flatlining. But an analysis in 2013 suggested a correlation between male outmigration and contraceptive use. Another analysis is now underway, which will probably confirm the impact out-migration of men may be having on contraceptive use and fertility rate."If we consider only women who are married and living with husbands, we find a high contraceptive prevalence rate," explains Sharad Pathak, a demographer at the government’s Family Health Division. "This rate is low only because lots of women generally do not need contraceptives when their husbands are away."<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/6365171c9c7e80680e02c253jpeg.jpg" alt="" width="900" height="826">However, experts warn that Nepal’s declining fertility rate may not mean that population growth will reach replacement level -- one in every four married women still have an unmet need for family planning. A third of young married women aged 15-19 do not use contraceptives, making them more vulnerable to unintended pregnancies and unsafe abortion.Kristine Blokhus at the UN Population Fund (UNFPA) says Nepali women are aware of the benefits of having fewer babies, but face barriers in accessing contraceptives: "Health facilities often run out of contraceptive stocks, and there are not enough trained health workers to provide long-term contraceptives like implants and IUD."A 2016 UNFPA assessment showed most health posts provide only condoms, pills and injectables because of the lack of trained staff. Only one third of the facilities provide all five types of modern contraceptives including implants and IUDS. In most villages, women have to choose between oral pills or Depo-Provera, which they cannot use if there are side effects. Male or female sterilisation is available occasionally, and most women complain their husbands do not want to use condoms.With rising female literacy, the number of women opting for traditional family planning like withdrawal and the rhythm method instead of modern contraceptives is also going up. In 1996, only 3% of married women used such natural methods, now it is 10%. However, the NDHS 2016 showed that 62% women using the rhythm method to avoid pregnancy did not have an accurate knowledge about the ovulation cycle.Nepal’s target is to increase its contraceptive prevalence rate to 52% by 2020, but it may not meet that goal because of male migration, the preference for natural methods, and family planning programs being scaled back due to a drop in U.S. funding after the <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841">gag rule under President Trump</a>. The United States has traditionally been the main supporter of family planning projects in Nepal, through organisations like Marie Stopes International that provide abortion services.Beth Schlachter, Director of Family Planning 2020, who recently visited Kathmandu to take stock of Nepal's progress, says: "The US gag rule might affect Nepal's family planning programs if organisations delivering safe abortion services here do not find other resources to supply contraceptives."Since Nepal is poised to become an 'aging' <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624">society by 2030 and an 'aged one' by 2050</a>, there is an even greater need to scale up family planning. For the country to reduce its dependency ratio and <a href="http://archive.nepalitimes.com/article/editorial/editorial-reaping-demographic-dividend,3621">reap the demographic dividend</a>, many more women must have easier access to a much wider range of contraceptives.The mix mattersWhen Nepal launched its first population control campaign in the late 1960s, its population was only 13 million, it was growing at 3% per year because the fertility rate was nearly 6 children per couple. The only contraceptive choice women had then was to get their partners to use condoms. Most men did not like using them, and women did not have any control over reproductive health. The pill could have given women freedom to limit or space births, but they were scared of its side effects.Later, injectables like Depo-Provera and IUDs were introduced and today the government provides five types of contraceptives for free, and conducts health camps offering permanent family planning methods like male as well female sterilisation. But many other contraceptives like emergency pills and female condoms are available only in private clinics, and most rural women cannot use them even if they want to.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141140/6365171e9c7e80680e02c254jpeg.jpg" alt="" width="900" height="609">Beth Schlachter, Director of Family Planning 2020, says Nepal needs to provide a much wider mix of contraceptives in order to protect women from unintended pregnancies, unsafe abortions and maternal deaths: "What a 15-year-old girl needs might be different from what a 24-year-old mother of two children needs," she says. "If we try to address all of them with just one or two methods, we will not be very successful."Marie Stopes International is preparing a pilot program to test the acceptability of a new type of Depo-Provera called Sayana Press which can be injected at home and would suit women who do not like to visit health posts every three months for their Depo-Provera.Read also:<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841">Cutting the lifeline</a>,  Kate Ryan<a href="http://archive.nepalitimes.com/article/editorial/editorial-reaping-demographic-dividend,3621">Reaping the demographic dividend</a>, Editorial

Migrating males and population decline

The Himalayan mountains are also known as the Third Pole because it is the largest repository of water stored as ice outside the two polar regions. However, it is divided by political boundaries that nature does not recognise – be it the air pollutants that flow or migratory birds that fly over the peaks. The Himalaya is also a geopolitical and climate change hot spot. In these geopolitically and environmentally challenging times, it becomes even more important to create oases of conversations, where candid and future-oriented discussions can take place at a people-to-people level. Platforms dominated by inter-governmental agencies have been able to do little. The Himalayan Future Forum (HFF) aims to be a platform that stands at the crossroads of climate, community, and connectivity, fostering dialogue and promoting citizen-led action. Growing up in the Indian Himalayan town of Kalimpong and spending the nascent stages of my career helping in setting up offices of the award-winning Annapurna Conservation Area Project (ACAP) that fostered community involvement in conservation, I have witnessed transformations both good and bad.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205070244_6e2087b11fff0cc6704eebaee6f169848a9cfd57c4a02d7d1fd45db2526d2f67.jpg" data-media-id="editor_0" data-image-id="20260205070244_6e2087b11fff0cc6704eebaee6f169848a9cfd57c4a02d7d1fd45db2526d2f67" data-rendition-name="original" width="5559" height="3711" loading="lazy" alt="HFF 2026"></figure>  There are initiatives like Nepal’s forest cover doubling in 30 years, or Bhutan’s drive for high-end sustainable tourism. At the same time, I have seen landscapes destroyed by bulldozers and tall buildings competing for air and sunlight in expanding cities. From crony capitalists patronised by political leaders engaged in plundering natural resources to citizen-led initiatives on cleanliness drives and waste management, the Himalayan region is full of stories from both ends of the spectrum of disappointment and hope. Life is about observing and, in one’s little sphere of influence, taking baby steps towards catalysing positive transformation. This is why, Nepal Economic Forum (NEF) had been hosting the Himalayan Consensus Summit in Nepal from 2014 to 2020 following which the Himalayan Future Forum (HFF) was incubated since 2023. HFF is an initiative to encourage multi-faceted dialogues on the topics of climate, community, and connectivity in the Himalayan region by bringing together leaders, experts, institutions, and practitioners from different countries and sectors.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205070244_a7e673507dcdb6e265cb6f76f2890f17af36f17006a7f6d0f2f0e1a288c89a09.jpg" data-media-id="editor_1" data-image-id="20260205070244_a7e673507dcdb6e265cb6f76f2890f17af36f17006a7f6d0f2f0e1a288c89a09" data-rendition-name="original" width="5364" height="3581" loading="lazy" alt="HFF 2026"></figure>  In this year’s edition, there are a series of sessions on 6 February with 34 speakers including ten international panelists. On day two the Himalayan Haat aims to showcase a variety of local, indigenous, and sustainable products. As in 2024, it is believed that the conversations and interactions at the HFF will lead to more partnerships and collaborations from climate financing to managing disasters to taking Himalayan brands global. YOUNG FELLOWS Beyond this, there are sessions on topics such as geopolitics and the Himalaya, as well as on migration which are especially relevant considering the past few years that have seen many events which impacted the global world order. One of the key features of HFF, guided by our ethos of bringing together experts, experiences, and enthusiasm, is also to ensure stronger youth representation through the HFF Youth Fellowship. This year, following a rigorous screening process, youth fellows were selected out of an overwhelming response. Those chosen will be able to attend the events as well as collaborate in future research and publications. Selected fellows will also be provided with full scholarships to the public policy program at Takshashila Institution, an independent centre for research and education in public policy in Bangalore. In a region where half of the population is under 25 years, it is important to get the future generations also in the room.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205070244_3416bd14d5249afeb357b11f760f49b0cd1d77feeac71d820406b2d9e86696bc.jpg" data-media-id="editor_2" data-image-id="20260205070244_3416bd14d5249afeb357b11f760f49b0cd1d77feeac71d820406b2d9e86696bc" data-rendition-name="original" width="5273" height="3520" loading="lazy" alt="HFF 2026"></figure>  Nepal presents an ideal location to hold meetings such as this, where no-holds-barred conversations can take place face-to-face. The country has good air connectivity and one of the most liberal visa policies in Asia. And while Davos is a good example to follow for convening global voices, we need not have so many private planes burning fossil fuel, as we can have participants take scheduled commercial flights or have regional participants simply take a road trip. Ultimately, the Himalayan region is also about festivities. No exchange of ideas is complete without immersing in art, culture, culinary experiences, and music. This is why HFF envisages graduating to a Himalayan Jatra, rooted in a region where people smile from the heart, and teach the world to smile with them. Join us at HFF 2026 as we move closer to this vision. See the schedule <a href="file:///Z:/%231297%20February%206/pix/page%209/HFF%202026%20Program%20Schedule%20(1)_compressed.pdf">here</a>. Sujeev Shakya is Chair of Nepal Economic Forum and Convenor of the Himalayan Future Forum.

Himalayan Futures Forum 2026

Kathmandu Valley alone now has over 700 cafes serving mugs made from freshly ground beans. ‘Americano double shot’, ‘Cappuccino’ and ‘Mocha’ have entered the Nepali language. It has also become a cash crop for thousands of farmers with near-perfect growing conditions along the Himalayan foothills.&nbsp; Yet, annual coffee production has declined by 15% to only 550 tons in the past years, and this meets only a fraction of the domestic demand of 6,000 tons.&nbsp; Nepali coffee fetches $22 per kg in the international market, but Nepal only exports 3% of its crop. If cleverly promoted, the international demand for Nepali coffee can be 8,000 tons. “Coffee is all about story-telling,” explains <a href="https://archive.nepalitimes.com/article/business/Gagan-Pradhan-and-Himalayan-Java,1076">Gagan Pradhan, founder of Himalayan Java Coffee</a>. “Nepali coffee has brand value because it is grown in the highest elevations on earth and is a cash crop for cooperatives and small farmers. There is tremendous potential for growth.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100216_1f366d8a85cc133fedee0ee72d7768d3a23bf51f8d43edbdadf98443bc0c01ba.jpg" data-media-id="editor_1" data-image-id="20260205100216_1f366d8a85cc133fedee0ee72d7768d3a23bf51f8d43edbdadf98443bc0c01ba" data-rendition-name="original" width="2000" height="1518" loading="lazy" alt="coffee culture in Nepal"> </figure>  The reason for the decline in coffee production lately is attributed to erratic weather caused by climate change, but mostly it is because it is manual-intensive, needing initial capital and patience for a return on investment. The strategy that makes most sense for <a href="https://nepalitimes.com/here-now/make-way-for-makalu-coffee">Nepal’s coffee industry</a> is to sell it as a rare, specialty product.&nbsp; Says Raj Kumar Banjara, master trainer at Nepal Coffee Academy and originator of the Himalayan Arabica brand: “There is no better crop for Nepal because we have the ideal soil and weather to grow specialty coffee, which can be exported to third countries directly instead of sending it through India like with ginger, cardamom, or tea.” These favorable conditions are at altitudes between 800m to 1,600m along the mid-mountains and temperature not exceeding 22°C, which allows cherries to &nbsp;develop slower, giving it a denser taste with complex flavours of fruits and nuts.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100216_35e470381d258d9598d30165d0dbb6b4294c389c61695bf8c47d72d2273b4629.jpg" data-media-id="editor_3" data-image-id="20260205100216_35e470381d258d9598d30165d0dbb6b4294c389c61695bf8c47d72d2273b4629" data-rendition-name="original" width="3872" height="2592" loading="lazy" alt="coffee culture in Nepal"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100216_f7ccb42d7a7fb656dadc7ba5132a6243b8f99a28f7877875172411b7a4c96bc0.jpg" data-media-id="editor_4" data-image-id="20260205100216_f7ccb42d7a7fb656dadc7ba5132a6243b8f99a28f7877875172411b7a4c96bc0" data-rendition-name="original" width="1024" height="768" loading="lazy" alt="coffee culture in Nepal"> </figure>  This is ‘Arabica’ coffee, and it is also considered ‘organic by default’ because farmers have limited access to chemical pesticides and fertilisers, adding to its premium. All of Nepal’s coffee is grown in only 4,300 hectares total, and this is just 0.36% of the area suitable for coffee farming. Still 31,000 households across 44 districts depend on this cash crop.&nbsp; Challenges include out-migration, limits on land ownership, and climate breakdown leading to colder, drier winters, droughts and heat stress. Shreeyanch Shrestha is the founder of Samparka Cloud Loyalty, a startup that helps businesses retain customers by giving them insights about customer behaviour. Among the services offered is a digital loyalty card for coffee shops, one of his biggest clientele.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100216_c80e17ac78016ae5a90f4b27105e16af6c39d1422665f9f9c9b1d8404e5e7d54.jpg" data-media-id="editor_5" data-image-id="20260205100216_c80e17ac78016ae5a90f4b27105e16af6c39d1422665f9f9c9b1d8404e5e7d54" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="coffee culture in Nepal"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100212_968c5b264ec2fb65014dc3ebc2777f0bf19f596a4152c59f9cad9d99dee79df7.jpg" data-media-id="editor_6" data-image-id="20260205100212_968c5b264ec2fb65014dc3ebc2777f0bf19f596a4152c59f9cad9d99dee79df7" data-rendition-name="original" width="1200" height="900" loading="lazy" alt="coffee beans"> </figure>  Shrestha is also a coffee enthusiast, and recently collaborated with Baato Maps on the playfully designed ‘Kathmandu Coffee Map’.&nbsp; “This was a marketing campaign but also a way to pay tribute to cafe owners we worked with,” he says. “A new generation of coffee farmers, processors, roasters and consumers seem to want to invest in upgrading their coffee experience.” COFFEE CULTURE Operators such as Raj Kumar Banjara have been in that game for over 30 years, even earning a PhD in Coffee Agriculture, running farms and teaching roasting and barista courses. Now, he makes short how-to videos on social media. Banjara’s Academy is run by Specialty Coffee Association certified Q Graders and Authorised Trainers.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100216_22433d3a8b71224cd8cb38105b9eb5502a104e03ccec2e3864c8b23efc9f3fc6.png" data-media-id="editor_7" data-image-id="20260205100216_22433d3a8b71224cd8cb38105b9eb5502a104e03ccec2e3864c8b23efc9f3fc6" data-rendition-name="original" width="3612" height="2028" loading="lazy" alt="coffee culture in Nepal"> </figure>  Also promoting a coffee culture through social media is Santosh Shah of Bariko Coffee. He documents his process on Instagram, from hand picking and processing coffee cherries to brewing.&nbsp; Nepal appears to be riding the Third Wave of Coffee (see box) as the beverage moves away from the café chain culture to one that values knowledge of the cherries, beans, the roasting process and brewing -- right from the plant to the cup.&nbsp; Along the way, there are tales to be told about where the coffee is grown, who grows it, and how farmers get a fair price for the product. Coffee then becomes a shared social experience that directly connects the consumer to the producer. Nima Tenzing Sherpa returned to Nepal from the United States to start Lekali Coffee Estate in 2018, and produces fine single origin coffee beans so that the quality of the product improves the quality of life of the growers.&nbsp; He told Nepali Times: “Specialty-grade beans are the only future for Nepal’s coffee industry. I am continuously hunting for the best coffee origins in Nepal.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260205100212_e08ba44d6396eb75da868404dd8cf2a26b71cd6d90ab3afaf7175790c111d21e.jpg" data-media-id="editor_8" data-image-id="20260205100212_e08ba44d6396eb75da868404dd8cf2a26b71cd6d90ab3afaf7175790c111d21e" data-rendition-name="original" width="3000" height="4000" loading="lazy" alt="coffee beans"> <figcaption>Photo: LEKALI COFFEE ESTATE </figcaption> </figure>  HISTORY OF COFFEE Human consumption of coffee began in Ethiopia when herders found their goats became perky after eating beans from a wild Arabica bush. The first commercial cultivation of the brew began in Yemen 600 years ago. &nbsp;&nbsp; Nepal’s coffee history is much younger. A holy man is said to have brought coffee seeds from Burma in 1938, and planted them in Gulmi, the district in the mid-mountains where the first coffee nursery was set up in 1981. The Nepal Coffee Company was founded in 1983 by Krishna Ghimire in Manigram near Butwal which educated farmers about the crop and recruited them to cultivate it. He then roasted the beans, and convinced the BhatBhateni stores, which had just opened, to sell it. The company still supplies coffee to cafes and has its own brands and farm. It supplies green beans to those who want to self-roast, or build a brand. In the 1990s, the National Tea and Coffee Development Board was established, and Himalayan Java Coffee (Nepal Made, right) opened its first shop in Kamaladi before moving to Thamel. Itr now has nearly 100 franchises across Nepal and overseas.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260207030236_1908f4a4246d373f51affa8ac48be90129e888f1222b8f10e5cd25421e931dd8.jpg" data-media-id="editor_9" data-image-id="20260207030236_1908f4a4246d373f51affa8ac48be90129e888f1222b8f10e5cd25421e931dd8" data-rendition-name="original" width="2052" height="1455" loading="lazy" alt="coffee map"> </figure>  What is the Third Wave? First Wave: Profit-driven, mass marketing, air tight containers and instant coffee. Consumption of coffee worldwide starts growing.&nbsp; Second Wave: Artisan-driven, origin and roasting style become important, epitomised by Starbucks and espresso. &nbsp; <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Nepali-specialty-coffee,4106">Third Wave</a>: Characteristics of the beverage take centre stage: origin of the beans, consistent processing techniques, and roasting style. Independent coffee shops demonstrate craftsmanship and knowledge of coffee beans from plant to the cup, promoting ethics and transparency.&nbsp; Coffee Districts Coffee is grown in over 44 districts of Nepal (see map, above). In the last fiscal year, Nepal produced 550 tonnes of Bourbon, Typica and Yellow Caturra varieties of Arabica coffee. The total plantation area in Nepal is 4,300 hectares, a fraction of the total suitable land. &nbsp;

Caffeine buzz

When I landed in Kathmandu last November, I arrived with a Diwali hangover. Not the festive kind, but the coughing, dust-coated, throat-scratching kind gifted by North India’s winter air. After a decade of breathing in Delhi’s seasonal gas chamber, my lungs were in an open revolt. But within days of landing in Kathmandu, my cough vanished. It felt almost miraculous. The air was crisper. The Air Quality Index was kinder, and the Himalayan peaks rose on the horizon.&nbsp;
But by the third week, the familiar grey veil returned. First as a faint blur, then peak by peak the Himalaya began to disappear. Locals said it had been getting worse every year.&nbsp;
Much of this haze is not Kathmandu’s doing. What drifts into Nepal each winter is a toxic spillover from the plains of North India and Pakistan: black carbon, brown clouds, and fine particulate matter carried across borders by seasonal winds. Kathmandu’s bowl-shaped valley simply traps what the region exhales.
Abid Omar, founder of the <a href="https://pakairquality.com/" target="_blank">Pakistan Air Quality Initiative</a>, put it bluntly: “We often view air pollution and climate change as separate silos, but in the Himalaya, they are one and the same.”
Black carbon is essentially soot from diesel emissions, brick kilns, and crop burning. It may be short-lived in the atmosphere, but when ash settles on snow and ice, it reduces reflectivity and accelerates melting.&nbsp;
Omar adds, “Black carbon is a threat to the water security of the entire Indus and Ganges basins.”
What burns on both sides of Punjab do not stay in Punjab. It ends up on glaciers that feed rivers, sustaining hundreds of millions of people downstream.
In November 2024, AQI levels in New Delhi hovered near 500 and about the same time Lahore briefly became the world’s most polluted city, with the AQI count crossing 1,100. These numbers are not abstract.
According to the <a href="https://www.stateofglobalair.org/resources/archived/state-global-air-report-2024" target="_blank">State of Global Air 2024 report</a>, India recorded more than 2 million deaths attributable to air pollution in 2023. Bangladesh and Pakistan each saw over 200,000 deaths. Air pollution is now one of the leading causes of premature death across South Asia.
Nepal, often imagined as cleaner by default, tells a sobering story of its own. Air pollution in Nepal led to an estimated <a href="https://www.worldbank.org/en/news/press-release/2025/06/17/air-pollution-is-the-number-one-health-risk-factor-in-nepal#:~:text=Vehicle%20Emissions:%20Continuing%20to%20electrify,airflows%20carry%20pollutants%20across%20borders." target="_blank">48,500 premature deaths</a>, with the loss of more than 1.4 million disability-adjusted life years. The University of Chicago’s <a href="https://aqli.epic.uchicago.edu/post/nepal-capital-chokes-as-wildfires-rage-en" target="_blank">Air Quality Life Index</a> estimates that particulate pollution cuts 3.4 years off the life of the average Nepali. In the Tarai region, life expectancy drops by nearly five years. In Kathmandu, residents lose 2.6 years.
Says infectious disease specialist Anup Subedee: “Air pollution is killing at a far higher rate than Covid-19 did during its worst years in Nepal. People are dying in their twenties of cancer, or having heart attacks and strokes in their thirties and forties.”
Nearly <a href="https://www.icimod.org/press-release/kathmandu-choked-on-polluted-air-for-75-of-the-last-90-days/?utm_source=chatgpt.com" target="_blank">40 per cent of winter particulate pollution in the Kathmandu</a> valley originates outside Nepal. Black carbon carried from Punjab, Haryana, and Uttar Pradesh in India, besides parts of Pakistan, rides the winds north, settles on Himalayan snow, and accelerates glacier melt by absorbing heat.
“The pollutants travel across borders within shared airsheds, creating one gigantic plume of polluted air over India, Nepal, Bangladesh, and Pakistan several times a year,” says Subedee.
In some Himalayan regions, <a href="https://www.icimod.org/success-stories/chapter-2/black-carbon-and-glacier-melt/" target="_blank">scientists estimate</a> that black carbon can increase localised melt rates by up to 30%. Yet global climate negotiations continue to treat glacial loss primarily as a carbon dioxide problem.&nbsp;
CHINA’S APPROACH
The South Asian story is transboundary, and more immediate as well as more preventable. This is not only about emissions. It is about coordination, and China offers an instructive contrast.
Since 2013, China has dramatically improved its air quality by declaring a '<a href="https://www.aljazeera.com/opinions/2025/12/12/what-new-delhi-can-learn-from-chinas-war-on-air-pollution#:~:text=In%20the%20following%20years%2C%20Beijing,29.3%CE%BCg%2Fm%C2%B3%20in%202024." target="_blank">war on pollution</a>'. A major air pollutant, suspended PM2.5 levels fell sharply through strict controls on coal, vehicles, and industry, massive investment in renewables, and legally binding national action plans.
Crucially, China shifted from city-by-city firefighting to a regional airshed approach. Provinces shared data, coordinated emergency responses, enforced unified standards, and tied environmental performance to political accountability. South Asian countries have done none of this.
Isolated national actions are insufficient when pollution itself ignores borders. India, Nepal, Bangladesh, and Pakistan share the same airshed. Without cooperation, each country keeps breathing its neighbour’s mistakes.
“As the government representing the largest population affected by air pollution, India should lead this effort. Instead, the region has drifted away from cooperation, and the cost is becoming catastrophic,” Subedee says.
The haze over Kathmandu is not only Nepal’s burden. It is a <a href="https://sapannews.com/2024/12/27/could-climate-diplomacy-be-the-googly-a-gamechanger-for-regional-cooperation/" target="_blank">regional failure</a>. The melting of South Asia’s glaciers is not just a global warming story. It is also a local one, written in the smoke rising from our own fields, factories, and highways.
If we keep ignoring black carbon, the Himalayas will keep losing time, snow, and stability. The disappearing peaks of Kathmandu are not a metaphor. They are a warning.
And like the air itself, that warning is already crossing borders. ©Sapan News
Pragyan Srivastava is an Indian journalist and associate editor at <a href="http://www.sapannews.com/" target="_blank">Sapan News</a>. <a href="mailto:pragyan@sapannews.com" target="_blank">pragyan@sapannews.com</a>

Cleaning up the Himalayan airshed

This is the 82nd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. In September, under pressure from GenZ activists, Home Minister Om Prakash Aryal pledged to ensure that overseas Nepalis would be able to vote in the March election. The analysis from experts, election officials, and much of the public was that the Election Commission was not prepared to ensure out-of-country voting in such a short time.&nbsp; But just because the diaspora cannot exercise its franchise does not mean Nepalis abroad cannot influence the election outcome. The 2021 census said 2.1 million Nepalis lived abroad, but realistically three times more live, work and study overseas.&nbsp; Being breadwinners also makes them decision makers for families back home. Most have left because they could not get meaningful jobs and sought opportunities abroad, which means they are not happy with the way Nepal has been governed by the established parties and leaders.&nbsp; The diaspora is therefore mostly an anti-incumbent vote bank, which was one reason the political leadership blocked out-of-country voting for so long – despite a Supreme Court ruling that all citizens had a constitutional right to vote, wherever they lived. &nbsp; In the 2022 polls, overseas Nepalis had already shown considerable influence by backing newer and alternative candidates like Balendra Shah for Kathmandu mayor, and parties like the RSP. In the four years since, and especially since the GenZ movement, support for a political shakeup has grown even stronger. So has technological reach that enables the diaspora to politically organise from overseas. &nbsp;‘Technology has reduced the distance in communication, but has also lowered the barrier in a way that allows overseas Nepalis to pressure family members,’ author Narayan Wagle wrote in an op-ed on Setopati this week. Indeed, all it takes for family members to be convinced whom to vote for is an ultimatum that relatives will stop sending money. With less than a month to go for the 5 March election, many Nepalis overseas are campaigning remotely for preferred candidates, even if they cannot themselves cast ballots.&nbsp; The overwhelming feeling seems to be that younger candidates should be given a chance. &nbsp;&nbsp; Read what some Nepalis abroad have to say. NEPAL'S NON-VOTING MIGRANTS <h2>My Respected Parents</h2> Anil Gole, Romania [This letter is a letter to my parents ahead of the election. They are UML supporters, my uncle is for the Nepali Congress (NC), and my grandfather supports the Nepali Communist Party (NCP).] My Respected Parents, I hear that election fever has picked up in the village. New faces with new ways of thinking have emerged this time. I don’t really understand politics, so what I say may feel bitter. But Father, when I see the flag with the sun in your hands, I remember the heat of Qatar from 12 years ago, your sunburnt skin and mother’s cheeks wrinkled with worry. Perhaps Uncle, too, found the Saudi heat so intolerable that he returned home. That may be why while seeking shade, he found the NC tree symbol endearing. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Great uncle spent his whole life back home in the village, which is perhaps why he identifies with symbols like the plough, the sickle, and the hoe.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040236_669402ff85bdbd58360c12e10d23900ad99596b7a8dc196b8db1bcfe7e81e80e.jpg" data-media-id="editor_0" data-image-id="20260206040236_669402ff85bdbd58360c12e10d23900ad99596b7a8dc196b8db1bcfe7e81e80e" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Overseas vote bank NT"> <figcaption>Anil Gole</figcaption> </figure>  Even then, at any cost, vote for the same politicians. Vote for the same politicians who have not developed the country, who have not fed the poor, whose sons have not been shot.&nbsp; What if the country does not change? I have changed my country. When homesick, I have learnt what it feels like to suffocate in tears under a blanket. Now my younger brother is old enough. Send him here as well. We brothers will earn together. We will marry off our sister in a grand way. So what if the country does not develop? We will build a small, cute house with a big yard. You can play with the grandchildren there. And when they grow up, they too can migrate. But if you vote for the right people and the country gets good leaders, future generations will not have to sweat in foreign lands. They will not have to leave the comfort of a mother’s lap to spend nights abroad in unknown cities. No matter how hard things get, they will not have to lie in letters to their mothers,saying, “I’m doing fine, Mother.” I have not lost courage because of your blessings. My body is here, but my mind is always back home in Nepal. Your children are here, but my children’s future is in your hands. That is why vote for the same politicians whose hearts did not bleed even when the young were killed, the same politicians whose children have not come home in a box. Mother and Father, please take care of each other. Yours truly, Your fortunate migrant son <h2>Algorithm versus vision</h2> Ambika Paudel, Qatar I have been in Qatar for 18 years, and work in the facilities management, engineering, shipping and logistics &nbsp;industry. I get to interact with people from across the world, and they are closely connected with their embassies through online systems and communities. I lead the Nepal Expatriate Community that has multidisciplinary professionals and have observed the need to revise the narrative around migrants. We are here for our families. The sacrifices we make are for them. We are working for our own career growth and families because there were no opportunities back home. Many of us have achieved a good standard of living through our hard work and merit. When I send money to Nepal, it is for my family and the benefit to the government is a byproduct. It would have been good if we got to vote, too. That possibility and promise got lost somewhere in the policy confusion and lack of technical capacity. Overseas Nepalis are also deeply invested in the election, but it is largely algorithm based. We are not questioning the vision of the candidates.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040236_dc05b31d3abcf126360d923615a785a36de5b62a8695af9cbff000b586d0336d.jpg" data-media-id="editor_1" data-image-id="20260206040236_dc05b31d3abcf126360d923615a785a36de5b62a8695af9cbff000b586d0336d" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Overseas vote bank NT"> <figcaption>Ambika Paudel</figcaption> </figure>  Our parents back home are the actual voters, and those overseas &nbsp;are talking to them. I don’t think they will be swayed just based on calls, and they shouldn’t be either. We are prioritising algorithms and words and social media boosts over vision, experience, and concrete plans. I am for the NC but I am not a blind supporter. Despite being at the forefront of every significant democratic change in Nepal’s history, the party has had lapses but it is currently on a new trajectory. Not all candidates of all parties are good so we have to elect competent leaders and question them. Whatever promises they make need to be examined for delivery and vision.&nbsp; There are also Congress loyalists who are swayed and influenced by the new, but I let it be — it is their right, their choice. Change requires vision and experience, it should not be based on hype, I remind them. Over online conversations, I tell them to vote wisely so they don’t regret it later. I returned from my break just recently so I cannot come home to vote as it will be too expensive. There are good human resources back in Nepal and in the diaspora which can be used. There are people in decision-making positions in their companies who are very capable and intelligent who could contribute to Nepal. These are missed opportunities in our policymaking and governance: Nepal needs to create opportunities for capable Nepalis.&nbsp; The new government can make the investment climate better through a one-door system so that services are accessible, quick and there is no need to go to multiple offices to start a company or pay taxes. This would also stop unnecessary bribes and other hassles. I don’t have plans to return in the near future. I have a good job and am earning well. I came to Nepal between 2016 and 2019 and remigrated again after things did not work out. <h2>The young need convincing</h2> Jeevan Kumar Dewan, Malaysia I have been living in Malaysia since 2001, and am an active member of the UML wing here. There is excitement about the upcoming election, but we are bound by contracts so cannot go home to vote.&nbsp; There was hope that we would be able to vote from overseas, but there were questions of security. Even though we won’t be able to vote, people are actively participating online and using social media to show their support to their candidates and parties of choice.&nbsp; Political parties prioritise organisational expansion overseas but there is no direct campaigning during elections. It is through conversations and social media engagement that people are participating, debating and expressing their support and loyalty.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040240_2ed54377199b995f0a19b7be98fff79004c13787c7a07185a47427467237277a.jpg" data-media-id="editor_2" data-image-id="20260206040240_2ed54377199b995f0a19b7be98fff79004c13787c7a07185a47427467237277a" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Overseas vote bank NT"> <figcaption>Jeevan Kumar Dewan</figcaption> </figure>  &nbsp;As a UML supporter, it is my duty to remind people to cut through the noise and to separate facts and truth. While elderly voters don’t need much convincing as they are loyal to the party, I do engage a fair amount with the young voters. I have to remind them not to get distracted by the videos shared in social media platforms. All new is not good just because it is new if there is no real political agenda. There is no doubt that we need change but being new is not enough nor can we overlook the contributions and experience of the old parties. All we can do is talk to the voters and try to get our message across. It is important to prioritise better managed migration and also to ensure migrants have proper guidance on how to invest their hard-earned money in productive sectors, even when it is not much, so they have something to fall back on after returning. I don’t have plans to return immediately, I go back and forth quite frequently. I have a stable job and I have seen how my friends who left secure jobs to return home ended up remigrating after their investment failed. I will stay here and continue with my job which I am happy with. <h2>The old need convincing</h2> Prajwal Poudel, Saudi Arabia I work as a data entry analyst in Saudi Arabia. People overseas have seen development, but have also experienced challenges of being away from home. Politicians are aware of this and didn’t want us to vote.&nbsp; When I was in Nepal, I did not care much about politics. It was not for me. But overseas we care about Nepal even more. Perhaps you don’t know the value of something unless you lose it. Perhaps distance makes hearts grow fonder. I am definitely more invested in Nepali politics after leaving.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040240_43ea30dfb58b873760e40177d84dca4bb34f1c9cdffdbc9a7c5a0c26b15e78b9.jpg" data-media-id="editor_3" data-image-id="20260206040240_43ea30dfb58b873760e40177d84dca4bb34f1c9cdffdbc9a7c5a0c26b15e78b9" data-rendition-name="original" width="738" height="1600" loading="lazy" alt="Overseas vote bank NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040240_dfbc2302411e1ae32a4ab048fa34d940147942c00845d82d9cf59574f5c2e0fe.jpg" data-media-id="editor_4" data-image-id="20260206040240_dfbc2302411e1ae32a4ab048fa34d940147942c00845d82d9cf59574f5c2e0fe" data-rendition-name="original" width="1080" height="1200" loading="lazy" alt="Overseas Nepali vote bank NT"> </figure>  So I have to make sure that family members back home make the right decision this election. My cousin is also with me in Saudi Arabia and I was talking to his parents and telling them to vote correctly. They have voted for the same faces for two decades. I said that if there had been changes we would not have had to migrate. That this time they should accept the masu-bhat and alcohol, say UML-Congress jindaawaad, take the money offered but finally stamp on Ghanti.&nbsp; My cousin posted a recording of that call spontaneously on Tiktok. It went viral perhaps because it resonated with the youth. We cannot vote but we have to make sure at least our close family members vote correctly. My mother also seems ready for a change despite her loyalty to the UML, but I tell her she does not need to change her party just change her vote this year.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260206040240_0234dfec6f97a726f67120124833bb3fdc84cbf794eee910736649c5624e7576.jpg" data-media-id="editor_5" data-image-id="20260206040240_0234dfec6f97a726f67120124833bb3fdc84cbf794eee910736649c5624e7576" data-rendition-name="original" width="1168" height="1556" loading="lazy" alt="Overseas vote bank NT"> <figcaption>Prajwal Poudel</figcaption> </figure>  We need to give the new ones a chance. But it’s also true that the new will not bring dramatic changes overnight. Conversations here are all about the election back home. We talk about who is getting elected from their areas. Who they think will win. But the hottest topic of conversation is of course Jhapa. For those of us abroad, the government should make our embassies stronger. Back home, I hope corruption will be curbed and that good roads will reach all corners of the country. This will allow people to develop the country themselves.&nbsp; I am the son of a Malaysia returnee. I even worked as a teacher in Nepal. I could not even afford decent clothes so I left everything and came here. I don’t know when I will return.

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