<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/6372307e9c7e80680e0c256cjpeg.jpg" alt="" width="1641" height="1000"/><figcaption>Photo: NYAYA HEALTH NEPAL</figcaption></figure>Viral hepatitis is a disease of the liver that is preventable, treatable and curable in most cases. It is a disease where elimination can and must be achieved.On this World Hepatitis Day, the World Health Organisation is highlighting the need to bring hepatitis care closer to the people. This means making hepatitis care available, affordable and accessible to one and all who need it without discrimination.This is a crucial component in the quest towards elimination of viral hepatitis as a public health threat by 2030. Elimination would translate to 90% reduction in incidence and 65% reduction in mortality by 2030, compared with the corresponding figures of 2015.The action against hepatitis cannot wait any longer. Firstly, it is the only communicable disease where mortality is showing an increasing trend. Globally, approximately 354 million people are suffering from hepatitis B and C and one person is dying every 30 seconds due to its complications.South-East Asia has 20% of the global morbidity burden of hepatitis. An estimated 218,000 people died due to hepatitis in the Region in 2019. About 95% of all hepatitis-related deaths are due to cirrhosis and liver cancers caused by the hepatitis B and C virus.Second, viral hepatis is a disease that is completely preventable. Clean food and good personal hygiene, along with access to safe water and sanitation, can protect us from hepatitis A and E. Measures to prevent hepatitis B and C need to focus on full coverage with hepatitis B immunisation including a birth dose, as well as access to safe blood, safe sex and safe needle usage.Third, a world free of hepatitis is practical and feasible, and it is one of the few infectious diseases the elimination of which is tangible. We do have the tools to diagnose, treat and prevent chronic viral hepatitis, and thereby eliminate viral hepatitis.Safe and effective vaccines exist to prevent hepatitis B, alongside new and powerful antiviral drugs that can manage chronic hepatitis B and cure most cases of hepatitis C. These interventions together with early diagnosis and awareness campaigns have the potential to prevent 4.5 million premature deaths in low- and middle-income countries by 2030.However, access to these services is often out of reach of communities as they are usually available at centralised/specialised hospitals at a cost which cannot be afforded by all. People continue to die because of late diagnosis or lack of appropriate treatment, if they are being diagnosed or treated at all. Early diagnosis is the gateway for both prevention and successful treatment.Modest testing and treatment coverage is the most important gap to be addressed for an effective response to the hepatitis epidemic. If we look at the treatment cascade of the South-East Asia Region, only about 10% of people with hepatitis know their status. And of those who know their status, only 5% are on treatment. Of the estimated 10.5 million people with hepatitis C, just 7% know their status, of which around 1 in 5 are on treatment.This gap, primarily attributable to general lack of awareness, needs to be patched up. This is what this year’s World Hepatitis Day campaign on 28 July is all about. It highlights the need to accelerate the fight against viral hepatitis by testing and treating the real people who need it, i.e. closing the equity gap by “leaving no one behind”.Even before Covid-19, very few countries were on track to reach the 2030 elimination goals set by WHO. The pandemic has put elimination efforts further behind. Rather, it has potentially jeopardised national elimination programs. Fear of Covid-19 has been a substantial barrier to hepatitis testing and treatment throughout the crisis.Amid all the challenges, the Region has continued to implement key interventions to prevent, detect and treat hepatitis, and to engage and empower at-risk populations. Since 2016, when the Region launched its Action Plan for Viral Hepatitis 2016–2021, nine countries have achieved more than 90% coverage of the third dose of hepatitis B vaccine. Four countries have achieved the hepatitis B control target of less than 1% seroprevalence among children over 5 years of age.En route to the 2030 target of eliminating hepatitis, there are some transitional targets to be achieved. By 2025, together we must reduce new infections of hepatitis B and C by half, reduce deaths from liver cancer by 40%, and ensure that 60% of people living with hepatitis B and C are diagnosed and that half of those eligible receive appropriate treatment. This can only be achieved if hepatitis care reaches to the community. In order to do so, several priorities must be addressed, and these include the need to:<ul><li style="font-weight: 400;" aria-level="1">Enhance political commitment across all countries of the Region and ensure sustained domestic funding for hepatitis.</li> 	<li style="font-weight: 400;" aria-level="1">Improve access to drugs and diagnostics by further reducing prices, including integrating costs in national health and domestic financing.</li> 	<li style="font-weight: 400;" aria-level="1">Develop communication strategies to increase awareness as the vast majority of the people do not know that they are infected, especially among subpopulations that are at higher risk of hepatitis B and C.</li> 	<li style="font-weight: 400;" aria-level="1">Innovate service delivery to maximise the use of differentiated and people-centred service delivery options across HIV, viral hepatitis and STIs to tailor and deliver services according to people’s needs and preferences in line with the primary health care approach. Decentralising hepatitis care to peripheral health facilities, community-based venues and locations beyond hospital sites brings care nearer to patients’ homes. Bringing care closer to the community will also need innovations to strengthen community engagement, community-based service delivery and community-led monitoring.</li></ul>For the first time, an integrated Regional Action Plan for viral hepatitis, HIV and STIs 2022–2026 is being developed by WHO. This integrated regional plan will ensure effective and efficient utilisation of limited resources available for the Region and will guide countries to adopt a person-centred approach rather than a disease-specific one.All countries of South-East Asia must accelerate the coverage of testing and treatment services, including through large scale adoption of innovative technologies, simplified approaches at the primary health care level, and community participation. WHO remains committed to make South-East Asia free from viral hepatitis by 2030.As we observe World Hepatitis Day, we must look forward and act together with communities and all stakeholders for a future free of hepatitis. This will lay a firm foundation for a healthier, more equitable and more prosperous Region and the world.Poonam Khetrapal Singh is the WHO Regional Director for South-East Asia.

Poonam Khetrapal Singh

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Bringing hepatitis care closer to you

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d49c7e80680e06009bjpeg.jpg" alt="" width="1500" height="803"/><figcaption>Photo : UNICEF</figcaption></figure>Last month, the prestigious <a href="https://www.nejm.org/" target="_blank" rel="noopener">New England Journal of Medicine</a> published a study of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">successful trial of a new typhoid vaccine</a> that could prevent thedeaths of many children around the world. The vaccine research was conducted at Patan Hospital by a Nepali researcher.The randomised control trial of the typhoid conjugate vaccine (TCV) was conducted among more than 20,000 participants in Lalitpur district, and the efficacy of the new vaccine was found to be 81.6% -- a major improvement on previous vaccines. (See box below).The positive news from Nepal came as various parts of the world, including the US, Europe, Samoa and Africa, struggled to cope with the biggest measles outbreak in decades. Most of the cases have now been associated with people forgoing recommended preventive shots because of fears of side-effects fanned by social media.Fear of vaccination started ever since a paper in 1998 in the medical journal <a href="https://www.thelancet.com/" target="_blank" rel="noopener">The Lancet</a> cited a link between autism and the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/maurice-hilleman-the-vaccine-man,1852" target="_blank" rel="noopener">measles, mumps, rubella (MMR) vaccine</a>. The research was later found to be fraudulent and retracted, but the anti-vaccine movement gained traction again in the past year after the rumours resurfaced on the Internet resulting in families rejecting early childhood immunisation against diseases like polio, rubella and measles.“The good news is that unlike in the rest of the world, people in Nepal demand vaccines. If we miss to vaccinate a child for any reason, parents come knocking, asking for the shots,” says Jhalak Gautam of the Family Welfare Division at Teku.Sameer Mani Dixit of The Centre for Molecular Dynamics Nepal concurs. “Entire communities actively participate in vaccination programs and are well aware of the benefits. Every mother in Nepal knows the immunisation schedule by heart.”The Centre for Molecular Dynamics Nepal has just completed a study on why the country has been so successful with its immunisation program, and the results will be published later this month. This study and similar studies underway in Senegal and Zambia are being conducted with  funding from the Bill and Melinda Gates Foundation, in an effort to analyse the success of vaccination programs in developing nations.Nepal’s national immunisation program started in 1988 and now vaccinates some 620,000 children under 15 months of age every year against 11 infectious diseases such as <a href="https://www.nepalitimes.com/banner/tb/">tuberculosis</a>, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">polio</a>, pneumonia and measles.The last case of <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener">polio</a> was detected in Rautahat district in 2010, and Nepal was declared polio free four years later. The country also eliminated maternal and neonatal tetanus in 2005. Similarly, Japanese encephalitis, diphtheria, pertussis and pneumonia have all been controlled, and there are regular vaccinations against congenital rubella syndrome and hepatitis B.Despite the high immunisation rate, thousands of Nepali children continue to die due to easily preventable and treatable communicable diseases <a href="https://archive.nepalitimes.com/news.php?id=16988#.XiBL7_4zaUk" target="_blank" rel="noopener">like diarrhoea</a> and according to Nepal Demographic Health Survey 2016, one in a hundred Nepali children have still not been vaccinated against any infectious diseases.Read also: <a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all the change in world health"</a>Immunisation coverage data from last year also shows a worryingly high dropout rate. While 93% of newborns received BCG jabs, the first in the national immunisation schedule, the coverage dropped to 73% by the time children received the last vaccine, an immunisation against measles and rubella, recommended at the age of 15 months.Several cases of <a href="http://archive.nepalitimes.com/news.php?id=186#.XiBGW_4zaUk" target="_blank" rel="noopener">measles</a> have been detected in Kapilvastu, Dang, Makwanpur, Sarlahi and Manang districts recently, and Nepal has not been able to meet its previously set target to eliminate measles and rubella by 2019. The new goal is to eliminate the diseases by 2023.“Dropout rate is a challenge, we have not been able to reach the remotest corners of the country, and children miss their shots because of migration,” says Jhalak Gautam. “We now have a strategy to identify missed pockets and deliver shots at home if required.”The Immunisation Section of the Ministry of Health is now gearing up for a nation-wide measles-rubella vaccination campaign aimed at those who might have missed routine shots. Three million children between the ages 9 months to 5 years are expected to participate in two phases of the campaign later this year.Polio drops will also be administered at the same time to 1.5 million children under five in 19 Tarai districts. The Immunisation Section is also introducing a new vaccine against rotavirus this June to reduce the prevalence of childhood diarrhoea.The new challenge to vaccination comes from an unlikely quarter: federalism. There is confusion about where the vaccines are sourced and who should pay for them. There is concern about the quality of vaccines, many of which need a cold chain with refrigeration to the point of delivery.Warns Patan Hospital physician Buddha Basnyat: “Nepal’s immunisation program is a model of success, but we cannot afford to be complacent.We have to introduce newer and more effective vaccines while also prioritising hygiene and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener">sanitation</a> simultaneously.”<h2>Successful trial of new typhoid vaccine</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d79c7e80680e06009cjpeg.jpg" alt="" width="1500" height="1000">Over 20,000 children between 9 months and 16 years of age in Lalitpur district participated in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">first large-scale randomised controlled trial</a> of a new vaccine against <a href="http://archive.nepalitimes.com/news.php?id=17306#.XiBGav4zaUk" target="_blank" rel="noopener">typhoid</a>, a disease that affects millions across South Asia.Half of them received the vaccine and the other half received control shots. The efficacy of Typhoid Conjugate Vaccine (TCV) was found to be 81.6%, and the results were published last month in the prestigious New England Journal of Medicine.Prior to this, a small-scale TCV trial was conducted in Britain, and the World Health Organisation (WHO) has since strongly recommend the use of the vaccine for countries and regions where the water and food-borne infection is most common. "Pakistan has been able to control typhoid with this vaccine and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30320-1/fulltext" target="_blank" rel="noopener">Vietnam</a> has eliminated it," says lead author of the paper, Mila Shakya, "Administration of this new, effective vaccine by our government will help control the most common bacterial disease in Nepal and South Asia."<a href="http://archive.nepalitimes.com/news.php?id=12158#.XiBGbP4zaUk" target="_blank" rel="noopener">Typhoid</a> is a contagious infection caused by the bacteria Salmonella typhi, which is found in contaminated food and water and which causes fever, diarrhoea and vomiting. It can easily be prevented with awareness, safe drinking water and frequent hand-washing.The vaccine is useful because it is a prophylactic in places where preventive measures are taking time to implement. There are some 21 million typhoid cases and 161,000 typhoid-related deaths annually worldwide. South Asia has been often dubbed as the hub of typhoid and there are some 500 cases per 100,000 population in the region.“This study is Nepal taking a lead in preventing typhoid, after never having really prioritised it. It might not kill as many people as other diseases do, but it still affects thousands of school-going children,” says physician Buddha Basnyat at Patan Hospital.TCV is <a href="http://archive.nepalitimes.com/news.php?id=18178#.XiBGdP4zaUk" target="_blank" rel="noopener">not the first typhoid vaccine to be developed</a>. Currently there is an injectable unconjugated polysaccharide vaccine for persons aged two years and above, and an oral capsule for those over six years of age. But they do not work well on young children and they provide protection only for a few years. TCV on the other hand can be given to children below 2 years and the immunisation lasts up to five years.“A single dose of the new vaccine is safe, immunogenic, and effective, and the deployment of the vaccine will reduce the burden of <a href="https://www.nepalitimes.com/opinion/so-far-so-good/infectious-enthusiasm-for-travel/" target="_blank" rel="noopener">typhoid</a> in high-risk populations,” stated the interim analysis. “This new evidence of efficacy is especially timely with the recent spread of extensively drug resistant typhoid fever, which threatens child health in affected regions.”Pakistan, which has been struggling against an outbreak of drug resistant typhoid fever since 2016 is already using TCV with positive results and its Sindh province will become the first region in the world to include TCV in routine childhood immunisations.<a href="https://www.gavi.org/" target="_blank" rel="noopener">Gavi, the Vaccine Alliance</a>, which has earmarked $85 million to fund the introduction of the vaccine in the world’s poorest countries, is supporting the program. Nepal is also eligible for funding from the alliance.Says Basnyat: “We should take action before we are also hit, like Pakistan, by the drug-resistant typhoid. What are we waiting for, when Gavi is ready to fund the vaccination program for free and its benefits are so clear. This is a case of vaccine under-utilisation.”Sonia Awale

Sonia Awale

A shot in the arm for vaccines in Nepal

<a href="https://nepalitimes.com/news/ball-in-balen-s-court">Nepal’s newly-installed Prime Minister Balendra Shah</a> unveiled his Council of Ministers after taking the oath of office on Friday in Kathmandu.&nbsp; Besides Nepal's pre-existing problems, his team will immediately have to deal with the fallout of the West Asia conflict to satisfy an electorate impatient for change. The Rastriya Swatantra Party (RSP) won a majority in the 5 March election and capped the Cabinet size at 15. Shah, a structural engineer and musician, himself has taken charge of the Defence and Industry Ministries. There has been an attempt to make the Cabinet inclusive with women in five of the new portfolios.&nbsp; After much negotiation, the powerful Home Ministry, a bone of contention between Shah and RSP Chair Rabi Lamichhane, has gone to Sudan Gurung, a hitherto little-known figure who <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">rose to prominence after the September GenZ protest</a> and won the election from Gorkha-2.&nbsp; Gurung will be in charge of Nepal’s internal security apparatus and maintaining law and order. And with Gurung, a close ally of the Prime Minister, in charge, some note the Home Ministry will be a hook for Shah if Lamichhane, with his share of controversies, steps out line.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a.jpg" data-media-id="editor_2" data-image-id="20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Notable RSP leaders, including vice-chair DP Aryal, were said to have been vying for the portfolio.&nbsp; Gurung is the founder of the non-profit Hami Nepal, which worked primarily in earthquake relief in 2015, and emerged onto the national stage during negotiations to appoint Sushila Karki as interim PM after the unrest. He was also involved in key negotiations that cemented Balendra Shah and Rabi Lamichhane’s political partnership in the runup to the election.&nbsp; Most new Cabinet members are not just first-time ministers, but are also freshmen lawmakers. Many are experts in their fields. Finance Minister Swarnim Wagle is an <a href="https://nepalitimes.com/here-now/nepal-needs-to-rebrand-itself">economist </a>with degrees from the London School of Economics and Harvard, and was previously Chief Economic Advisor at the UNDP Regional Bureau for Asia and the Pacific, and also served in Nepal’s National Planning Commission.&nbsp; Previously a member of Nepali Congress, Wagle exited the party in 2023 following differences with top leadership, and joined the RSP. Wagle won a by-election from Tanahu-1 in 2023 and won again from the same constituency in this month’s election.&nbsp; Shishir Khanal, who heads RSP’s foreign affairs department, has been appointed Minister of Foreign Affairs. &nbsp;Khanal is co-founder of Teach For Nepal, was briefly Education Minister when the RSP was part of the the Pushpa Kamal Dahal-led coalition government in 2023.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42.jpg" data-media-id="editor_4" data-image-id="20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Law Minister Sobita Gautam is a lawyer by profession and worked in governance and public policy before she was elected as the youngest MP in the 2022 election.&nbsp; Health Minister Nisha Mehta is a nurse and became a lawmaker under the Proportional Representation system in this election which swept the RSP to power with a near two-third majority.&nbsp; Education Minister Sasmit Pokharel, a first-time MP elected from Kathmandu-5, served as an aide to Balendra Shah when he was mayor of Kathmandu and a was member of the KMC City Planning Commission.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f.jpg" data-media-id="editor_5" data-image-id="20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Biraj Bhakta Shrestha is Energy Minister, and also served as the Minister for Youth and Sports in the Dahal-led coalition government in 2024. Before joining RSP, Shrestha was elected to the Bagmati Provincial Assembly in the 2017 elections representing the r<a href="https://nepalitimes.com/here-now/rsp-s-activist-dna">eformist Bibeksheel Sajha Party</a>. He will immediately face the challenge of addressing the <a href="https://nepalitimes.com/news/rough-road-ahead-for-new-nepal-rulers">impact of the West Asia war,</a> including rising petroleum prices and a shortage of cooking gas. Sita Badi, who was elected through the PR system, is Minister for Women, Children and Senior Citizens. She was born and brought up in the underserved and marginalised Badi community in Surkhet and has been advocating for the rights and welfare of women, children, and minority communities. Other ministers include RSP spokesperson Pratibha Rawal as Minister for Federal Affairs and General Administration as well as Land Management, and Gita Chaudhary as Minister for Agriculture, Sunil Lamsal is Physical Infrastrucutre, Transport, and Urban Development Minister, Khadka Raj (Ganesh) Paudel as Tourism and Civil Aviation Minister. Dipak Sah is the Labour and Employment Minister, and Bikram Timilsina is Communication Minister.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed.jpg" data-media-id="editor_8" data-image-id="20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Meanwhile, RSP vice-chair DP Aryal, who many thought would be home minister because of his proximity with Rabi Lamichhane has been proposed as Speaker of the House.&nbsp; Aryal previously served two brief stints as the Minister of Labour when RSP was part of the RSP’s coalition governments in 2023 and 2024. As minister Aryal came <a href="https://nepalitimes.com/editorial/skeletons-in-the-cabinet-k5x6py1v">under scrutiny </a>for his involvement in an employment agency that was investigated for illegal acquisition of wealth in 2020. If appointed House Speaker, Aryal will be expected to play a neutral and non-partisan role in Parliamentary affairs. &nbsp; With the full Cabinet announced on Friday, Prime Minister Shah and his team now have their work cut out for them. &nbsp;The government’s first priority will be ensuring the safety and long-term security of the almost two million <a href="https://nepalitimes.com/here-now/migrant-workers-in-wartime">Nepalis living and working in the Gulf</a> amid the ongoing conflict in the region, and taking steps to cushion Nepal’s economy from the Israel-US war on Iran. The new leaders will also be tasked with implementing the findings of the Karki Commission report on the September violence that paved the way for the election and the rise of the RSP. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_11" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> <figcaption>Snapshots from PM Balen Shah's swearing-in ceremony</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_12" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a.jpg" data-media-id="editor_13" data-image-id="20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c.jpg" data-media-id="editor_14" data-image-id="20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  &nbsp;Full list of ministers: Prime Minsiter: Balendra Shah Home Minister: Sudan Gurung Finance Minister: Swarnim Wagle Foreign Affairs Minister: Shishir Khanal Law, Justice and Parliamentary Affairs Ministry: Sobita Gautam Energy, Water and Irrigation Minister: Biraj Bhakta Shrestha Education Minister: Sasmit Pokharel Physical Infrastrucutre, Transport, and Urban Development Minister: Sunil Lamsal Communication and Information Ministry: Bikram Timilsina General Administration Minister: Pratibha Rawal Women, Children and Senior Citizens Minister: Sita Badi Health and Population Minister: Nisha Mehta Agriculture Minister: Gita Chaudhary Culture, Tourism and Civil Aviation Minister: Khadka Raj (Ganesh) Paudel&nbsp; Labour Minister: Dipak Sah

Nepal swears in new Cabinet

Next to my home in Bhainsepati stood a dead Uttis tree next to a public tap. A nearby water tank built a year earlier had killed its roots.
If the tree collapsed, people living nearby and those queuing up to fetch water at the tap would be hurt. With the storm season approaching, the risk was obvious. The tree could also fall on my own house, so I volunteered to find a way to remove this threat.
Little did I know how difficult it would be. A forest officer acquaintance told me there is a special procedure for cutting risky trees. I contacted the Lalitpur District Forest Office (DFO).&nbsp;
He said a technical report from a field officer was needed, and passed on her number. When I called, she asked for the location, photos, and a video. I send them all.
The ward office also suggested I use Lalitpur Metropolitan City’s mobile app, Lalitpur Alert, to report the problem. I uploaded photos, and submitted the complaint. This seemed to be very easy and efficient.
Indeed, the next day the municipality called me back and I explained the situation. They said they could not act without permission from the DFO. I asked why the app existed if the city could not act on such complaints. The officer said he did not know. My happiness was short-lived.
A couple of days later, the app notified me that my problem had been solved, and the complaint was removed. But the dead tree still stood there defiantly.&nbsp;
A week later, two forest technicians arrived on a scooter to inspect the tree. They looked up at the tree and asked if I had a measuring tape so they could measure its diameter.
“You are the technicians,” I told them. “You came to inspect the tree, and you came without a measuring tape?”
I rummaged at home and found a tape measure. They got the diameter and said they would prepare a technical report, but I would have to obtain a recommendation letter from the ward office and submit it to the DFO.
“This tree is dead,” I told them. “It is on public land. You have seen it with your own eyes. You know it's dangerous, so write a report and arrange for it to be cut. Why do I have to run from office to office to apply for recommendation letters?”
Their answer was simple, yet expected: “Those are the rules.”
They left, and I gave up. Two technicians spent half a day visiting the site. The metropolis runs a complaint system with a mobile app funded with public money. The ward office has staff to solve problems. Yet none of these institutions took the responsibility to remove a dangerous tree.
Everyone is busy citing rules and regulations and passing the buck. Weeks passed. Everyone reacted to the problem, but no one took any responsibility to resolving it.
Then, one bright December morning under a deep blue sky, a few neighbourhood boys were swinging their axes on the trunk. They had no proper equipment, no safety gear, and no professional experience.
I gave the boys some money and so did a neighbour. It took an hour or so for the tree to come crashing down safely. We had paid to have the tree cut illegally, and the matter ended there.
Multiple government offices, technicians, procedures, and mobile apps could not remove a dangerous tree, and we had to break the law to cut it. The tree is gone now, but the real problem remains: an inefficient bureaucracy.&nbsp;
It is perhaps symbolic that the tree is the election sign of the Nepali Congress, which was part of Nepal's governance and bureaucracy for decades and did not perform well in this month's election.&nbsp;
That is the bureaucracy that the new RSP government now has to get to work. But it will not be easy.
I posted on Facebook: ‘When people feel leaders have grown arrogant or corrupt with power, they change their minds and their votes. If those who replace them follow the same path, voters will again change their minds and votes.’
I continued: ‘The strength of democracy lies in this simple principle: the more citizens act as independent voters, the stronger democracy becomes. The more they behave as party loyalists, the weaker it grows. If we want a better system, we must demand deep reform of the state bureaucracy and hold institutions accountable.’&nbsp;
The first responses came from two senior government officials. They told me privately that they agreed by 200% but could not say so publicly.
It is quite normal for a Nepali to get the run around in government offices, it is almost a given to be asked for a bribe. As an environmental reporter and citizen, I have numerous such examples.
It is not just one sector that has been suffering. It is everywhere, and this is just an example of how complicated our bureaucracy is. As a 40 something person, I am old enough to remember the 1990 pro-democracy movement, &nbsp;the Maoist insurgency. Many promises made then by the politicians were broken.
We fought for rights, we fought for regime change. The country has changed political systems several times, from monarchy to multiparty democracy and finally a republic.
Yet one thing that remains largely untouched or reformed is our inefficient and corrupt bureaucracy. The new government, to be led by the youngest prime minister in our history must start this reform if it wants to deliver.&nbsp;
Otherwise, we may have to keep changing governments every few years, and still find ourselves unable to legally cut down even one dead tree.

A dead tree tests Nepal's bureaucracy

The RSP and its prime minister are being sworn in this week after gaining an unprecedented election victory. This is a welcome change for many Nepalis who see it as a remedy to decades of coalition instability.&nbsp; Yet Nepal’s political history suggests otherwise. No majority government has ever completed its full term. This reveals a deeper structural problem: weakly institutionalised parties dominated by personalities rather than ideas. 1951: Dissatisfaction with the oppressive Rana regime among the educated elite led to the creation of political parties like the Nepali Congress (NC), Praja Parishad (later merged into the Nepali Congress), Gorkha Parishad, and the Nepal Communist Party.&nbsp; They emerged secretly, mainly in India during the height of that country’s independence. They organised a successful armed uprising against the Rana rule.&nbsp; 1959: The NC won a two-thirds supermajority in the first general election. Within a year, King Mahendra staged a coup and established the partyless absolute monarchy called the Panchayat system.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260322130332_a416ab5703287898f0566dc6d2a6b95d797ce2f4ed55bffcfae2e8edc7737c5e.jpg" data-media-id="editor_0" data-image-id="20260322130332_a416ab5703287898f0566dc6d2a6b95d797ce2f4ed55bffcfae2e8edc7737c5e" data-rendition-name="original" width="675" height="849" loading="lazy" alt="Mahendra and BP"> </figure>  1991: After the People’s Movement, the ban on parties was lifted and Nepal became a constitutional monarchy. Elections were held under a new Constitution and the NC won 110 out of 205 seats, joining the United Leftist Front which functioned as a loose coalition.&nbsp; Prime Minister Girija Prasad Koirala’s first term ended with his resignation due to infighting, particularly with Ganesh Man Singh, who accused him of <a href="https://doi.org/10.2307/2645025" target="_blank">“emerging as a dictator, downgrading democratic norms and values, and even selling out national interests.”</a> Parliament was dissolved and the NC ended up losing the ensuing elections. 1994: Following the NC’s defeat, a <a href="https://doi.org/10.2307/2645025" target="_blank">hung parliament emerged</a> with the UML forming a minority government that lasted only nine months before collapsing after a no-confidence vote, allowing a NC-led coalition to return to power.&nbsp; 1999: Voters gave the NC a second chance and the party won 111 out of 205 seats. The party was divided between supporters of Koirala and Krishna Prasad Bhattarai, who became prime minister. &nbsp;The internal NC power struggle intensified and Koirala became prime minister again only to face bribery scandals, the Maoist insurgency, and the royal massacre.&nbsp; In 2001, under growing pressure from both the public and the party, <a href="https://www.nytimes.com/2001/07/20/world/nepal-premier-resigns-caught-in-chaos-after-royal-blood-bath.html" target="_blank">Koirala was forced to resign</a> to be replaced by Sher Bahadur Deuba. The party eventually split into Koirala’s NC and Deuba’s NC (Democratic). &nbsp;In this chaos, king Gyanendra dissolved the parliament and assumed executive powers.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260322130332_e107b95de5641044f72a13fd20f417d16b9a2d1ecbae3492126ee5fd4244bd84.jpg" data-media-id="editor_4" data-image-id="20260322130332_e107b95de5641044f72a13fd20f417d16b9a2d1ecbae3492126ee5fd4244bd84" data-rendition-name="original" width="1250" height="753" loading="lazy" alt="Deuba and Girija"> </figure>  2017: This was the first election under the federal constitution. The UML and Maoists created a surprise pre-electoral alliance, breaking the Maoist coalition with the NC. The left alliance won a massive victory with the UML winning 121 seats and the Maoists 53 seats. Prime Minister K P Oli fell out with Pushpa Kamal Dahal of the Maoists. The House was dissolved, with the UML itself breaking into factions. What followed was seven shaky coalition governments in eight years.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260322130352_8b09b374d7fcb811e0a652c7f60b30eea4b9052a19ed3d768ba8ca9aaeb4dec7.jpg" data-media-id="editor_5" data-image-id="20260322130352_8b09b374d7fcb811e0a652c7f60b30eea4b9052a19ed3d768ba8ca9aaeb4dec7" data-rendition-name="original" width="667" height="1000" loading="lazy" alt="Oli and Prachanda"> </figure>  2022: The RSP was formed only four months prior to elections, but managed to become the fourth-largest party. In this month’s &nbsp;election, the RSP won a commanding parliamentary majority by presenting itself to the electorate as different from the discredited old parties.&nbsp; The RSP leadership structure is largely personality-driven and opaque. Party leader Rabi Lamichhane joined the governing coalition with the Maoists and UML securing four ministerial positions. Lamichhane became Home Minister and Deputy Prime Minister, using his swing vote to be the kingmaker party in the coalition. Lamichhane was embroiled in various scandals which he blamed on political vendetta. There was internal dissent within the party and among supporters who felt the coalition betrayed RSP’s founding ideals.&nbsp; Lamichhane <a href="https://thediplomat.com/2023/02/key-ally-quits-government-in-nepal/" target="_blank">reportedly</a> bypassed the party’s internal mechanisms, unilaterally deciding to pull out of the government without broad consultation.&nbsp; The youth-led September protests gave the RSP an opportunity to represent GenZ aspirations, and its popularity was cemented after Balendra Shah joined the party as a prime ministerial candidate.&nbsp; With its dramatic election victory, there is a question whether the &nbsp;party can separate itself from its two leaders, and have internal democracy. Or will it just be a vessel for new political elites to continue staying in power?&nbsp; ‘BALEN PARTY’ The RSP has increasingly relied on the same tactics that the NC once used in its heyday. Backed by Balendra Shah’s meteoric rise to fame, the RSP is called ‘The Balen Party’. <a href="https://nepalitimes.com/opinion/cyberia/rsp-s-pr-list-is-not-good-pr" target="_blank">RSP’s PR list</a> includes celebrities, actors, singers, pageant winners, business personalities, and athletes to maximise visibility and public appeal. Many of these soon-to-be MPs have little to no experience working in government, or together as a team. Which is perhaps why they needed a two-day orientation last week. In today’s attention economy, political currency depends on visibility. This is why the RSP’s strategy to harness Shah’s popularity was necessary to secure victory, while Shah needed a political platform for the election.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260322130348_abd1522a1f4f8ad4a0861c3916d86bd9688deafc7c44081b976378405d2b8e39.jpg" data-media-id="editor_8" data-image-id="20260322130348_abd1522a1f4f8ad4a0861c3916d86bd9688deafc7c44081b976378405d2b8e39" data-rendition-name="original" width="900" height="900" loading="lazy" alt="Balen and Rabi"> </figure>  Political parties are essential for a democracy, but when they &nbsp;revolve around one dominant leader, internal institutions become weak, and decision-making becomes centralised in the leader rather than in party committees, rules, or ideological platforms.&nbsp; This is exactly what led to the downfall of the NC and the UML. Both over the years were ridden with inter- and intra-party strife and failed the electorate. RSP must take a lesson from this and unite to institutionalise beyond its two personalities. Or it will suffer the same fate as the legacy parties. Since its inception, RSP has espoused a populist and anti-establishment agenda. The ‘new’ RSP with the Balendra brand gained massive support by being a clear ‘other’.&nbsp; The RSP can fall into the same trap as the NC and the UML by defining itself by what it is not, rather than what it is for. Beyond the external enemies they oppose, these parties often struggle to articulate what they actually stand for.&nbsp; RSP positions itself as an alternative to established parties — a pragmatic, results-oriented political force rather than one driven by traditional ideologies. However,<a href="https://www.cambridge.org/core/books/abs/theorizing-in-comparative-politics/parties-and-ideology/8386083191B53EC86A239B8852D4A6A6" target="_blank"> ideology gives a party identity and direction.</a> Without ideological grounding, RSP risks becoming a hollow vessel for power-chasing politicians who oppose each other’s every move, a story that is all too familiar.&nbsp; RSP can no longer define itself as being anti-establishment. It is now the establishment.&nbsp; While RSP might look like Congress 2.0 to many who have seen Nepal’s democratic trajectory, RSP does differ from past majority parties in both positive and negative ways.&nbsp; Times have also changed. Nepal is no longer a monarchy, literacy rates are much higher, social media has made information more accessible, and Nepalis are less forgiving, as seen by the events that transpired on 8-9 September 2025.&nbsp; The RSP has fielded more qualified candidates, and they could steer the country in the right direction. Many are experts in their fields and have had years of experience prior to joining politics. Having experts from such different backgrounds is a huge asset.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260322130352_426011e8c377bffcef6fcb4371325b36fb940eb5a8ab66d3c76ff5cf6f1943c7.jpg" data-media-id="editor_10" data-image-id="20260322130352_426011e8c377bffcef6fcb4371325b36fb940eb5a8ab66d3c76ff5cf6f1943c7" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="RSP new MPs"> </figure>  Moreover, having MPs from various other parties/fields can also prevent a cult following of hardcore loyalists within the party.&nbsp; There are members loyal to certain RSP leaders in the party, but there are also those who will not hesitate to go against their leaders if need be. The RSP has little opposition in Parliament, so its own members may have to take on a check-and-balance role. Nepal is in a much better spot institutionally compared to what it was like back in the early days of its democracy. There is a Constitution, there is no active conflict, the monarchy is no longer an existential threat to democracy, and the local and provincial governmental bodies have had the time to settle.&nbsp; This means the RSP is in a better position to work without the basic institutional hurdles that previous governments faced, but it will not be able to hide behind institutional issues if it fails to deliver.&nbsp; In the past, majority parties could easily pin the blame on an authoritarian monarchy, a Maoist conflict, a lack of consensus during the constitution-building process, or a newly implemented federal system.&nbsp; Most of these were just excuses for incompetency. Governments were formed and fell based on self-serving negotiations, but they managed to keep the parties afloat, and the citizenry was willing to give them a second, third, or even fourth chance.&nbsp; The RSP will not have this privilege. Nepal has many problems, but its governmental bodies are better institutionalised than when the NC last had a majority. A challenge for RSP now would be fixing broken institutions, not building new ones. A recurring issue during Balendra Shah’s tenure as Kathmandu’s mayor were his <a href="https://kathmandupost.com/politics/2026/01/28/can-nepal-s-viral-mayor-run-the-country" target="_blank">disputes with the bureaucracy</a> that resulted in months of unpaid salary for KMC staff, a lack of collaboration between him and Deputy Mayor Sunita Dangol, and rarely any public appearances.&nbsp; The RSP is inheriting a bureaucracy tainted by deep-seated patronage networks. Sustaining a government requires institutional collaboration and a willingness to work together, not disruption and division.&nbsp; While Nepal has seen the rise of many populist figures in its democratic history, the RSP’s victory based on Balendra Shah’s fame is new. Populism is usually harmful for a democracy because it punishes dissent, turns criticism into betrayal, and fuels hyper-nationalism, authoritarianism, and polarisation. A trend of punishing criticism is already visible on online spaces. Without an effective parliamentary opposition, the responsibility for democratic accountability will fall on the media and civil society. If the trend of intolerance to criticism deepens, Nepal risks sliding toward a majoritarian politics where popularity replaces accountability. Time and again, the Nepali people have given opportunities to parties that promise change, only to face disappointment. Nepal’s political history shows that majority governments fail not because they lack seats, but because they lack institutions.&nbsp; The electoral earthquake Nepal just witnessed could bring sweeping reforms or drown the country’s fragile democracy. If RSP hopes to succeed where others failed, it must build a party that outlives its founders. Suvexa Pradhan Tuladhar is an Early Career Policy Research Fellow at the Nepal Institute for Policy Research (NIPoRe).

Will it be different this time in Nepal?

On Friday, Balendra Shah is taking his oath of office as Nepal's prime minister in a capital city of which he was a mayor till six months ago.
At 35, he will be among Nepal’s youngest prime ministers. His reticence and reclusiveness have reinforced his brand as a doer rather than a talker. This was a persona he cultivated as mayor of someone who cleaned up the city by managing garbage. But he also chased off sidewalk vendors in an effort to ‘beautify’ the city.&nbsp;
After being elected, Shah did not attend RSP events in official capacity, and he was absent at an MP orientation last week.&nbsp;
His refusal to engage with the press, and even stopping to post on social media, have added to the air of reclusiveness. But as prime minister, he may have to communicate more even if it just to stop conspiracy theories and intrigue.&nbsp;
The people he will now represent would like to know, and have a right to know, what he is up to. Otherwise the feeling will grow that Nepal is entering uncharted territory. Governance, the economy and investment do not like uncertainty.
Political scientist Pyakuryal notes that calling Balen a 'man of few words' may serve as a useful epithet if he governs with quiet efficiency rather than fanfare. "But as Prime Minister, he must engage the nation’s will, not simply manage from above," she says.
She adds: "The real test lies in his choice of style: will he lead exclusively, keeping decisions close, or inclusively, opening space for dialogue and shared ownership of governance?"
Nepal's newly-elected lawmakers were sworn in on Thursday. And once sworn in as PM on Friday, Balendra Shah is set to appoint a ‘minimalist’ Cabinet. Although the Constitution caps the size of the Council of Ministers at 25, the party has decided to stick to maximum 18 and not split ministries to accommodate loyalists as was done in the past.&nbsp;
&nbsp;"The Cabinet must support the leadership of the Prime Minister while ensuring accountability to the Parliament,” notes political scientist Sucheta Pyakuryal. “But the questions that come to mind are: will the RSP MPs readily submit to Balen’s leadership and is Balen’s absence from the party’s official events an unwillingness or hesitation to submit to the party?”
Prime Minister Sushila Karki and her ministers ended their interim tenures this week, and she was lauded for upholding her commitment to hold a free, fair and peaceful election. But her image was tarnished for her reluctance to release the investigation report on the September violence, as well as recommending her Home Minister Om Prakash Aryal for a National Assembly seat, and her personal secretary to the National Trust for Nature Conservation. President Ram Chandra Poudel has put Aryal’s nomination on hold. &nbsp;
The Investigation Commission report leaked on Wednesday said the state failed to stop the firing on protestors by Police on 8 September and blamed the Army for not preventing the arson next day. It recommended the prosecution of prime minister KP Oli, home minister Ramesh Lekhak, and Police chief Chandra Kuber Khapung.
Notable names said to be in consideration for the Cabinet include many who are experts in their fields, and RSP wants a young lawmaker as Speaker. The new government will plunge headlong into the economic fallout of the West Asia war.
RSP, with its near two-third majority, does not have to placate any coalition partner, so Nepal is at long last expected to have a stable government after 35 years. Despite hopes that there will not be the usual horse-trading this time, there is tension between supporters of RSP chair Rabi Lamichhane and Balendra Shah. The two have been negotiating in hotel rooms for Cabinet posts for loyalists.&nbsp;
Shah’s larger-than-life online persona and nationwide appeal delivered the RSP its overwhelming electoral victory this month, and this makes the party’s core leadership beholden to him. To what extent is Shah willing to meet Lamichhane’s demands is the critical question, and we will know the answer by this weekend.
Says Pyakuryal: “Because this election showcased personality politics rather than the regular party politics, the dangers of ego-clashes, power-tussles and intraparty realpolitik become very real and this kind of equation can greatly hamper the spirit of democracy, representation and collective good."

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 <figcaption>Animation: ANUP TAMU</figcaption>
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