Sagar Tamang first met Laxmi Tamang in video calls between Malaysia and Pokhara. He was working as a security guard in Malaysia, and had sent her a <a href="https://nepalitimes.com/banner/facebook-nation">Facebook </a>request. Before long, between messages and calls, they were in love and planning a future together. Laxmi could see it clearly: after six years Sagar would <a href="https://nepalitimes.com/diaspora-diaries/migrant-worker-returns-to-create-work-at-home">return home</a> to Sankuwasabha, they would get married and have children, live in the home that Sagar had built, and she would open up her tailoring shop with Sagar’s savings from abroad. But Sagar revealed that he was experiencing shortness of breath and his legs had begun to swell. She pleaded with him to come back, but he would only return after his roadside property back home was built. Sagar’s parents had already built a new house with his income and were planning another nearby. The symptoms worsened over time, prompting Sagar to eventually consult a doctor. Both his <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639">kidneys had completely failed</a>. A seemingly healthy, energetic 28-year-old suddenly turned into a dialysis patient. Sagar lived with his mother, father, five sisters and four brothers in Sankuwasabha, and the family depended entirely on a piece of land they farmed. An older brother left home to seek work elsewhere but that was not enough. So, after just finishing Grade 10 Sagar decided on an <a href="https://nepalitimes.com/here-now/overseas-job-seeker-now-creates-jobs-in-nepal">overseas job</a>. He arrived <a href="https://nepalitimes.com/here-now/the-malaysia-nepal-migrant-scam-nexus">in Malaysia</a> at just 20, saddled with loans, and an immense pressure to raise the economic status of his family. But upon arrival, he found that he would be working in agriculture, not as a security guard as per his contract. Toiling for 11 hours in the sun every day, he felt worn down and disillusioned with the<a href="https://nepalitimes.com/news/push-factors-driving-nepalis-out?fbclid=IwAR0Og_Lv1SMmn69MAkgqu1Ywu8IoLuB_v9KpnjG2F8PR-OAOCDvL6kLoKlk_aem_AX_Vm0Bo8vLUzR_RAr8GpJ8dDX53u8v0zPMP1GzR590UiMfz5jHkg7k14WF5cAQOHwY"> promise of life abroad</a>. His living situation, made up of a tightly regulated, crowded compound with other migrant workers, was no better. Only when he heard the distorted voice of his mother through his flip phone did Sagar find a sense of solace. Over the next two years, Sagar developed friendships with other Nepalis working with him, and eventually accepted that his life abroad was nearly permanent. He planned to stay aboard at least 10 years. And after writing a letter to his company, he was able to successfully switch to security guard work. Although the hours were longer, it beat the difficult manual labour Sagar was previously forced to complete for a meagre salary. Sagar fell into a routine he thought he would follow for the next eight years: get ready, go to work, return to the compound, and call Laxmi before going to sleep. But two years ago, his health reached a breaking point, and he had to return to Nepal for dialysis. Upon his arrival, he was rushed to Bir Hospital for immediate treatment. To this day, Sagar has never stepped foot inside the houses his family built with his overseas earnings. Read also:<a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating"> Dirty, Dangerous, Difficult ... and Dehydrating</a>, Pinki Sris Rana <h2>Dialectics of dialysis</h2>  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051509054_5b8972cf42e1d1ae531b7d32c0492380964f065432a8dd0a7e41674b7160b266.jpg" data-media-id="editor_7" data-image-id="2025051509054_5b8972cf42e1d1ae531b7d32c0492380964f065432a8dd0a7e41674b7160b266" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Dying to work overseas NT"><figcaption>HARD LABOUR: Sagar Tamang in a dialysis session at the National Kidney Centre in Kathmandu (right) after both his kidneys failed while working abroad in harsh conditions.</figcaption></figure>  It is estimated that <a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating" target="_blank">one in four </a>Nepali kidney patients is a returnee migrant. <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank">Factors </a>such as excessive heat, dehydration, and unhealthy diets can lead to chronic kidney disease, including kidney failure. Many returnees head straight to a dialysis bed in Kathmandu instead of taking the first bus home. In dialysis wards across the country, scores of young men under 40 sit in hospital beds, unable to work or earn for their families anymore. Many remain in debt for treatment, or have had to relocate to seek care. For patients with no source of reliable income, even finding a willing landlord to rent out a room in the capital can be almost impossible without the right connections. However, Sagar’s cousin, who had also developed chronic kidney disease while working abroad and had moved to Kathmandu from Sankhuwasaba for dialysis, took him in. Laxmi finally met Sagar two months later. She found it hard to hold back tears whenever she saw his face. She was able to stay with her brother in Bhaktapur for some time, but eventually the couple decided to marry. Laxmi’s mother and sisters urged her to put off the marriage until Sagar had completed a kidney transplant. The couple eloped. Two days after their marriage, Laxmi’s family called them to come to their home in Nagarkot to celebrate. Now, the couple lives in a rented house near the National Kidney Centre with other dialysis patients and their families. Sagar walks to his dialysis session three times a week. In this house, there is a sense of solidarity among patients, and Laxmi especially feels a comfort knowing that her neighbours understand her position as the wife and caretaker of a dialysis patient. Members of the house cook for each other, help with transport to the hospital, and sometimes even <a href="https://nepalitimes.com/here-now/when-disaster-strikes-home">lend money</a>. So far, Sagar has used his savings from abroad to pay for the direct and indirect costs of his treatment. However, the money is running out as the couple grapples with the city’s <a href="https://nepalitimes.com/opinion/is-free-health-care-possible-in-nepal?fb_comment_id=3363039693768713_5667191770020149">cost of living and medical bills</a>. The government offers free lifetime haemodialysis for patients, but the Rs5,000 monthly allowance does not come consistently, in full, or just never comes at all despite repeated requests to the patient’s municipal office. Those receiving treatment in the Kathmandu Valley also access medicine through Bhaktapur’s Shahid Dharmabhakta National Transplant Centre (SDNTC), but under the hospital’s insurance are required to pay for 10% of the cost.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051509058_2001d2b6d07ca8406575bd1c89f714b5b224d64bf25437b55bda0e21475fdbc4.jpg" data-media-id="editor_12" data-image-id="2025051509058_2001d2b6d07ca8406575bd1c89f714b5b224d64bf25437b55bda0e21475fdbc4" data-rendition-name="original" width="2773" height="4160" loading="lazy" alt="Dying to work overseas"><figcaption>Sagar with his wife Laxmi in Pokhara.</figcaption></figure>  Once his family’s primary earner, Sagar can no longer make or send money due to his condition. His family runs a goat and <a href="https://nepalitimes.com/banner/are-you-sick-of-chicken">poultry farm</a>, but has been forced to take loans to stay afloat and cannot send money for Sagar’s treatment. Until recently, Laxmi worked 12 hours a day as a tailor and house cleaner. Sagar, his mother and Laxmi, have been making trips to SDNTC in preparation for his transplant. In Nepal, only relatives or the spouse of the patient are allowed to be donors for their <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">kidney transplant</a>. This can be debilitating for patients whose families are unwilling or unable to donate due to pre-existing health issues such as hypertension or diabetes. Wives and mothers are the most likely demographic to donate to a male patient. Due to Sagar’s inability to come home and officiate his marriage it is yet to be recognised by the municipality, making Laxmi an ineligible donor. After finding out his father’s blood type did not match and refusing his younger sister’s offer to give her kidney, he and his mother decided that they could start the transplant process together. Even Nepal’s prime minister K P Oli has had a double kidney transplant, but for those who cannot find a donor within the family, the remaining years of life is measured by the humming and erratic beeps of a dialysis machine three times a week. It is going to be a lengthy and expensive process, but it is the only hope for Sagar. And what are his immediate plans after a successful transplant? To return home, to finally see his siblings, father, neighbours and friends, he tells us. He has seen his father once since his <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">return to Nepal</a>, but has not seen his siblings since he left for Malaysia. They have not visited him in Kathmandu yet, but he hopes that they will before his transplant. The couple believes that after his transplant, anything is possible: finally getting their marriage recognised, opening up a tailoring shop, having children, building a life in Sankuwashaba. Laxmi strongly objects to Sagar ever leaving Nepal again, but he remains open to the idea.

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Dying to work overseas

At the National Kidney Centre in Kathmandu, a substantial number of the staggering 800 patients who come for regular kidney dialysis are migrant returnees from the Gulf and Malaysia.&nbsp;
Last month alone, 90% of the 90,000 Nepalis who went abroad were migrant workers. Most of them went to West Asia. They are healthy when they leave, but are <a href="https://nepalitimes.com/editorial/too-hot-to-work">exposed to extreme temperatures</a>, and many return with ruined kidneys.
Nepal is suffering an epidemic of renal failure due to the workers’ continuous exposure to excessive heat, chronic dehydration, harsh work environment, and the tendency to go for energy drinks immediately after returning from work. The problem will get worse in coming decades with nonsurvivable wet-bulb summer temperatures in the countries where Nepali migrants work.&nbsp;
Truth be told, renal failure is not confined to migrant workers. Increasingly high numbers of young Nepalis are suffering from lifestyle-related ailments. Individuals as young as 25 are living with high blood pressure, fatty liver, and diabetes, among others.
In the past 40 years, Nepal has seen a dramatic transformation from a country with mortality mostly from infectious diseases to one where people are living longer but are dying due to lifestyle-related ailments. A <a href="https://nhrc.gov.np/wp-content/uploads/2022/02/BoD-Report-Book-includ-Cover-mail-6_compressed.pdf">2019 study by the Nepal Health Research Council</a> found that non-communicable diseases accounted for 71% of deaths in the country.&nbsp;
Diabetes, high blood pressure, and the irrational use of painkillers are some of the main reasons behind this figure. Kidney failure can be prevented if diabetes and hypertension are controlled in the initial stages.
Renal health is very much linked to the quality of life and economy. Patients do not suffer alone, often they are the sole breadwinners and their condition will greatly impact their families.
As per the World Health Organization, 10% percent of Nepal’s total population (300,000 people) suffer from kidney issues, 30,000 of them are in the final stage, and 3,000 need dialysis or transplant every year.
The increasing burden of non-communicable diseases is a global phenomenon but developing countries like Nepal face a double whammy as we continue to battle preventable infections too.
The chances of survival for people suffering from renal failure are slim, but the good news is that the government provides dialysis and transplantation services free of cost.&nbsp;
Currently, over 90 health facilities throughout the country provide free dialysis services to over 6,000 patients with renal failure. Over 3,000 patients have undergone kidney transplants since the service started about a decade ago, including a former prime minister and other senior government officials.&nbsp;
Every year Nepal spends Rs2.11 billion on the treatment of patients with renal failure. Local governments also provide monthly livelihood allowances to those with kidney failure or undergoing transplants. This is the highest amount the government has been spending for any single disease.&nbsp;
Even so, the focus is on the treatment of the 3,000 people living with kidney failure and scant attention has been paid to 270,000 others who suffer from some sort of kidney disease, and another 270,000 who are at risk of kidney disease.
Providing free dialysis service is not a sustainable solution. Authorities concerned should promote prevention, and encourage renal failure patients to opt for transplants. Despite the legal provision that allows any immediate family to donate a kidney, many with renal failure cannot find one.&nbsp;
Road traffic accidents are one of the biggest causes of deaths today and a kidney from brain-dead donors is a viable option. But this requires increased awareness about organ donation.
Preventing kidney disease is the best way, and the first step is to launch awareness campaigns, the cost of which is minimal compared to the treatment cost of renal patients.
The public should be told about the dangers of obesity, excessive consumption of alcohol, tobacco, salt, and junk food as well as insufficient intake of vegetables and fruits. Regular exercise, drinking plenty of water, and cutting on sugar should be promoted.
Screening is crucial to early diagnosis and a lot of lives can be saved if testing for non-communicable diseases is made free once a year for all age groups. Even then, most Nepalis do not undergo tests unless it is an emergency.&nbsp;
The government has established laboratories at the health post level to carry out the test, but very few make use of the service. People can monitor protein levels in urine and do a creatinine test, a measure that shows how well one’s kidneys are performing or filtering waste from blood. The tests cost just Rs100.
Above all, these awareness campaigns should be launched at the school and community levels so that we have an early chance to save every kidney from severe damage. Before things get worse, we Nepalis and Nepal can bring down the burden of non-communicable diseases, cut medical costs, and save lives.
Rishi Kumar Kafle is a senior Nephrologist and is the founding President of the National Kidney Center in Kathmandu.

Saving kidneys to save Nepal

Between mid-June and mid-October alone, almost 37,500 Nepalis left for the UAE for jobs, placing it among the top destination countries. Many of these workers will likely be engaged in the delivery of the COP28 Climate Summit that will ironically be held in the UAE, the world’s fifth <a href="https://nepalitimes.com/news/nepal-s-greenwashing-in-glasgow">biggest</a> exporter of refined petroleum, with the head of the Abu Dhabi National Oil Company (ADNOC) service as conference president. Prime Minister Pushpa Kamal Dahal will lead the Nepali delegation.Migrant workers form <a href="https://worldmigrationreport.iom.int/wmr-2022-interactive/">88% of the UAE population</a>, so one cannot talk about COP28 or the UAE by ignoring migration. For Nepal, too, the climate crisis and the migration economy are linked.<a href="https://www.hrw.org/news/2023/11/21/uae-migrant-worker-abuses-linked-broader-climate-harms">New research</a> by Human Rights Watch (HRW) states that the COP28 host’s role in climate injustice goes beyond it being one of the largest fossil fuel producers and among the highest per capita emitters. It also relates to its treatment of migrant workers. HRW interviewed 151 current and former migrant workers and their families from Bangladesh, Pakistan and Nepal. Despite negligible per capita greenhouse gas emissions, the three countries are among the most climate vulnerable and have suffered extreme weather and slow-onset events linked to climate change.&nbsp; The climate impact countries like Nepal face should also be considered from the perspective of their mobile populations in the UAE and other countries. Migrant workers are exposed to extreme heat with inadequate protection, and because widespread abuse like wage theft and exorbitant recruitment fees limit the ability of workers to send home remittances, including during climate-linked emergencies. Dubai’s maximum temperature on some days <a href="https://www.khaleejtimes.com/uae/weather/uae-temperatures-cross-50oc-for-first-time-this-summer">exceeded</a> 50 Celsius this summer, and the UAE itself is vulnerable to heat stress due to atmospheric warming.The Intergovernmental Panel on Climate Change (IPCC) has said that the Gulf <a href="https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter10.pdf">states’</a> wet bulb globe temperature (WBGT) is ‘expected to approach, and possibly exceed, the physiological threshold for human adaptability (35°C) by the end of the century’. Migrant workers, including Nepalis, are disproportionately exposed.The most common heat mitigation strategy used in the Gulf including the UAE are ‘summer midday bans’ that stop outdoor work in the afternoons for a few hours. But a <a href="https://oem.bmj.com/content/80/6/347">study</a> in <a href="https://oem.bmj.com/content/80/6/347">Kuwait</a> found that despite the ban there was a substantial increase in the risk of occupational injuries associated with extremely hot temperatures. Another <a href="https://www.researchgate.net/publication/333293731_Assessment_of_Heat_Stress_Exposure_among_Construction_Workers_in_the_Hot_Desert_Climate_of_Saudi_Arabia">study </a>found that the highest heat intensity for workers in Saudi Arabia was from 9 am to noon, while the ban is in effect between noon and 3 pm. HRW’s research recommends that the UAE move away from arbitrary, calendar-based midday bans towards risk-based measures such as the WBGT.&nbsp; Heat is a health hazard. It can exacerbate pre-existing conditions, impair cognitive function, and increase the risk of workplace injuries and long-term illnesses like end-stage renal failures. Dialysis rooms across Nepal that are filled with Gulf returnees. &nbsp; HRW’s <a href="https://www.hrw.org/video-photos/interactive/2023/11/21/migrant-workers-bear-the-brunt-of-uae-extreme-heat">research</a> follows three dialysis patients who are all UAE returnees describing how they did not get support from the UAE. The Nepal government provides dialysis for free, but the cost of medicines, injections, and transportation add up. Chitrakala, the wife of a dialysis patient, Til, who accompanies him to the hospital multiple times a week for his dialysis says, “In some ways, I find it comforting to be at the hospital because in the waiting room, I realise I am not alone. It is not just my family that is facing this.”&nbsp; Another UAE returnee, Purna, says it is after he frequented the dialysis centre that he realised that kidney failure is common among migrant worker returnees. The situation will worsen in a changing climate. “The UAE is externalising their own climate risks onto migrant workers who are labouring under woefully inadequate protections. These workers often experience chronic health harms linked to extreme heat, and then return home without any compensation from the UAE and instead let countries like Nepal bear all the serious health costs like dialysis treatment,” says Michael Page of HRW.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76.jpg" data-media-id="editor_9" data-image-id="20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="COP28 and migtants NT"> </figure>  There are other labour abuses like wage theft and exorbitant recruitment fees that also contribute to climate injustice, the HRW report argues. Climate emergencies back home exacerbate the mental stress of wage theft and recruitment debt as families in Nepal are in increasingly dire and even life-threatening situations.&nbsp; Workers HRW spoke to who were unable to send remittances because of labour abuses spoke of the dilemma they face: their families lose both critical financial support and the help they could have provided for urgent tasks like rebuilding damaged property had they stayed home. But for many, even exiting the UAE with outstanding recruitment debts or unpaid wages during such climate emergencies posed a challenge. Workers had to pay fees to retrieve their passports including by obtaining ‘reverse remittances’ on loan from families back home already reeling from life-threatening climate emergencies. Good migration can be transformative, but bad migration can be devastating for families. To be sure, remittances have been critical for economies of Nepal and other South Asian countries, but they do not substitute their responsibility. Historical and major greenhouse gas emitters also have a duty to support communities heavily impacted by the climate crisis. <a href="https://www.knomad.org/sites/default/files/publication-doc/migration_development_brief_38_june_2023_0.pdf">Remittances</a> are equivalent to a quarter of Nepal’s GDP, while Pakistan and Bangladesh are among the top 10 remittance recipients globally. Remittances have also been a lifeline including post-earthquake and during Covid. But these numbers mask the individual experiences of migrant workers and their families who face abuses and many of whom end up in financially worse situations than they did pre-migration. Virtually all migrant workers pay hefty fees for jobs which itself creates a huge dent on the returns to migration while excluding some of the poorest communities from even attempting to migrate. But even that does not guarantee a good job. The July 2021 <a href="https://www.icimod.org/article/the-melamchi-flood-disaster/">Melamchi flood</a> was a climate-induced disaster in Nepal, and one of its victims told HRW researchers: “During the flood, all we wanted was to save our lives. We survived, but we lost everything. The flood finished us.”His wife is headed to the UAE for a waitressing job which cost her Rs &nbsp;200,000, and borrowed at 24% annual interest. If all goes well, her first year’s salary of a mere $262 a month will just go to repay the loan. Another Sindhupalchok returnee from the UAE said, “Whether climate change or not, we have to migrate. We used to be self-sufficient but now have to buy food. Yields are lower. Insects and diseases are more common.” Climate change can be a compounding factor for longstanding emigration such as from Nepal to the Gulf, and adds to the burden of past, present and future migrant workers. The UAE is also being criticized for its restrictions on civil society and free expression during COP28. The HRW research states these affect migrant workers by limiting their ability to raise workplace concerns and seek structural, worker-centered reforms. The government’s opacity around <a href="https://pomeps.org/climate-the-environment-and-health-of-migrant-workers-lessons-from-kuwait">health data</a> hampers research for <a href="https://vitalsignsproject.org/wp-content/uploads/2023/06/Vital_signs_3_online.pdf">evidence-based</a> policymaking including for better outdoor protections, while academics and journalists tend to <a href="https://www.hrw.org/news/2021/10/01/uae-tolerance-narrative-sham-0">self-censor</a> to avoid reprisals. At the COP 28 in Dubai, Prime Minister Dahal would do well to dwell on the links between the host country and increasing climate vulnerability that Nepalis face both at home from weather extremes and heat stress at their workplaces in the UAE.

Too hot to work

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06f59c7e80680e0a5f92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The past year-and-half since the Covid-19 outbreak, Nepal’s limited health resources all had a singular focus. But now that the second wave is waning and the lockdown has been eased, hospitals are once again flooded with patients with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">diabetes</a>, cardiovascular diseases and kidney ailments.Many of these patients had left these conditions untreated, and doctors say nursing them back to health will be more complicated. One of the most common disorders is hypertension or high blood pressure, which has become an epidemic.Hypertension is a silent killer and one of the most common causes of chronic conditions like <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener noreferrer">kidney damage</a> that are often too costly to treat for the majority of Nepalis. Now, mental stress due to Covid has also added to the problem.“Hypertension makes up for the majority of patients in hospitals these days now that the lockdown has been relaxed,” says cardiologist Prakash Regmi. “Also worrying is that many of these are new patients coming in due to Covid-related stress, a large number of people who had their blood pressure under control previously after treatment are also relapsing.”To be sure, Nepal has been seeing a dramatic rise in hypertension patients even before the pandemic – some of them in their teens and 20s. <a href="https://www.hindawi.com/journals/ijhy/2021/6610649/" target="_blank" rel="noopener noreferrer">A paper published in March</a> in the International Journal of Hypertension, shows that since 2000, the hypertension rate in Nepal has been increasing at 3.5% per decade, and 44.7% of Nepali men will be suffering from hypertension by 2025.The study also found that high blood pressure is disproportionately affecting men, the elderly, those without formal education, and those who reside in urban areas, and seems to be most common in Gandaki Province.Worldwide, an estimated 1.13 billion people have hypertension, and it is responsible for 9.4 million deaths globally every year. In 2015, 1 in 4 men and 1 in 5 women had elevated blood pressure.In Nepal, close to one-third of the adult population has some form of hypertension, but in urban centres the figure is as high as 40%, with 25% in rural areas suffering from it.There is no specific cause of hypertension, but its biggest risk factor is high sodium intake. A survey in 2020 revealed that on average, the mean dietary <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.13813#:~:text=Overall%2C%20estimated%20mean%20salt%20intake,d%20(SD%20%C2%B1%204.7)." target="_blank" rel="noopener noreferrer">salt intake of a Nepali</a> per day is 13.3 mg. Most of the world consumes double the WHO recommended 5g of daily salt intake, increasing the risk of heart disease and strokes, which kills some 3 million people annually worldwide.“Traditionally Nepalis have a preference for salty food, but now with higher consumption of processed and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">junk food</a>, our salt intake has grown,” says public health expert Aruna Uprety, adding that the sodium content in packaged foods is often much higher than what companies claim.In May WHO (World Health Organisation) released a new set of <a href="https://www.who.int/news-room/events/detail/2021/05/05/default-calendar/launch-event-who-global-sodium-benchmarks-for-different-food-categories" target="_blank" rel="noopener noreferrer">global benchmarks for sodium levels</a> that will act as a guide for countries and industry to reduce sodium content in more than 60 categories of processed foods, in line with the global target of reducing salt intake by 30% and hypertension by 25%, both by 2025.Another prominent risk factor is mental stress and lack of physical exercise, both of which have been exacerbated with people staying at home for months and under the uncertainty of the pandemic. Family history of hypertension also plays a significant role in an individual developing high blood pressure, as does smoking and drinking alcohol.Undetected hypertension, and non-medication to control it, can lead to other disorders like stroke, heart disease, kidney failure, etc.Despite the huge burden of the disease on public health and the economy, treatment of hypertension is ill-managed. Patients are never diagnosed because often times there are no prior symptoms.And of the 50% who are diagnosed with high blood pressure, half ignore their condition and get no treatment. Of the remaining, 25% do get some kind of treatment but half of them again do not follow-up or take the correct dose of medication.“All in all only about 10% of hypertension patients get proper treatment in Nepal. Lack of proper health monitoring system, as well as misconceptions about life-long medications, hasn’t helped,” says cardiologist Prakash Regmi. “This often leads to a point where treatment is either too expensive, or even unmanageable.”Hypertension is first and foremost a lifestyle disease with strong ties to a possible failure of crucial organs in the human body. Its prevention and control are heavily dependent on an <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">individual’s choice of diet</a>.A state-sponsored robust awareness campaign to focus on preventive measures and a strong healthcare system are urgently needed to reduce the epidemic of hypertension.Says public health expert Aruna Uprety: “Mandatory blood pressure check-ups for certain age groups at fixed intervals is a good place to start. It goes a long way in reducing the cost of the disease and human lives.”Stages of hypertension<ul style="font-weight: 400;"><li>Normal: Less than 120/80 mm Hg</li> 	<li>Prehypertension (Elevated): Systolic between 120-129 and diastolic less than 80</li> 	<li>Stage 1 (Moderate): Systolic between 130-139 or diastolic between 80-89</li> 	<li>Stage 2 (Severe): Systolic at least 140 or diastolic at least 90 mm Hg</li> 	<li>Hypertensive crisis: Systolic over 180 and/or diastolic over 120</li></ul>Types of hypertension<ul style="font-weight: 400;"><li>Primary or essential: Most common high blood pressure among adults. No specific cause but risk factors include diet, age, physical activity and genetics.</li> 	<li>Secondary: Up to 10% of hypertension is secondary. Most often caused by another medical condition or the use of certain medicines.</li></ul>Risk factors<ul style="font-weight: 400;"><li>High salt/sodium intake</li></ul>WHO recommendation: 5gm/day<ul style="font-weight: 400;"><li>Mental stress</li> 	<li>Lack of physical exercise</li></ul>WHO recommendation: at least 150–300 minutes of moderate-intensity aerobic physical activity<ul style="font-weight: 400;"><li>Family history of high blood pressure</li></ul>

Sonia Awale

Why do so many Nepalis have high blood pressure?

It was 30 years ago this month that investment into ‘Baby Arun’, the 201MW first phase of the run-of-river Arun III project, was brought to a screeching halt when the World Bank officially withdrew its support. This brought about profound and fundamental changes in the way Nepal’s power sector subsequently developed. Nepalis suffered debilitating power outages between 2008-2016 due to shortages attributable to the cancellation. At the same time, the gap left by Baby Arun was filled by private sector investment in ways that were not obvious in 1995. It took 30 years, but in many ways Nepal’s power sector is more healthy today than it has ever been, and likely better than if the project was built as planned. At a projected budget of $1.08 billion, Baby Arun would have cost the equivalent of Nepal’s entire annual government expenditure in 1995. It was to be funded by concessional grants and loans from multilateral and bilateral funders, including the World Bank, Asian Development Bank (ADB), KfW, and investment by the government itself. At the time, Nepal’s total electricity generation capacity was only 230MW, and the trajectory of the power sector changed dramatically following the cancellation. In the past 30 years, $5.4 billion has been invested in the power sector led by private investors, and much of it from domestic banks and pension funds (table, right).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150840_c13d6f9f34d7163832b3089eabdad6f20d2d5cef3a53039e0432add2be6c32f0.jpg" data-media-id="editor_0" data-image-id="20250829150840_c13d6f9f34d7163832b3089eabdad6f20d2d5cef3a53039e0432add2be6c32f0" data-rendition-name="original" width="984" height="521" loading="lazy" alt="30 years after Baby Arun"> </figure>  Nearly 70% of the new megawatts generated were by private independent power producers (IPP) in the past 30 years, while the Nepal Electricity Authority (NEA) and its subsidiary companies added 30% of new capacity. Almost 80% of total debt financing came from domestic banks and employee retirement funds. International assistance for power generation dropped dramatically over this time, accounting for only about 15% of investment. Before 1995 new power projects used to be entirely dependent on foreign aid. Since 1995, 63% of new generation came from 171 small hydropower projects with an average capacity of 12MW, while 4% was from 21 solar photovoltaic and biomass projects developed by local IPPs.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150844_5bc299fc78be90b95ce4727b0b3bdaa4542e17e126718cc8725d136630ffc097.jpg" data-media-id="editor_1" data-image-id="20250829150844_5bc299fc78be90b95ce4727b0b3bdaa4542e17e126718cc8725d136630ffc097" data-rendition-name="original" width="988" height="503" loading="lazy" alt="30 years after Baby Arun"> </figure>  Over three decades, investment in Nepal’s power supply came primarily from new actors that had never before been involved in this sector. The rate of electrification rose from 10% to close to 100% -- sufficient to meet domestic needs during most of the year, and in 2024 made Nepal a net exporter of power to India for the first time in its history. As practically all the new investment in this period went into run-of-river hydro and solar projects, rather than into hydropower reservoirs with seasonal storage, Nepal continues to rely on imports from India during the dry winter months. Surplus electricity generation for export during the monsoon is slated to grow rapidly as another 200 solar and hydro projects are nearing completion of construction, with over 5,000MW of power capacity. Private Power The cancellation of Baby Arun inadvertently accelerated the entry of the private sector into Nepal’s power generation. The government enacted the Electricity Act in 1992 to attract private IPPs and diversify away from total dependence from international aid, but had been struggling for several years to conclude the first agreement with the 60MW Khimti Project. There remained a large gap between the tariff that the government thought was reasonable versus what was demanded by the Norwegian investor Statkraft, and the private sector arms of the World Bank and ADB that were financing the project. The shock of World Bank withdrawal from Baby Arun put tremendous pressure on the government, then led by the UML as it is now. The Bank’s decision to terminate its involvement was ostensibly, at least partially, taken in response to a letter critiquing the project sent by the UML while it was in the opposition.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150848_7fb3641d776fe86a09ad60a758f7e16660a409fdb15e541644f13646b0894347.jpg" data-media-id="editor_2" data-image-id="20250829150848_7fb3641d776fe86a09ad60a758f7e16660a409fdb15e541644f13646b0894347" data-rendition-name="original" width="949" height="446" loading="lazy" alt="30 years after Baby Arun"> <figcaption>BAD NEWS: Newspaper clippings from the early 90s on tender announcement ahead of loan approval (left) and secrecy surrounding environmental assessment (centre) of Arun III before its eventual cancellation in August 1995.</figcaption> </figure>  The government was forced to soften its position and agree to the investors’ terms following the cancellation of Baby Arun. It directed NEA to sign a power purchase agreement (PPA) with Khimti. It was concluded in January 1996, and this was followed by a second PPA in July 1996 with Panda Energy, the American developer of the 45MW Upper Bhotekosi project. The expensive USD-denominated agreements to buy power from two international private producers, with price escalation clauses tied to the New York Consumer Price Index, sent alarm bells ringing. There was worry that the country was heading towards unaffordable tariff rates for the consumer and potential bankruptcy for NEA as a result of inevitable future weakening of the Nepali Rupee. The government had strong-armed NEA into signing these agreements, and realised that concessionary financing terms that Nepal was used to receiving for public sector projects such as Baby Arun and Kali Gandaki A, that included below-market interest rates and 40 years repayment period with a 10 year grace period before starting repayment, were not the norm for private sector investors. Nepal’s status as a less than attractive destination for foreign investment meant that the country had few options but to accept expensive dollar PPAs from international developers with the high commercial interest rates and short repayment periods imposed by their banks because of high investment risks. In the end, the government ended up having to additionally provide a sovereign guarantee in order to close the deal at the insistence of the lenders – committing it to repayment in case NEA defaulted on paying the IPPs. It is reasonable to assume that the extraordinarily high political cost of agreeing to the PPA terms would have meant that no government would have willingly agreed to them in 1995 had it not suffered the trauma of the loss of concessionary-financed public sector projects as large as the Baby Arun. It has taken NEA 25 years to consider offering dollar-denominated PPAs again: to cover the foreign exchange portion of the investment in the 216MW Upper Trisuli-1 and 120MW Rasuwa-Bhotekosi Hydropower projects. It seemed unlikely at the time, but it turned out that the dire situation Nepal found itself in 1995 planted the seed to mobilise investment for affordable power from within the country. Double Whammy After the dual shock of first losing investment in Baby Arun and having to sign expensive power purchase agreements with international IPPs, the first proposal for an alternative strategy to mitigate the risk of foreign currency investment into hydropower projects came from a group of engineers within the Arun III team at NEA. Led by <a href="https://archive.nepalitimes.com/news.php?id=4900">Deputy Director Damber Bahadur Nepali,</a> engineers convinced the leadership that NEA needed to invest in a subsidiary company to build a series of locally-designed and domestically-financed projects that would have lower cost with rupee-denominated PPAs. They registered the Chilime Hydropower Company Limited (CHCL) in October 1995 with 51% shares from NEA, 25% from its employees, and 24% available for the general public, 10% of which was prioritised for local residents at the project site. The 22.1MW project is in Rasuwa on a tributary of the Trisuli, and mobilised debt financing from the Employee Provident Fund, which manages retirement savings for employees of the government, public enterprises, and private sector institutions. CHCL’s experience showed that NEA employees themselves believed that individual hydropower projects with operational independence from NEA could be developed profitably in Nepal by its own engineers -- and they were willing to put their own money on the line. Chilime also demonstrated that there was money in the country, particularly with retirement funds, looking for opportunities for long-term investments. Following completion of Chilime in 2003, CHCL led the formation of three other NEA subsidiary companies that completed construction in 2023 and 2024, producing 168.3MW using fully rupee-tied investment. NEA’s largest subsidiary, the Upper Tamakosi Hydropower Limited, completed construction of its 456MW plant in 2021.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829160812_ce9ab8b49c598970db3f5bf0a079061ef52f153b28d9f4ead2bb1b26bfd7c2f3.jpg" data-media-id="editor_4" data-image-id="20250829160812_ce9ab8b49c598970db3f5bf0a079061ef52f153b28d9f4ead2bb1b26bfd7c2f3" data-rendition-name="original" width="3000" height="1571" loading="lazy" alt="30 Years after Baby Arun"> <figcaption>DAMNED: The $700 million 456MW Upper Tamakosi built entirely with domestic funds before it was destroyed by the September floods last year. </figcaption> </figure>  There were some delays and cost overruns on this run-of-river project, the largest in the country with a final cost of over $700 million -- all of it sourced domestically. The five subsidiary companies launched by NEA have produced almost two times as much new power as NEA has over the past 30 years. Seven other NEA subsidiaries are currently constructing projects to add another 474MW to the national grid. But even more important than NEA subsidiaries have been local IPPs: Nepali companies which have over the past three decades enthusiastically entered the hydropower sector. From a regulatory perspective, the credit for mobilising domestic private investment to engage in power generation goes to Minister of Water Resources Shailaja Acharya, who in 1998 offered a flat feed-in-tariff of Rs4/kWh for hydropower projects under 10MW. This upfront offer removed a major barrier that early developers had faced of having to spend money to carry out a detailed feasibility study before they could even start tariff negotiations with NEA. She had laid the foundation stone of the Chilime project, and proved to be the champion of opening up the sector for domestic IPPs. The guarantee of a PPA with a fixed tariff, irrespective of project specifications, gave small power developers the confidence to apply for survey licenses and invest in feasibility studies so they could directly approach commercial banks and make a case for their project producing required revenue to repay loans. Domestic IPPs started adding power to the national grid in 2002. Their contribution was initially modest, and first projects were small and commercial lenders who took time to be confident about providing debt financing to a sector which had previously not been considered suitable for private sector investment. While the first 10 years were slow, with less than 10MW being added to the grid each year, this increased twenty fold over the following ten years, resulting in the equivalent of a Baby Arun being added by Nepali IPPs to the grid each year. A total of 84 IPPs added 232MW, 328 MW, 454MW, and 400MW of new generation to the grid in 2021-2024 (graph). There was explosive, exponential growth as domestic developers have surged ahead to account for 76% of the new megawatts added to the grid since 2020, compared to 24% by NEA and its subsidiary companies. The megawatts that IPPs are adding have followed the classic ‘hockey stick curve’ with the ‘breakout point’, signaling the rapid growth phase in 2020. Private producers are expected to accelerate new generation in the coming years with 300 solar and hydropower projects adding 11,000MW. Another 166 hydropower and 96 solar projects are currently in the survey stage, and are in line to add another 11,000MW to the construction pipeline. One major challenge is finding financing required for the projects. Domestic investment will no longer be sufficient to finance this ambitious pipeline of renewable energy projects. Project developers as well as NEA and the Electricity Regulatory Commission will have to leverage their substantial experience accumulated through the construction of over 200 projects to attract regional and international investment and hedge the risks of dollar-denominated PPAs. Following the cancellation of Baby Arun, <a href="https://nepalitimes.com/opinion/people-power/decentralising-power-in-nepal">Nepal developed a highly distributed power sector</a>. The national electricity grid is currently supplied with power from a remarkably decentralised array of hundreds of hydropower and solar photovoltaic projects spread across 43 districts and all seven provinces.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150848_0c3aa66b34bfb08380a624f397bf3ebb4126f4d6b41a26115848b496876f501b.jpg" data-media-id="editor_6" data-image-id="20250829150848_0c3aa66b34bfb08380a624f397bf3ebb4126f4d6b41a26115848b496876f501b" data-rendition-name="original" width="1228" height="867" loading="lazy" alt="30 years after Baby Arun"> </figure>  This presents a sharp contrast to the pathway of a few large public sector hydropower projects with a sprinkling of private sector projects that was envisioned as part of NEA’s investment planning when Baby Arun was being considered the front runner for investment. The strategy then was to allow public sector investment in a few large hydropower projects with thermal plants to fill the gap. Knowing what we know now about acceleration of climate change impacts and increased extreme weather events, following this path would have made Nepal’s power sector highly vulnerable. Decentralised generation greatly improves the resilience of Nepal’s power supply as damage to power plants in one part of the country need not affect other areas that have their own generation. Following the investment plan where over two thirds of the country’s power supply would have come from power plants on the Arun River, would have greatly imperiled Nepal’s energy security. All rivers in Nepal are susceptible to flooding from cloudbursts made more frequent by climate change. The Arun River which is fed by glaciers in Tibet is also at risk to glacial lake outburst floods. Bikash Pandey is Director of Clean Energy and Circular Economy at Winrock International. People Power is his regular column in Nepali Times on global energy issues relevant to Nepal. <h2>Decentralised and Diversified</h2> In the 30 years since the cancellation of ‘Baby Arun’: Hydropower projects constructed cover capacities ranging from less than 1MW to 456MW and developed by IPPs from across the country with strong local involvement in purchasing equity shares. Renewable energy sources contributed to the generation mix through solar IPPs that further contribute to climate resilience, and cover shortfalls during low rainfall. The government is committed to solar contributing 10% of the power on the grid. Increasing solar beyond this target and providing incentives to project developers to invest in utility-scale battery storage would further improve resilience. BIG ARUN: The 900MW Arun III project under construction since 2018 at Num in Sankhuwasabha (pictured, below) is a separate initiative by a different project developer using a different financing modality. The ‘Baby Arun’ version of Arun III was cancelled in 1995.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150852_df534df5166eb5a9bb4cbe101627bdec7ac1df2a405a9d3988d1c86fcc8ecdeb.jpg" data-media-id="editor_7" data-image-id="20250829150852_df534df5166eb5a9bb4cbe101627bdec7ac1df2a405a9d3988d1c86fcc8ecdeb" data-rendition-name="original" width="1750" height="1312" loading="lazy" alt="30 Years after Baby Arun"> </figure>

30 years after Baby Arun

This is the 72nd 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. My father ran a store and that is where I spent all my time till Grade 6. Doing my homework. Serving customers. I then moved to my maternal grandparents’ house because I used to get along with my cousin who was a year older than me. We did everything together, and were best friends. We took turns studying: I was a night owl, and he was an early riser. Before I went to bed after studying all night, I woke him up. My mother was 44 when I was born, the same year my eldest brother got married. My sister-in-law becoming a part of our family was how my mother referenced my age. I liked making money, and was always a hustler. In Grade 7, I learnt to handle a tractor and helped my brother-in-law to plough, earning Rs10 a day. As I got better, he paid me more. By Grade 9, I was already making Rs500 per day, but had to slow down to prepare for my exams. From an early age I knew I did not want a 9-5 job. There just wasn’t enough money in it. I wanted to get into business, and compared my brother who worked in the post office and what businessmen made. It did not help that my brother was honest, and never took bribes. A friend and I made money selling cheap Chinese phones at a premium to our friends. We blasted music on the phones and pretended that we were giving them a discount. After SLC, I started teaching math and other subjects. I was soon a shareholder in the same school and in the evening I was involved in our family’s floriculture business, growing amaranth and marigold for garlands.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020844_1b54b999d67122a50c4c7e6204cc737bcc99bf2a68db6499a4566a7f61a880b4.jpg" data-media-id="editor_0" data-image-id="20250831020844_1b54b999d67122a50c4c7e6204cc737bcc99bf2a68db6499a4566a7f61a880b4" data-rendition-name="original" width="955" height="1314" loading="lazy" alt="Diaspora Diaries 72"> </figure>  It was then that a friend suggested we learn the Korean language. We could be earning significantly higher in Korea for similar efforts. I had no plans to go abroad but he convinced me. I did not know anything about Korea, and was scolded at the language institute when I asked someone to point Korea on the map.&nbsp; It was only there that I learnt you had to pass an exam for the Korean Employment Permit System (EPS), and pay for language classes. After a week, I decided it was not for me and dropped out. But my friend convinced me to give it one more try. I did not prepare much for the exam, and it was no surprise that I failed. But it was just by one mark, and people would pity me for failing “just by one mark”. It was a brand of failure. It hurt my ego. I had to turn things around by taking the exams seriously, and locked myself up to study hard.&nbsp; Even when we had visitors, my wife told them I was not home. If I was not in my room learning Korean, I would be with a group of ten of us test-takers comparing notes and practicing late into the night. The exam was difficult, but this time I passed, the only one in my group who did.&nbsp; As someone who never liked the idea of doing a job, I still had my doubts about going to Korea. It did not help that one of my acquaintances had returned a month after he had left, and he discouraged me from migrating given that I was already making good money in Nepal.&nbsp; But my wife suggested that I give it a shot since I had worked so hard for it. And if it really turned out not to be my cup of tea, I could always return. What did I have to lose, I thought, at least I would get to visit Korea. My job there was in an electrical company that made circuit boards. I worked all day, earned good money. In the evenings, I kept myself busy with my real estate business back in Nepal. I had learnt the tricks of the trade from fellow real estate agents back home, but at the time did not have the capital to invest.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020848_941e961e2045058f255ad89884b51faa7d2365c68236e5cbe573d63d769ac6c5.jpg" data-media-id="editor_1" data-image-id="20250831020848_941e961e2045058f255ad89884b51faa7d2365c68236e5cbe573d63d769ac6c5" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Diaspora Diaries 72"> </figure>  In Korea, it helped that I had salary records that allowed me to get loans from financial institutions both in Korea and in Nepal. Ultimately, I started earning more from my real estate deals in Nepal than from my job in Korea. This was all thanks to my ability to take loans because of the EPS scheme. My wife has been managing the flower business while I was away. My finances grew stronger over the eight years I was in Korea. I paid off the loans that I had borrowed to buy land. But real estate did not satisfy me entirely. I wondered: what is my brand? What will I be known for? What is my contribution to society? Real estate is for wealth, but that is about it. I needed to sell one piece of land and use the revenue to start a venture. I took classes in business, and returned to Nepal six months ago and got back to my family’s ancestral roots in floriculture. In Nepal too, I am continuing the entrepreneurship training I had started in Korea with the Bridge International. Such exposure helps us reflect on our business such as our branding, vision, and proactive aspects like the importance of strong recordkeeping.&nbsp; I am now working to upgrade and expand my floriculture business. With a friend who is still in Korea I am building a cooling room to increase the shelf-life of flowers and other produce and set up a market in my village where others can sell their produce. Floriculture is our primary business, but it is seasonal and earns good money only during festivals like Tihar.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020848_a008ffeba13896e6918f68ff6e687c8fe11140d86a96f1ec11690547f2bcd415.jpg" data-media-id="editor_2" data-image-id="20250831020848_a008ffeba13896e6918f68ff6e687c8fe11140d86a96f1ec11690547f2bcd415" data-rendition-name="original" width="1280" height="720" loading="lazy" alt="Diaspora Diaries 72"> </figure>  So, I grow tomatoes to ensure year-round earnings. I also am engaged in other businesses like real estate and online shopping. I work round the clock in Nepal — a strong work ethic is something I picked up in Korea.&nbsp; My Korean bosses would work alongside us, that motivated us. I work just as hard in Nepal as I did in Korea. People here often ask me why I am pushing myself so hard. But making garlands comes easy to me, it is work my forebears were involved in. My childhood memories are about plucking flowers with my sister. I have a comparative advantage in this work. It comes naturally to me, it is easy and I enjoy it. And sometimes, if there are too many garlands to make, I can multitask while holding meetings. My fingers just fly. I am good at this job, but my wife is even better and faster.&nbsp; When there is too much load, we can also outsource the work. To be known as the flower guy would be great personal branding. The मखमली guy. Or the सयपत्री guy. I decided to come home for just this with a one-way ticket. “अब पासा: जाँदैन ल्हासा!” &nbsp;

The flower guy

It cannot be a coincidence that after pushing bills to constrict freedom of expression and allow greater <a href="https://nepalitimes.com/news/security-or-espionage">surveillance of citizens</a>, Nepal’s government is now tightening controls on civil society.
In a <a href="https://nepalitimes.com/opinion/guest-editorial/command-and-control">series of recent moves</a> journalists have been sued for contempt of court, imprisoned for YouTube videos, or ordered by courts to desist from investigating corrupt officials.
An amendment to the Print and Publications Act that would hand the power to shut online media to the Chief District Officer (CDO). Another draft Bill would allow a political appointee to head a new Media Council with the power to revoke a journalist’s license. The draft counter-intelligence Bill would let random officials to arbitrarily tap phones, read emails and trail citizens.
Now comes yet another draft Bill that would replace the <a href="https://archive.nepalitimes.com/news.php?id=10675">Social Welfare Council (SWC)</a> with direct government control over registration, regulation, and management of non-governmental organisations, nonprofits and charities. There are more than 54,000 NGOs, 200 international NGOs registered with the SWC.
The draft makes civil society organisations needlessly jump through hoops to carry out work that complements the government in the social sector. Critics say the Bill was drafted without any consultation with <a href="https://nepalitimes.com/opinion/comment/nepal-s-rights-groups-must-step-up-4r4z6ck4">civic groups</a>.
“This Bill’s content is questionable whether it intends to allow for civil society organisations in Nepal a free space to operate,” concludes Dr SP Kalaunee, Country Representative of BlinkNow Foundation and Chair of the Association of International NGOs in Nepal (AIN). “The draft seems oriented towards controling rather than facilitating the work of civil society organisations.”
The Bill will be open for feedback from the public, and integrates the National Directives Act (1961), Association Registration Act (1977), and the Social Welfare Act (1992) and proposes dissolving the SWC and replacing it with a new Social Welfare Department under the Ministry of Women, Children and Senior Citizens.
Non-government groups will now be required to get approval from the Registrar Office, the CDO or the provincial government depending on their area of operation. Those working across provinces will have to get permission from the federal government. &nbsp;
The government says the Bill is intended to vet organisations to see if they are engaged in espionage, violate national security, assist a foreign state, commit treason, cause strife between federal units, or incite communal violence.&nbsp;
CSOs working in Nepal have long called for legislation to better facilitate their work, minimise administrative and bureaucratic red tape which have posed operational challenges. But they are opposed to such drastic control.&nbsp;
Read also: <a href="https://nepalitimes.com/banner/the-crow-and-the-scarecrow">The crow and the scarecrow</a>, Om Astha Rai
The NGO Federation of Nepal also issued a statement this week calling the Bill ‘retrograde and cumbersome’. It added: ‘Most of its provisions are intended to further constrain and control civil society organisations rather than facilitate and strengthen them, and reduce the role of citizen participation … it is an attack on our civil liberties, inclusivity, and transparency, and curtails our <a href="https://archive.nepalitimes.com/news.php?id=5156">democratic values and constitutional rights</a>.’ &nbsp;
<a href="about:blank">Nepal’s graduation</a> from least-developed country status next year may mean less aid for Nepal, and higher interest rates on loans from multilateral creditors. The <a href="https://nepalitimes.com/news/how-usaid-cut-affects-nepal">closure of USAID </a>and reduction in bilateral grants means the work of INGOs will be even more vital – especially to meet its <a href="https://nepalitimes.com/here-now/target-2030-for-maternal-and-newborn-health">SDG targets by 2030</a>.&nbsp;
“We are competing with other countries at a time when the global aid environment is shrinking, so the support we receive is directly dependent on a conducive environment for INGOs to operate and function,” says Kalaunee. “INGOs follow regulations of the nations they operate in, they will not protest or wait around for governments to change their minds or policies.”
Social safety net
Since 1977, the work of non-governmental actors in Nepal has been regulated by the Social Service National Coordination Council (SSNCC) chaired by Queen Aishwarya.
After the <a href="https://nepalitimes.com/banner/one-moment-30-years-ago-today">1990 People’s Movement</a>, King Birendra set up the Social Welfare Council (SWC) as an autonomous body in 1992 through the Social Welfare Act. But since then the SWC has been dogged by controversy and allegations of corruption and extortion.
In 2018, the Commission for the Investigation of Abuse of Authority (CIAA) filed a Rs315 million corruption case against 14 individuals, including the Minister of Women, Children and Social Welfare and SWC chair Badri Prasad Neupane and other officials for violating public procurement laws to rent out three hectares of its property around Bhrikuti Mandap.
Civil society groups have for years called for reforms in the SWC, and a report was drawn up to restructure it before this Bill proposed its dissolution. INGOs in particular will now have to go through the Social Welfare Department and multiple ministries for permissions.
A particularly objectionable provision in the draft stipulates that NGOs must have a Board of Director made up almost entirely of secretaries of various ministries. The NGO Federation has urged the government to take a civil society-friendly approach and not tangle its work in red tape and control. It says the government has no option but to revise the bill in its current form.
“Civil society organisations need an open space to operate, and an autonomous body to oversee them,” says Kalaunee. “Non-government organisations support in the areas prioritised by the government but by definition they cannot be a part of government.”

Big, beautiful Bills

An average Nepali could live 3.3 years longer if air pollution is reduced to meet the World Health Organization (WHO) guideline, according the annual <a href="https://aqli.epic.uchicago.edu/">Air Quality Life Index</a> 2025 published this week. The annual average concentration of tiny suspended particles in the air (PM2.5) in Nepal in 2023 was 38.3 μg/m3, nearly eight times the WHO standard, and 10% higher than 2022. Thirty years ago, air pollution in Nepal was half the current levels. WHO says particulate concentration above 5μg/m3 &nbsp;is<a href="https://nepalitimes.com/here-now/what-is-invisible-is-more-dangerous"> hazardous to health</a>.&nbsp; The most <a href="https://nepalitimes.com/banner/why-is-the-air-in-bhaktapur-so-bad">polluted parts of Nepal</a> are along the Indian border in Rutahat, Mahottari, Dhanusha, Parsa and Bara districts in Madhes Povince where average life expectancy is reduced by as much as 5.3 years.&nbsp; People in Sarlahi, Siraha, Saptari, Morang, Sunsari, Rupandehi and Jhapa are also dying at least 4 years earlier. The Air Quality Index 2025 report which is published annually by the Energy Policy Institute at the University of Chicago, says the figure is relatively lower for Kathmandu and Lalitpur at 2.6 and 2.4 years. After the Madhes, Kosi and Lumbini Provinces are the most polluted — especially in towns along industrial corridors and near the border. Karnali Province was by far the cleanest, followed by Sudurpaschim. Read also: <a href="https://nepalitimes.com/here-now/epicentre-of-pollution">Epicentre of pollution</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250828060856_136770cc84e114e8993af82e6a682c45d9458060e4ecf45f18e9f210673e1279.jpg" data-media-id="editor_4" data-image-id="20250828060856_136770cc84e114e8993af82e6a682c45d9458060e4ecf45f18e9f210673e1279" data-rendition-name="original" width="753" height="584" loading="lazy" alt="AQLI map"> <figcaption>Potential gain in life expectancy from permanently reducing PM2.5 from 2023 concentration to the WHO guideline.</figcaption> </figure>  Air pollution is now the leading external<a href="https://nepalitimes.com/editorial/cleaner-air-longer-lives-0z0okfeu"> threat to life expectancy in Nepal</a>, exceeding both tobacco and diet-related risks, which reduced average lifespans of Nepalis by 1.9 years and 1.3 years respectively. The Air Quality Management Action Plan for Kathmandu Valley introduced in 2017 had identified vehicular emissions, brick kilns, and construction as the most polluting. It adopted measures to strengthen air quality monitoring, develop emissions inventory, and conduct impact assessments. Other major sources of emissions in Nepal include <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">forest fires</a>, crop residue and garbage burning as well as transboundary pollution from India and Pakistan. The report says India is the world’s most polluted country with the particulate concentration in 2023 at 41 μg/m3, an average resident in India could live 3.5 years longer if pollution levels were brought down to meet the WHO guideline. Residents of New Delhi on average would live 8.2 years longer if they breathed clean air. South Asia has some of the world’s most polluted cities. On some winter days, Kathmandu records the worst air quality in the world. In 2023, PM2.5 concentrations in South Asia declined by 9.6% between 2021 and 2022 due to lockdowns during the peak of the Covid-19 pandemic. ‘After a dip in 2022, particulate pollution in South Asia increased by 2.8% in 2023 — though it remained 7% lower than in 2021,’ <a href="https://aqli.epic.uchicago.edu/report/annual-update-2025">states the report</a>. ‘In the region’s most polluted countries, particulate pollution’s impact on life expectancy is nearly twice that of childhood, and maternal malnutrition and more than five times that of unsafe water, sanitation and handwashing.’ Elsewhere, unprecedented wildfires caused particulate concentrations to rise to levels not seen since 2011 in the United States and since 1998 in Canada. China also registered a decline in air quality, an increase of 2.8% in particulate pollution in 2023 relative to 2022, the first in a decade since the start of its ‘War on Pollution’ in 2014.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250828060856_94860b929d0fb161220ad72ecb76fcd29ba8e306bd6b844485a4171dadb6bb47.jpg" data-media-id="editor_8" data-image-id="20250828060856_94860b929d0fb161220ad72ecb76fcd29ba8e306bd6b844485a4171dadb6bb47" data-rendition-name="original" width="754" height="501" loading="lazy" alt="AQLI line graph"> <figcaption>Annual average PM2.5 concentration in Nepal from 1998-2023.</figcaption> </figure>  Globally, the PM2.5 concentration in 2023 was 1.5% higher than in 2022, and nearly 5 times the WHO guideline. If global particulate pollution were permanently reduced to meet this guideline, an average person around the world would gain 1.9 years of life, adding 15.1 billion total life years to the <a href="https://nepalitimes.com/opinion/the-future-is-older">global population</a>, the report adds. ‘Particulate pollution remained the greatest external threat to human life expectancy in 2023, with <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">its impact comparable to smoking</a> and surpassing other major health risks,’ the report says. ‘Its toll on life expectancy is more than 4 times that of alcohol use, 5 times that of transport injuries or unsafe water, sanitation, and handwashing, and more than 6 times that of HIV/AIDS.’ The report also highlights the need for open data, and says that accessible air quality information has translated into reduced particulate concentrations and gains in life expectancy in the United States, China, and Poland. Besides data, the report says, investment in monitoring and other air quality management infrastructure must be matched by political will, ambitious policies, capacity building, and sustained enforcement.

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