https://www.youtube.com/watch?v=Xf4OpwoblRc&amp;feature=youtu.beProblem: Some 70% of Nepalis are carriers of the tuberculosis bacillus and many of them have full-blown versions of the disease. Although diagnosis and treatment is available, the sick cannot travel to hospitals. How to test the sputum of patients, and deliver antibiotics in remote and road-less parts of Nepal?Solution: By drones.Nepal has been acclaimed for its directly observed treatment short course (DOTS) for treating tuberculosis, which demands a combination of antibiotics that are administered under supervision. However, TB is difficult to diagnose and treat in remote parts of this country.That is why the Britain Nepal Medical Trust (BNMT) is taking a big leap in treating TB with a pilot project in a remote part of Piuthan district in the mountains of central Nepal. Read also: <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">TB or not TB</a>, EditorialThe Trust has cleverly recycled the <a href="http://archive.nepalitimes.com/news.php?id=294#.XPkeWBYzaUk" target="_blank" rel="noopener">DOTS</a> acronym to DrOTS, this time to mean Drone Optimised Therapy System, and is running test flights in the district to collect sputum samples and deliver both diagnoses and treatment to patients living in up-country villages.The drone flies to health posts in the mountains, and returns sputum samples to the district hospital in Swargadwari Municipality and the public health centre (PHC) in Piuthan Municipality. The samples are tested using a <a href="http://archive.nepalitimes.com/news.php?id=17747#.XPkeaxYzaUk" target="_blank" rel="noopener">GenExpert kit</a>. If they are positive, patients are given DOTS treatment using smart pill boxes, which keep electronic records of whether or not patients have taken the antibiotics.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44c69c7e80680e04d34djpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Photo: RAMU SAPKOTA</figcaption></figure>“We are using the drones experimentally to ensure that we can reach the hidden cases of tuberculosis, since every untreated patient is a potential carrier of the disease and can spread it,” explains Shraddha Acharya, BNMT coordinator in Piuthan.During the pilot phase, drones will be used only to collect sputum samples from remote settlements. If the tests are successful, the Trust hopes to use the unmanned craft to also deliver medicine.Thanks to the initiative, health personnel will no longer need to walk for days to deliver sputum samples from health centres in the villages to the district hospital and PHC for testing, and then return with medicines for those who test positive. The current system results in delays in getting medicines to patients, and also lack of supervision administering the antibiotics.Read also:<a href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/" target="_blank" rel="noopener">For Nepal, a game-changer in TB control</a>, Buddha Basnyat and Maxine CawsCommunity Health Worker Sita GC (pictured above) says the drones are god-sent because they can deliver samples in 25 minutes, where earlier it took 2-3 days. “Logistics was a huge problem because of unreliable transport; now it is easy to diagnose and treat quickly,” she adds.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44ca9c7e80680e04d34ejpeg.jpg" alt="" width="640" height="427">Maxine Caws (pictured above) of BNMT, an epidemiologist with the Liverpool School of Tropical Medicine, says the drones are being tested in Piuthan because it is the mountain district in Nepal with the highest TB prevalence. Last year, the district treated 379 patients for tuberculosis, but 335 new cases were detected in the same period.The remote-controlled craft are handled by drone specialist Nepal Flying Lab. “We found this to be an exciting project because the drones are ideal for bridging distances to remote areas and the sputum samples and medicines are not too heavy,” says the lab’s Uttam Pudasaini, who adds this is the first time such deliveries are being tested in Asia.The drones weigh 9kg when empty and can carry another 7kg in a cargo hold designed to protect against biohazards; they can be airborne for 30 minutes. The craft flies at speeds of up to 1km per minute, and is controlled by a pilot at the takeoff point who coordinates with a health worker at the destination. In future, the project plans to train health workers to fly the drones themselves.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44cd9c7e80680e04d34fjpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d19c7e80680e04d350jpeg.jpg" alt="" width="640" height="427"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d49c7e80680e04d351jpeg.jpg" alt="" width="640" height="359">The technology has been used for TB control in Zimbabwe and Papua New Guinea. In Nepal, the pilot project is funded by the Nick Simons Institute till December. “Further extension will be determined by whether it is successful and cost-effective,” says Caws.Sita GC says so far up to 35 positive cases of TB have been detected from sputum samples in Piuthan this month. However, many people refuse to give samples, and others do not follow instructions on taking antibiotics.The ministry of health is also involved in the drone trials. Spokesperson Mahendra Shrestha says that if the tests are successful the government will take over the program and try to replicate it for TB control in other remote areas.“If this project is successful, Piuthan and Nepal will be famous worldwide. But the biggest challenge is to first make the tests work,” says Shrestha.<h2>TB or not TB</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110813110/636a44d79c7e80680e04d352jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>There are 10 million new cases of tuberculosis every year, and the medieval disease still takes the lives of 1.5 million people annually worldwide.South Asia accounts for 40% of the global TB burden, with over 4 million cases as well as 40% of total fatalities, a third of them patients who succumbed after they failed to respond to treatment. But worsening air pollution, smoking and alcoholism are big risk factors for TB infection in the region.Some 11 Nepalis die every day from the highly contagious infection.There are 40,000 new cases of TB here every year, and Nepal also has a very high rate of latent TB infection. Despite antibiotics, it is often difficult to reach patients in underserved parts of the country and Nepal’s harsh terrain makes it hard to access diagnosis and treatment on time. Experts say there is huge under-reporting of cases.Nepal is a role model in the community-based DOTS (directly observed treatment short course), with its supervised administration of antibiotics to patients. Yet, experts say much more aggressive <a href="https://www.nepalitimes.com/banner/for-nepal-a-game-changer-in-tb-control/" target="_blank" rel="noopener">case detection and an early treatment system</a> should be in place if the country is to meet the UN target of reducing TB mortality by 95% and cutting new cases by 90%, by 2035.This means developing techniques to reach the poorest in the remotest parts of the country, and also requires increases in Nepal’s TB control budget and prioritising the infection otherwise known as the ‘poor man’s disease’.<a href="https://archive.nepalitimes.com/page/resistance-to-live-saving-drugs-threatens-to-set-back-progress-in-nepal" target="_blank" rel="noopener">MDR (multi-drug resistant) TB</a> is also spreading, as patients develop resistance to commonly used drugs for treatment. The last survey in Nepal showed that among previously treated cases, anti-microbial resistance was found in 15.8% of cases, against the world average of 18%.Nepal also has the added challenge of an open border with India and migrant workers continue to bring infections home, while many patients from India come to this country for treatment.The UN General Assembly held its first-ever, high-level meeting on tuberculosis last year to draw attention and generate investment for TB research, treatment and diagnosis. The SAARC TB Centre located in Kathmandu focuses on prevention and control of tuberculosis and TB/HIV co-infection. Research is also needed for non-resistant drugs with shorter regimen.Sonia Awale

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Nepal tests and treats TB with a flying pharmacy

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110811118/636a2ab39c7e80680e04592fjpeg.jpg" alt="" width="1400" height="933"/><figcaption>TB OR NOT TB: Birat Nepal Medical Trust team in Hetauda on Wednesdady used the Holi festival to raise awareness about tuberculosis in Nepal. Photo: Antonio Beltrán Rodríguez</figcaption></figure>Tuberculosis killed 33 million people worldwide between 2000-2015, more than the entire population of Nepal. The infection still kills three people every minute all over the world, and 11 Nepalis a day. This perfectly curable medieval disease is the <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">biggest infectious killer</a> in the world today, more than HIV or malaria. In sharp contrast, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/ebola-in-asia,1764" target="_blank" rel="noopener">Ebola</a>, which receives far more media coverage, killed only four people in 2017.Read also:<a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">TB or not TB</a>, Editorial<a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a>, Sonia Awale<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110811118/636a2ab69c7e80680e045930jpeg.jpg" alt="" width="800" height="702">World Tuberculosis Day on 24 March is an opportunity for governments to renew efforts to control this devastating disease. More than 40% of the world’s TB cases occur in South Asia. While much research and funding focuses on HIV-associated TB and <a href="https://archive.nepalitimes.com/page/resistance-to-live-saving-drugs-threatens-to-set-back-progress-in-nepal" target="_blank" rel="noopener">multi-drug resistant (MDR) TB</a> in sub-Saharan Africa, HIV infected individuals make up only 9% of global TB cases and less than 1% had MDR TB in 2017. Despite a huge sample size, there is a lack of research on TB in South Asia, particularly India, and on cases not associated with HIV. If nothing is done, TB will cost another 28 million lives in the next 10 years.These shocking figures may seem like numbing statistics, but at an emotional level in Nepal, we all know people, including many family members, who have suffered and died of TB. Many readers also may have suffered from TB, and fortunately have been cured. <a href="https://www.nepalitimes.com/editorial/tb-or-not-tb/" target="_blank" rel="noopener">Tuberculosis</a> is so rampant in South Asia that every working day, clinicians struggle with the question in any random patient: Is this TB? This is in sharp contrast to the western world where TB is essentially a biblical disease.While Nepal is a role model in the community-based DOTS (directly observed treatment short course) treatment, which ensures index patients are taking their medicines, this alone will not suffice in the battle against TB, since a patient would often have already infected others in the household and workplace. Which is why active case finding and early treatment is the key. But tragically there is massive under-reporting -- Nepal gets over 40,000 new cases of TB a year with over 4,000 deaths, but many do not get diagnosis and treatment due to lack of resources for TB control.The first ever prevalence survey for TB in Nepal is currently underway, and preliminary findings show a substantial increase in the estimate of total TB cases in the country. This would be consistent with the results of other prevalence surveys in the region, which have all demonstrated that the burden of TB has been substantially underestimated in South Asia. For example, evaluation of data from multiple sources in India showed an increase of more than 80% in the estimated incident TB cases from 1.6 million to 2.9 million in 2014. Although better than DOTS, just active case finding and treatment will not be enough to bring TB under control.This is where George Comstock’s work becomes relevant in Nepal and South Asia. In the 1950-60s this epidemiologist worked with the largely Inuit population in the town of Bethel in Alaska. He determined that, although patients and their household contacts were being treated properly, the rates of TB in the community was not declining as predicted. He felt that unless latent TB infection was treated, the TB organism ‘pool’ would continue to perpetuate the disease. Many people who are exposed to the tuberculosis organism will just have an infection, that is latent TB, without any symptoms.Comstock started treating latent TB infections with one drug (isoniazid) which, sure enough, brought down TB cases in Bethel. Since then, multiple studies all over the world have shown that treating latent TB infection this way helps substantially decrease the TB pool in the community and make a resounding impact in the control of TB. Indeed, this is how TB has been nearly removed from many poor communities in the West. For many reasons, including financial and perceived concerns of isoniazid’s liver toxicity, Comstock’s game plan has never been taken seriously in South Asia. It is time we change this and replicated the strategy.In 2018, the World Health Organization (WHO) emphasised treatment of latent TB in high incidence countries. This will be a game-changer in Nepal, besides the <a href="http://archive.nepalitimes.com/news.php?id=17747#.XJN9YyIzaUk" target="_blank" rel="noopener">highly efficient Gene Xpert machine</a> used for active case finding. By decreasing the pool of tuberculosis patients, we have a chance to meet the lofty <a href="https://www.who.int/tb/post2015_strategy/en/" target="_blank" rel="noopener">WHO END TB strategy</a> of reducing global incidence by 90% and deaths from TB by 95% by 2035. But even these targets only represent a reduction in TB to the levels seen in developed western nations today, not elimination.These targets are not achievable unless there is a dramatic escalation in TB control efforts and a significant paradigm shift in our approach. To attain the target, the annual decline in global TB incidence rates must accelerate from 2% per year in 2015 to approximately 17%  per year by 2025. This requires the deployment of George Comstock’s strategy to act now, and to observe this year’s TB Day slogan ‘It is time for action’.Buddha Basnyat is a physician at Patan Hospital and Max Caws is with the Britain Nepal Medical Trust in Kathmandu.

For Nepal, a game-changer in TB control

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

India and China have a long-standing border dispute along their Himalayan border which has erupted in violent skirmishes. But Indian and Chinese officials last week agreed to ignore Nepal’s own border dispute with India to facilitate trade. The Indian Ministry of External Affairs this week flatly rubbished <a href="https://nepalitimes.com/editorial/territorialism">Nepal’s territorial claims</a> to the Lipulek Pass and the Kalapani Region, including Limpiyadhura, which Nepal considers as the source of the Mahakali River that forms Nepal’s western border with India. The latest episode in this dispute has come as Sino-Indian relations have thawed after US President Donald Trump slapped <a href="https://nepalitimes.com/news/nepal-and-the-us-india-tariff-tiff">sanctions on Indian exports</a>. The joint communiqué in Beijing said India and China had agreed to resume their border trade through the Nathu La, Sipki La and Lipulek during Chinese foreign minister Wang Yi’s visit to New Delhi. Lipulek is a pass 10 km north-east of <a href="https://nepalitimes.com/news/there-is-precedent-to-settling-kalapani">Kalapani</a> which has been disputed ever since the Survey of India published its 1879 map, where the source of the Mahakali was suddenly shifted from Limpiyadhura to Lipulek.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250826060824_4e68dd5964e0995b91148de9978a1de52b19691e1b01f52a405924fd130c22bd.jpg" data-media-id="editor_3" data-image-id="20250826060824_4e68dd5964e0995b91148de9978a1de52b19691e1b01f52a405924fd130c22bd" data-rendition-name="original" width="2000" height="2083" loading="lazy" alt="Lipulek dispute explainer"> </figure>  This tributary of the Mahakali was called the Kali on this map, and is a fordable tributary and not the main channel of the border river. The main Kali River was renamed Kuti Yangdi, and this happened while the British were still in India presumably to gain access to the Lipulek in contravention of the 1816 <a href="https://nepalitimes.com/banner/borderline-disorder">Sugauli Treaty</a>.&nbsp; This subterfuge continued even after India gained independence in 1947. Nepal has maintained that the main channel of the Kali is the border as per the 1816 treaty, when Nepal lost a third of its territory to British India. It is all well and good that India and China are now friendly enough to <a href="https://archive.nepalitimes.com/news.php?id=19447">open border trade</a> routes, but it should not be in violation of Nepal’s territorial integrity. Nepal should be called for diplomatic and political negotiations regarding the Lipulek pass and the Kalapani region comprising Limpiyadhura.&nbsp; Read also: <a href="https://nepalitimes.com/opinion/comment/when-xi-meets-modi-and-oli">When Xi meets Modi and Oli</a>, Kanak Mani Dixit China and India, but especially the latter, should invite Nepal to discuss these issues and iron out the disputes based on facts and evidence and maps. Nepal had sent seven diplomatic notes to India and three to China so far regarding the Lipulek and Kalapani. India has not responded to any of them. China replied once saying that Nepal and India should sort out their border disputes first before voicing their opinions. Nepal welcomes the recent talks between India and China that it hopes will positively impact on settling border disputes that are mostly stalled since the 1962 Sino-Indian war, the 73-day military standoff over the disputed Doklam region between China and Bhutan, and the 2020 Galwan clash in Ladakh. Nepal’s two large neighbours seem to have come to their senses and realised that it is in their interest to collaborate rather than confront each other when President <a href="https://nepalitimes.com/opinion/trump-s-first-month">Trump is acting erratically</a> with threats of sanctions and tariffs.&nbsp; Prime Minister K P Oli should bring up Nepal’s grave concerns about the Lipulek during his state visit to India next month when he will meet Prime Minister Narendra Modi in Bodh Gaya. The two are also expected to meet next week at the Shanghai Cooperation Organisation summit in Tianjin when Chinese President Xi Jinping will also be present. But even before that Nepal should send diplomatic notes to both the Indian and the Chinese governments regarding their agreement to resume border trade through the Lipulek.&nbsp; Here is a timeline of the developments regarding the Lipulek: Sino-Indian Agreement of 1954 This 8-year Agreement on Trade and Exchange between Tibet and India was signed in Peking on 29 April, 1954 by the Chinese Vice-Foreign Minister Chang Han Fu and the Indian Ambassador Nedyam Raghavan.&nbsp; There was no explicit mention on the border settlements either on the Line of Actual Control (LAC) or on Ladakh, although trade and pilgrimage through Lipulek and other 5 passes (Sipki La, Mana Pass, Niti Pass, Kungri Bingri Pass and Dharma Pass) were agreed upon.&nbsp; Trade between Uttar Pradesh state and the Tibet Autonomous Region was through ‘border &nbsp;point of the agreement states: ‘With a view to facilitating the visits of persons engaged in border trade and the exchange of commodities and means of transportation, (India and China) have decided that Lipulek (Qiangla) be the border pass for the entrance and exit of the said persons, commodities and means of transportation from the two sides.’ The agreement expired on 6 June 1962 during the Sino-Indian war, and the two sides did not renew it. Bilateral ties started to normalise only in the 1990s with the Indian decision in 1988 to abandon its policy of settling ‘territorial issue’ for ‘normalisation of relations’. India There was no reaction from Nepal to the 1954 agreement since Nepal did not have diplomatic relations with China yet at the time. Sino-Indian Agreement of 2005 The Political Parameters and the Guiding Principles for the Settlement of the Sino-Indian Boundary Question is detailed in 11 Articles, which outline the steps to be taken for a Peaceful and Tranquil Border. The agreement was a direct outcome of the Special Representatives mechanism that had been set up through a 2003 agreement. It also incorporated the Confidence Building Measures in Military Field along the Line of Actual Control (LAC) in the Sino-Indian Border Areas signed in 1996.&nbsp; A protocol on Modalities for the Implementation of Confidence Building Measures in the Military Field along the Line of Actual Control in the India-China Border Areas signed during Chinese Premier Wen Jiabao’s India visit, which stated in Clause 2 of Article 5: ‘Both sides agree to extend in principle to expand the mechanism of border meeting points to include Kibithu Dhamal in the Eastern Sector and Lipulek Pass (Qing La) in the Middle Sector. The precise locations of these border meeting points will be decided upon mutual consultations.’ Nepal’s Foreign Ministry issued a statement in 2005 stating that Nepal had asked China about the issue and the Chinese Embassy clarified that the agreement had nothing to do with Kalapani. This was perhaps the first time that Nepal had objected to the Sino-Indian agreement on Lipulek. King Gyanendra had staged a coup d’état on 1 February 2005, just two months prior to this agreement. The Nepali press voiced criticism of China in particular for disregarding the country’s sentiment.&nbsp; Sino-Indian Agreement of 2015 India and China signed several documents during the state visit of Chinese President XI Jinping to India on 18 September 2011. Number one on the list was: ’Opening a New Route for Indian Pilgrimage (Kailash Mansarovar Yatra) to the Tibet Autonomous Region of the People’s Republic of China’.&nbsp; The Indian foreign ministry stated: ‘The MoU provides for conducting the annual Kailash Mansarovar Yatra through Nathula Pass in Sikkim in addition to the existing Lipulek Pass in Uttarakhand’. On May 15, 2015, China and India issued a Joint Statement during Indian Prime Minister Narendra Modi’s visit to China. Point 28 under the ‘Trans-border Cooperation’, states that the two sides agreed to ‘hold negotiation on augmenting the list of trades commodities, and expand border trade at Nathu La, Quingla/Lipulek Pass and Sipki La Pass’. Nepal’s objection to the 2015 agreement was stronger than in 2005. Prime Minister Sushil Koirala called up Narendra Modi to express Nepal’s displeasure It was not until 2020 that Nepal’s Foreign Minister disclosed that ‘Nepal had expressed its disagreement in 2015 through separate diplomatic notes addressed to the governments of both India and China … including Lipulek Pass as a bilateral trade route without Nepal’s consent.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250826060824_d4497e2620bba81211d27e427393974877e09006abc26e13055508996e5b29ea.jpg" data-media-id="editor_8" data-image-id="20250826060824_d4497e2620bba81211d27e427393974877e09006abc26e13055508996e5b29ea" data-rendition-name="original" width="1108" height="1550" loading="lazy" alt="Lipulek dispute explainer"> </figure>  The new political map of India published by the Survey of India in November 2019 that incorporated areas east of the Kali River including Kalapani as Indian territory sparked renewed public, and political, attention to the Mahakali dispute. The Nepal government then countered by formally approving the publication of the new Political and Administrative Map of Nepal including all territories lying to the east of the Mahakali River on May 18, 2020. In June, the House of Representatives unanimously endorsed the second amendment to the Constitution of Nepal to update the country’s new political map in the national emblem. Sino-Indian Consensus of 2024 A 6-point Consensus on Peace and Tranquility on the Line of Actual Control (LAC) was agreed on December 18, 2024 between the Special Representative of the People’s Republic of China, Wang Yi, and the Special Representative of the Republic of India, Ajit Doval.&nbsp; India has not denied that this is a consensus, while China made it clear that this was not a Joint Statement. This Consensus is in line with the 2005 agreement, and was agreed during the 23rd round of the Special Representatives talks held after a gap of five years aimed at restoring bilateral ties frozen because of the military standoff in Ladakh. The agreement included: cross-border communication and cooperation, promoting the resumption of pilgrimages by Indians to Xizang, cooperation on crossborder rivers, and trade at the Nathu La Pass. Nepal made no reaction to the statement despite Lipulek being the pilgrimage route for Mansarovar and Kailash.&nbsp; Prabhakar Sharma is a construction engineer and an international border expert who has worked as a survey engineer for the Cameroon-Nigeria border demarcation by the United Nations.

Lipulek dispute explainer

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.

Warning: breathing is hazardous to health

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.”

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30 years after Baby Arun

Lipulek dispute explainer

Warning: breathing is hazardous to health

Big, beautiful Bills