<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219c9c7e80680e0c02c6jpeg.jpg" alt="" width="1000" height="662"/>This year’s health budget kept the contribution to health insurance of the previous year's allocation of Rs7.5 billion. However, the plan to hand over the institutional management of health insurance programs to the private sector through the Ministry of Finance defeats the fundamental goal of the health security.This is not entirely surprising, of course, because the Health Ministry had passed a <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">narrow and poorly thought model of health security</a> for Nepal, and there were already concerns that it would eventually be handed over to the private sector and traded as a commodity.A private company can contribute to a health insurance program. But can they really contribute to national public health security, understand equity, expand <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">access to the poorest and the most marginalised</a> population, and negotiate with the government providers for quality services? Are they fundamentally designed to serve the poor?Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">National health insurance not as easy</a>, Sonia AwaleThe private sector has a role in contributing to achieving Universal Health Coverage by mainly serving the affluent. The poor neither can afford private health insurance nor access expensive private hospitals. Even if they are admitted to hospitals, they have to bear <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">catastrophic expenses</a> pushing them into the vicious cycle of poverty.The private insurance companies only pool the resource, they do not share the risk for those who cannot afford to pay the premium. It will be naïve to assume that such companies could be easily maneuvered to deliver services as a fair-price approach. There are around 20 registered private health insurance companies and 366 private hospitals in Nepal, and some are <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling health insurance at exorbitant premiums</a> many times higher than the current premium cap.There are six national health security indexes: prevent, detect, response, health, norms, and risk. During the pandemic, insurance companies got richer by <a href="https://www.nepalitimes.com/latest/nepal-tries-to-ensure-covid-19-insurance/">selling fake insurance schemes</a> while the hospital profits bulged through expensive Covid treatment. Very few hospitals treated Covid patients with a humanitarian approach. None of their technical advancements helped effectively prevent, detect, and respond to the pandemic.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/6372219f9c7e80680e0c02c7jpeg.jpg" alt="" width="1641" height="1000"><figcaption> </figcaption></figure>The current health insurance program has identified the elderly, completely disabled, leprosy, Multi-Drug Resistant TB patients, people living with HIV, and ultra-poor as target populations to waive their premium. Though not adequate, this is an equity approach.But none of these target populations are <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">eligible for private health insurance</a>, or they will have to pay a much higher premium. It will be unwise to assume that these companies will change overnight and be equitable. They are powerful enough to influence government policy and have the power to bend them to suit their commercial interests.Read also: <a href="https://www.nepalitimes.com/editorial/poor-health-makes-nepalis-poorer/">Poor health makes Nepalis poorer</a>, EditorialInstead, the government should <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">strengthen the Health Insurance Board</a> and explore ways to integrate health security with the broader social security scheme. In the short term, there are urgent but straightforward reforms like recruiting adequate and skilled human resources, strengthening the organisational systems, revising the design of service purchase strategy and equity, and gradually, having effective providers/purchasers split for better implementation.Ultimately, the program will benefit by forming a broader and more robust social security structure, co-incidentally introduced at the same time by the government. It would be able to absorb costs by pooling tax-based health care contributions and merging subsidies given to the treatment of cancer, renal failure, and other chorionic diseases under one integrated umbrella.But the current government does not appear serious about <a href="https://www.nepalitimes.com/opinion/health-insurance-must-be-an-election-agenda/">reforming health insurance</a>, and simply does not understand the fundamental principles of health security. Health insurance is not just limited to providing health care, but is a part of broader health security.Read also:  <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">Health tip</a>, EditorialThe idea that health security can be strengthened by passing the buck to the private sector amounts to abandoning the constitutional commitment to provide health care, not as a service but as a citizen's fundamental right. The Nepal government is a signatory to achieving the health targets of the Sustainable Development Goals.As argued by Nepali Congress leader Gagan Thapa, who is one of the pioneers who <a href="https://archive.nepalitimes.com/article/editorial/health-tip-editorial,4032">pushed health insurance</a> in Nepal, they contribute to strengthening the health system, strive for healthy populations, cushion the poor and provide them access to health services. It is a vehicle for mobilising adequate health resources, enhancing health security, and ultimately achieving Universal Health Coverage.These goals cannot be met by trading the people's health as mere commodities.Gaj Gurung has a PhD in public health from Chulalongkorn University and Sushil Koirala is a public health expert. Both are based in Bangkok.Read more: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/">Is free health care possible in Nepal?</a> S P Kalaunee

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Dangers of privatising health insurance in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111124/6372175d9c7e80680e0ba9e2jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVE</figcaption></figure>If Nepalis are to vote on issues rather than personalities in this year’s elections, they should pay attention to the manifesto of the Nepali Congress (NC) which has put an emphasis on the 2017 National Health Insurance Act.It was the NC’s firebrand leader <a href="http://archive.nepalitimes.com/article/from-nepali-press/Reviving,3589" target="_blank" rel="noopener noreferrer">Gagan Thapa</a> who pushed that legislation when he served as Health Minister. He is now the party’s general secretary, and sees <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener noreferrer">health insurance</a> as a way to improve the access and affordability of quality health care in Nepal.Even for a country like Nepal, universal health coverage is not a distant dream if there is the necessary political will. The Covid-19 pandemic has already made it evident that investing in health care and prevention is central to the well-being of the society with added economic benefits.Many countries in the region have health insurance for their citizens. An example is <a href="https://www.social-protection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=54059" target="_blank" rel="noopener noreferrer">Thailand's Universal Health Coverage Scheme</a>, lauded as the best model for a developing country.The Nepal Health Insurance program was initiated to achieve universal health coverage and was one of the key agendas in the 2015 election with widespread political support. The program actually started in 2016 and the Health Insurance Act was enacted in 2017.With Ministry of Finance (MoF) funding, it offers monetary protection to people by paying directly to the service providers’ on-behalf of insured members.In a few years, Nepal’s health insurance program has had a scalable impact. Our 2020 study in the Kaski district showed that in patient expenses of insured families was less than that of non-insured ones, and were also better protected against catastrophic expenses than the non-insured.Broadly, the program aimed to improve the health quality through provider and purchaser split, and by employing a strategic purchasing approach. For instance, in Thailand, the National Health Security Office purchases services for 43 million people independently which has played a large role in improving health care services.Health insurance generates an additional health budget, as it is a pooling mechanism. The MoF has allocated the insurance budget without curtailing the current national health budget.Unfortunately, the insurance scheme design and implementation have been drowned out by political rhetoric resulting in operational ambiguity and erratic implementation. Without a serious political will to strengthen the program, it is likely to come to grief before long.Insured people are dissatisfied with service providers for their historically low-quality services. In fact, the quality of care has worsened in places after the insurance scheme was introduced, resulting in a high drop-out rate.In turn, service providers are frustrated over the Health Insurance Board (HIB)’s sluggish reimbursement process and some have even stopped their facilities. The HIB does not have adequate skilled human resources to speed up the reimbursement, nor has it formulated an efficient service purchase mechanism.The Board has not been able to function as a prudent insurance manager because of the lack of basic organisational policies on human resources, finance, monitoring and evaluation, communication etc. There are also crucial design errors in the insurance program, such as reimbursement strategy, un-equitable premiums, and provider/purchaser split, to name a few.The current program primarily employs fee-for-service (FES) which is a traditional, retrospective and input-based approach with a cumbersome process to review, validation of cost, and payment. The FES was selected despite other programs including <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener noreferrer">free health service</a> and safer motherhood implementing relatively efficient, output-based and prospective approaches such as capitation.There are also traditional and cultural problems within the MoH, and HIB as a semi-autonomous body does not have the influence or muscle to monitor and negotiate with service providersThe premium amount and benefit package was fixed through very limited study which was a modest Rs2,500 and Rs 50,000 respectively in the beginning, later increased to Rs 3,500 and Rs100,000 but with no scientific basis.This benefit package is quite small for a family of five. The amount gets smaller with increased cost for the high prevalence of non-communicable and chronic diseases in the general population.Apart from the targeted groups (with premium subsidy), the flat premium amount of Rs3,500 for the rest is largely unbalanced. The richest 10% of Nepal's population has more than 26 times the wealth of the poorest 40%. What this means is that while Rs3,500 is peanuts for some households, it could be a monthly household food expense for others.Despite this, the HIB claims that there is no clear provider and purchaser split between MoH and HIB, the former has a high influence on the latter’s organisational structure, as such, many staffing decisions are still pending the ministry’s approval years later.The majority of the HIB staff are seconded from the Ministry of Health,  none of them are health economists or have financial background. Learning by doing is a costly, ineffective and inefficient approach for a high-priority national program.Similarly, the Health Insurance Board is incapable of coordinating with line ministries for the program's effective implementation. For example, the Act has delegated the NIB’s members to standardise service providers' quality control. However, its board is dominated by MoH members.This results in poor service quality, leading to dissatisfaction amongst insured populations and in the high dropout rate and under-utilisation of the services.Nepal’s health insurance program must undergo a serious and urgent reform to prevent it from becoming obsolete:Short to medium term recommendations:<ol><li>HIB needs to develop organisational guidelines to streamline reimbursement. The focus must be on demand generation to enrol rich, healthy and poorest groups equitably.</li> 	<li>The health service purchasing strategy must be reviewed, and this should also guide the structure and human resources needed.</li> 	<li>Private health service providers will inevitably be integrated into the program given the access gaps created by the limited number of public providers. But private providers are often more politically placed and vested interest can put HIB in a weaker negotiating position.</li> 	<li>HIB should develop standards for hospital/PHCC preparedness, provide additional training and incentives for the health workers and develop monitoring tools.</li> 	<li>Integration with other social security funds and health programs will improve efficiency and reduce duplication and wastage. Coordination with these funds will help access data on informal, and formal sector populations and cross-share promising practices particularly on investment.</li> 	<li>HIB should partner with existing research agencies and health economists to conduct studies and use ground-up feedback to reform.</li></ol>Long term recommendations:<ol><li>Premium-based pricing won't be fair or sustainable because of poverty and amidst high informal sector employees. So HIB should look into the possibility of fully tax-funded schemes for the informal sector populations.</li> 	<li>Provider and purchaser split: The provider and purchase split might go through lengthy technical and political discussion after HIB fulfils the majority of short and medium plans eventually. It requires having clear roles and responsibilities between MoH and HIB, understanding of the scope of work and mutual trust.</li></ol>Gaj Gurung is a public health practitioner currently based in Bangkok, Thailand. He has PhD in public health from College of Public Health and Sciences, Chulalongkorn University. His PhD evaluated the Nepal Health Insurance Program implementation fidelity and its effectiveness in reducing the out-of-pocket health expenses amongst insured populations.

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Health insurance must be an election agenda

We often see ourselves reflected in the other. For someone who grew up in Kathmandu Valley in the eighties and nineties, this maxim comes alive with an even greater force. Nepal’s media ecosystem was dismal, the school curriculum was narrow and did not provide opportunities for creative expression. Perhaps that is why I became obsessed with MTV videos and Bollywood films. I saw my developing self reflected in these story-lines and razzmatazz. When the media and education system do not engage the public and reflect myriad interests, aspirations and lifestyles of the population, citizens get detached and disconnected from their roots. I left for America for further studies, and was somewhat determined to never return to Nepal. It was a country full of potholes and black-outs. But foreigners have been fascinated with our country for decades. In the early 19th century, Francis Buchanan-Hamilton led a pioneering expedition and documented more than a thousand species of plants native to the region. Almost a century later, in 1905, Frenchman Sylvan Levi published ‘the first attempt to produce a comprehensive study of Nepal’, drawing on not just indigenous but available Chinese and European sources as well. After Nepal opened up in the 1950s, different kinds of foreigners have traveled here -- most notably, cold-war era spies disguised as diplomats, and later came the hippies. I returned to Nepal in 2013 and was primarily struck by two major demographics - the artists and the expats. Energised by the recent revolution, the creatives were making vibrant, powerful works. The expats, on the other hand, demonstrated a different way to navigate life in Kathmandu Valley. These two groups of people re-introduced Nepal to me and I began seeing my country and my hometown with a renewed perspective. Which is why one particular image from Giovanna Caruso’s ongoing show at the <a href="https://www.instagram.com/thekalasalon/?hl=en" target="_blank">Kalā</a><a href="https://www.instagram.com/thekalasalon/?hl=en" target="_blank"> Salon</a> curated by <a href="https://nepalitimes.com/review/facades-and-flowers-from-nepal-to-italy" target="_blank">Sophia L Pandé</a> instantly caught my attention -- rather, it called out to me, as if it was composed for me, framing a key moment from my own life. Its title is, coincidentally, 2013. Like most of her other works, the pen-and-ink drawing is punctuated by an explosion of watercolour: a woman standing confidently in front of a Newa-style house, a leg arched up, as if she is fixing a strap around an ankle before stepping out on an adventure. The watercolour depicts a rainbow streaming out of a pot through a second-floor window. The rest of the details are rendered in realism – clusters of garlic and onion hanging to dry from the rafters, and further down a stack of corn. There are towels drying, even an old water pump.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251201121216_f440de5b5402fe0877dc46d94f41647bd46b00035b61241d46fc9f7ffbd87d0f.jpg" data-media-id="editor_3" data-image-id="20251201121216_f440de5b5402fe0877dc46d94f41647bd46b00035b61241d46fc9f7ffbd87d0f" data-rendition-name="original" width="4032" height="3024" loading="lazy" alt="art review Kala Salon"> </figure>  When I walked over to this artwork with Caruso, she chuckled, “Ah, this work is a celebration of my 30 years in Nepal.” It was while trying to calm a restless group of students during her teaching days in Italy that Caruso first came across an iconic image of Kathmandu Darbar Square. She had found an old box of slides and while projecting images from the Himalaya to engage her students, the artist was determined to travel to Nepal. The first flat she rented was close to the square and the view from her rooftop was the same as the one she had encountered inside her classroom. She has been traveling to Nepal every year since. Some of her favourite drawings depict Khokana in morning fog. From 1993-2006, she drew murals at Ram Mandir and Pashupatinath, asking sadhus to guide her and correct her depictions. Caruso received a classical education, which means she was trained to focus on perspective and geometry while capturing mainly portraits and still lives. She is influenced by M C Escher and his explorations of mathematics and symmetry. No wonder she finds the Darbar Square architecture so compelling. She also names as inspiration Gustave Dore, whose style is different from Escher’s and I can see how she has fused these influences in her body of work: Escher’s austerity complimented and slightly dislodged by Dore’s comics and caricatures. “Before starting, the painting needs to be complete in my mind,” she explains as we pass a series of portraits titled Saraswati, Lakshmi, Kali Dancing, and Durga dominated by a roaring tiger. “These are all real people, I ask my friends and family members to sit for me.” The Kali in the drawing has the artist’s fiery copper red hair and she is dancing, surrounded by various men with flowing hair. The artist seems to have experimented here, drawing the revelers from above, and indulging in playful abandon. Depictions of Nepal are often in danger of being exoticised. But Caruso is familiar with her subjects, knows our alleys and temples intimately. Her colours and compositions are passionate and dense. In an essay, Anirudh S Chari writes the artist’s work is splashed with rapturous energy and most drawings have a carnivalesque element. ‘Kali Dancing’ illustrates this idea perfectly in that she has turned Kali’s usual fearsome portrayal on its head by depicting and embracing another feminine principle - the capacity to celebrate and create joy. Apart from drawing inspiration from Hindu goddesses and Nepal’s multi-colored rituals, Caruso has also drawn the Sumerian Ianna and Lillith and the Egyptian Nut. She enjoys drawing Nataraja, and says it is because “Shiva is a good husband”. We stand another painting titled 100 Days a Lion. “There is a saying in Italian, Better one day as a lion than a hundred days as a sheep, but I thought why not 100 Days a Lion?” This sentiment captures this nomadic artist’s spirit spanning four decades, in which she has captured urban energy as well as the sacred imagery of ‘life diaries on canvas’. From Venezia to Kathmandu and Journeys In Between Giovanna Caruso The Kalā Salon Chhaya Centre Mall, Thamel Till 12 December 10am- 8pm

Looking at Nepal from Venice

The COP30 climate summit in Brazil ended this week <a href="https://nepalitimes.com/opinion/cop30-to-cop31">without tangible commitment</a> from countries to reduce fossil fuel emissions. Its impact will be felt halfway around the planet here in Mustang which is already seeing weather extremes.&nbsp; Geographically, Mustang is on the Tibetan Plateau, north of the main Himalayan chain. It is in the rainshadow, and a high altitude desert. Winter snow has failed for eight of the past ten years, unseasonal blizzards, and frequent glacial collapse leading to floods. The Kali Gandaki Corridor follows one of the deepest gorges in the world between Annapurna and Dhaulagiri, the world’s seventh and tenth highest peaks. Lush pine forests cover the southern flanks of these mountains, but within a few kilometers the vegetation undergoes a dramatic change to a landscape of red, brown and grey cliffs.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_c66ade5e32d20530003abba893869426d75b42d10e4725c28361d738b402721f.jpg" data-media-id="editor_1" data-image-id="20251129021144_c66ade5e32d20530003abba893869426d75b42d10e4725c28361d738b402721f" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  It gets more arid the more north you go. Snow and rain in Upper Mustang used to fall mostly in winter, but now there are cloudbursts and blizzards at other times of the year.&nbsp; In the ancient walled city of Lo Manthang, elderly men have gathered at a local tea shop to drink the salted butter tea. Some sip home-made liquor infused with medicinal herbs.&nbsp; The sun has set, the temperature plummets, and the wind howls outside. Everyone agrees it does not snow like it used to any more. Read also: <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Comings and goings in Mustang</a>, Shrijan Pandey  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_ffaabf00a533984cadf160b2e56734cddb6f64d1a660401417d2982a3818f161.jpg" data-media-id="editor_3" data-image-id="20251129021144_ffaabf00a533984cadf160b2e56734cddb6f64d1a660401417d2982a3818f161" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> <figcaption>The flat mud roofs are leaking because rain is now falling where there used to be snow.</figcaption> </figure>  “The weather has changed drastically over the years,” says Lopsang Tsomfel Bista, Chair of the Lo Dekhar Municipality. “It doesn’t snow in winter, and it falls when it is not supposed to.”&nbsp; Lack of snow means that in spring, the pastures where nomadic herders graze their yaks and goats do not have enough grass. Previously, winter snow on the meadows would seep slowly into the soil with the spring thaw, bringing out fresh grass shoots. &nbsp; In recent years, even if there is winter precipitation, it falls as rain. The soil is not able to soak in rain as efficiently, and torrential downpours increase the risk of soil erosion and floods.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_93ca69bec63577c5f6cbff8db809c11bce2d8fe01469d3374c20a6f20a7c93f1.jpg" data-media-id="editor_4" data-image-id="20251129021144_93ca69bec63577c5f6cbff8db809c11bce2d8fe01469d3374c20a6f20a7c93f1" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  “There used to be up to 1,500 mountain goats in every village, but now they have stopped keeping livestock,” says Bista. This is due to lack of grass and new lowland diseases moving up the mountains. Mustang has lost 28% of its population between the census in 2011 and 2021, and outmigration also means there are fewer people left to carry on a pastoral lifestyle.&nbsp; “Herders have asked for vet services in their communities because there are new insect-borne diseases,” says Yangchen Dolker Gurung of the Lo Gyalpo Jigme Foundation. Read also: <a href="https://nepalitimes.com/opinion/winds-of-change-sweep-mustang">Winds of change sweep Mustang</a>, Jagannath Adhikari  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_902593732af83db5792128be5a3bd87c00e0c62ff894afa4c98bffde64e96d26.jpg" data-media-id="editor_6" data-image-id="20251129021144_902593732af83db5792128be5a3bd87c00e0c62ff894afa4c98bffde64e96d26" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> <figcaption>The mud walls of monasteries and homes are crumbling because of unseasonal rainfall. </figcaption> </figure>  Mustang is flanked to the east and west by mountains that rise up to 6,000m, and glaciers on their slopes are melting fast, turning into lakes. With the rising temperature, the risk of Glacier Lakes Outburst Floods (GLOFs) has also risen.&nbsp; At the rate global average temperatures are rising, scientists say that the Himalaya will lose up to two-thirds of the remaining ice caps. When glaciers melt, it not just raises the risk from GLOFs but also affects water supply downstream.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025112903114_1a6af68965ded5f23897a623bec2e2bed0da4c6663f0af5b5bf79883f2a11c9f.jpg" data-media-id="editor_7" data-image-id="2025112903114_1a6af68965ded5f23897a623bec2e2bed0da4c6663f0af5b5bf79883f2a11c9f" data-rendition-name="original" width="1022" height="767" loading="lazy" alt="Mustang map NT"> </figure>  FLOODS Ringzin Sangbo Gurung in Chumjung village recalls the devastation caused by a GLOF on 8 July this year that swept away a newly inaugurated bridge. The floodplain is now strewn with boulders and sand brought down by the flood which caused damage worth Rs28 million. The flood also damaged the irrigation canals that feed riverside farms where locals grew potato, buckwheat, millet and spinach. Nyima Wangmo Gurung runs a homestay in Nyamdok village, and says: “We don’t have water when we need it. And there is too much when we don’t need it.”&nbsp; Read Also: <a href="https://www.nepalitimes.com/banner/mustang-forced-to-adapt-to-climate-crisis">Mustang forced to adapt to climate c</a><a href="https://www.nepalitimes.com/banner/mustang-forced-to-adapt-to-climate-crisis">risis</a>, Ronan Wallace and Yungdrung Tsewang Gurung  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_7ae98274ea20e910311ec4431ba0aa3ecd9fe92caaed029a33c185198b33d0d2.jpg" data-media-id="editor_10" data-image-id="20251129021144_7ae98274ea20e910311ec4431ba0aa3ecd9fe92caaed029a33c185198b33d0d2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  With warming temperatures, farmers in Mustang are growing lowland vegetables which was not possible before in plastic greenhouses. The farms depended on snowmelt in spring to irrigate their fields, but there is less snow to melt in past years. “The last heavy snowfall in winter was about eight years ago, since then we have got little or no snow,” says Tashi Norbu Gurung, Chair of Lo Manthang Rural Municipality. “This affects farmers during the April planting season.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_010e09f4e9335f39c62f4d6027489c86423b3d10ddfb83558820f6a7a56a477b.jpg" data-media-id="editor_11" data-image-id="20251129021144_010e09f4e9335f39c62f4d6027489c86423b3d10ddfb83558820f6a7a56a477b" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  It is not just lack of snowfall that is a problem. Springs have gone dry, and some villages like Dhey have been forced to relocate because life became &nbsp;impossible without water.&nbsp; Villagers of Samjung also <a href="https://nepalitimes.com/news/climate-migration-is-already-happening">migrated</a> to Namashung, near a river when water sources dried up. But now the new settlements are threatened by GLOFs. Karma Gurung, who runs a lodge in Choser, remembers the big flood of 35 years ago which swept away farms and covered them with debris. There have been more frequent, but destructive floods since then in Kagbeni, Lubra and other valleys. Read also: <a href="https://www.nepalitimes.com/banner/mixed-blessings-in-mustang">Mixed blessings in Mustang</a>, Mukesh Pokhrel  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_da2212bc1ad49c17d126e24bbd92d3fca18e3e6bdd58ac61df14c962deb2edcd.jpg" data-media-id="editor_14" data-image-id="20251129021144_da2212bc1ad49c17d126e24bbd92d3fca18e3e6bdd58ac61df14c962deb2edcd" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  MUD WALLS Because snowfall has been replaced by rain, Mustang’s traditional mud-wall architecture is now in <a href="https://nepalitimes.com/here-now/leaky-roofs-on-the-roof-of-the-world">danger of collapsing</a>. The homes here are closely packed, have flat roofs stacked with juniper branches for firewood. With rain in place of snow, the roofs now leak.&nbsp; Women in Thinkar village say their walls are falling apart. Some homes have collapsed, and families forced to move out. Yangchen Dolker Gurung of the Lo Gyalpo Jigme Foundation says locals need plastic sheets, cement walls and corrugated roofs to cope with the rain.&nbsp; But this would mean that Mustang’s villages would lose their traditional architecture style.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_59c475cdde3bee8d03ed05e9038c0cf36f1acd31e3d3596f145469e5b4404d9d.jpg" data-media-id="editor_16" data-image-id="20251129021144_59c475cdde3bee8d03ed05e9038c0cf36f1acd31e3d3596f145469e5b4404d9d" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  The ancient 1.5m thick mud walls around Lo Manthang built 600 years ago, the king’s palace, and monasteries are also at risk. “Changes in precipitation patterns, altering the intensity, frequency, and timing of rainfall and snowfall, have damaged traditional and cultural infrastructure, particularly mud-built private and public buildings as well as religious and heritage sites,” explains Bhawani Pandey at the Lo Gyalpo Jigme Foundation. “With the rain, and because the monuments and stupas are made from mud, they have eroded. There is leakage, and the monuments are in a dilapidated condition.” Read also: <a href="https://www.nepalitimes.com/banner/climate-smarter-himalayan-infrastructure/" target="_blank">Climate-smarter Himalayan infrastructure</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251129021144_dfc8c93a0a8619893f0d97076d1f9cbba3818e1cc716a903ff9908dbb8939ef6.jpg" data-media-id="editor_18" data-image-id="20251129021144_dfc8c93a0a8619893f0d97076d1f9cbba3818e1cc716a903ff9908dbb8939ef6" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Too little snow, too much rain NT"> </figure>  The Lo Manthang Rural Municipality along with Lo Gyalpo Jigme Foundation, are working on a Local Adaptation Plan of Action and the Disaster Preparedness and Response Plan, which the Nepal government has made mandatory for every municipality. “We took a bottom-up approach and collected data from each village, they know best the impact of climate change and what their needs are,” says Yangchen Gurung. To address the hazards of climate change, local communities and municipalities are adapting through their own resources, without waiting for outside help to improve water conservation, control soil erosion and protect from flood.&nbsp; Says Pandey, “We are returning to conserving traditional drought-resistant crop varieties, organic pest and disease control, cultivating high-value crops and fruits, and practicing sustainable pasture management through rotational grazing. We have also developed new building codes for homes that incorporate water-resistant coating for mud roofs and walls.” &nbsp; Additional Reporting by Tashi Wangyal. &nbsp;

Too little snow, too much rain

The September protests and worry about what is in store for Nepal in 2026 have added more uncertainty to a <a href="https://nepalitimes.com/here-now/nepal-needs-to-use-its-money-better">struggling economy</a>. Real estate transactions are stagnant, industries are operating below capacity because of declining domestic demand, the construction sector is slack, and investors are in wait-and-watch mode. In contrast, total bank deposits increased by Rs124 billion in the month before mid-October to Rs7.4 trillion. Official remittance inflows hit a record $13 billion in the past year. Nepal’s banks are flush with cash, with nowhere to put it. &nbsp; “The economy has flatlined. Non-performing assets are up, and real estate is at a standstill,” said Ashoke SJB Rana, CEO of Himalayan Bank.“There is excess liquidity in the market, with not many places to invest.” The main reason seems to be that both <a href="https://nepalitimes.com/here-now/relocate-reallocate-recover">domestic and foreign investors were spooked</a> by the targeted violence of 9 September, and are so worried about the runup to elections in March that they are holding on to their wallets. Not just businesses, the political uncertainty is keeping individuals &nbsp;from making big financial decisions.&nbsp; Sujeev Shakya, author of the <a href="https://nepalitimes.com/review/retrofitting-nepal-for-future-shocks">newly-released book Nepal 2043</a>, notes that the current doldrum is due to Nepalis playing it safe with their money. &nbsp; “People are holding on to their assets, and keeping their cash,” he says. “They are not investing in real estate, and avoiding buying gold because it is so volatile.”&nbsp; One sector in which banks have a lot of exposure is hydroelectricity, but even here recent floods have shown that this investment is <a href="https://nepalitimes.com/here-now/global-warning-bell-in-belem">increasingly at risk from climate breakdown</a>.&nbsp; Nabil Bank, with its focus on sustainable banking, for instance, has financed 56 hydropower projects with an installed capacity of 3,000MW.&nbsp; Says Nabil CEO Manoj Kumar Gyawali: “We cannot ignore unpredictable rainfall, increased glacier melt, more frequent glacier lake outburst floods, and landslides. These risks mean that while hydropower is essential, Nepal must diversify its energy mix." &nbsp;&nbsp; An open secret in the banking sector is that much of the liquidity is supected laundered money. Banks also have close ownership links with big businesses, and this means that even with a slow economy, banks lend to themselves or to each other to keep transaction volumes up.&nbsp; This is one reason for a high default rate. In the first three months of this fiscal year, 4.86% of bank loans were non-performing, meaning one out of about every 20 borrowers had defaulted. A year ago, this figure was 4.04%. Banks are therefore reluctant to lend, dampening the overall investment climate. &nbsp; Ironically, the high default rate is keeping mainstream newspapers in Nepal afloat at a time when the media business is also in crisis. Even as they suffer from a massive drop in advertising revenue, most daily newspapers often add pages to fit notices to borrowers about repayment, or announcements of bank auctions of collateral property. “While banks may be making a much smaller percentage of income compared to a few decades ago, they are still making a profit,” notes Shakya. “And so they are actually quite happy to be in this low-risk situation. Banks are conservative organisations after all.”&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251128041136_b33dd18d7ce221e273bd18d8a5c4ba4c9196f762b95b87fd24c60df6c2426065.jpg" data-media-id="editor_4" data-image-id="20251128041136_b33dd18d7ce221e273bd18d8a5c4ba4c9196f762b95b87fd24c60df6c2426065" data-rendition-name="original" width="1500" height="1022" loading="lazy" alt="Banks"> <figcaption>Illustration: BHANU BHATTARAI / NEPALI TIMES ARCHIVE</figcaption> </figure>  Among the most striking videos of the September protests that was shared globally by tens of millions of people was the Hilton and Hyatt hotels and the Ncell building burning. That recognisable international brands were targeted did not just cause huge losses to owners, but also damaged Nepal’s overall investment climate. Looting Bhat-Bhateni and homes of businessmen also sent a negative message, spurring capital flight.&nbsp; “That was very bad optics for potential investors, you simply worry about the security of your investment when you see things like that,” says Himalayan Bank CEO Ashoke SJB Rana.&nbsp; Nepal will graduate to Middle Income Country status next year, and donors are set to move from aid to private investment. While this could reduce misuse of money, it could dry up grants and soft loans to the health and education sectors.&nbsp; But the harm may go deeper than just the aftermath of the September events. The recent<a href="https://nepalitimes.com/news/double-trouble-with-taxes"> double taxation issue</a> involving the Dolma Impact Fund, and an earlier controversy over Ncell’s capital gains tax have also put Nepal’s business climate in negative spotlight internationally.&nbsp; The banking sector is firmly on the side of investors. Says Ashoke Rana at Himalayan Bank: “This is a tax regime, it is absurd to order the payment of these taxes retrospectively. When investors see that the rules of the game can change arbitrarily, they won’t really want to put their money here. ” &nbsp; One of the positive changes in the ways Nepalis are using money is digital transactions through QR codes and mobile banking. With smartphones making up 70% of all mobile phones, QR transactions are easy and have become a part of daily life. ONLINE BANKING&nbsp; Most businesses and ride shares have this feature on board, and people do not need to carry a lot of cash or multiple bank cards. But as digital payments become the norm, the days of free transactions may be coming to an end.&nbsp; “Right now these transactions are free for the most part. This is a subsidy by the banks, because of course, it does cost something to make sure the payments go through,” says Rana at Himalayan Bank. “However, as income decreases, banks may have to look for ways to make money, so they may charge small percentages on each QR transaction.”&nbsp; Rapid digitisation has changed not only how customers use money, but also how banks think about their offices. Himalayan Bank’s new Thamel branch, for example, has cancelled plans to redesign the office for 20 tellers.&nbsp; “We realised that people were able to do so much of what they wanted digitally that we plan to have only four tellers,” says Rana.&nbsp; But cutting down on facilities and staff has not always made for a better customer experience at some bank branches.&nbsp; Economist Sujeev Shakya conducts ghost customer experience checks for banks which involves decoys entering banks to evaluate what it is like for somebody to set up a bank account.&nbsp; The stealth missions found that standards of service have regressed, with banks having a working environment reminiscent of government offices.&nbsp; Shakya points out that the general experience of going to the bank should be much better. “Sometimes it’s a knowledge issue -- banks may try to ask for non-disclosure contracts even when they don’t know why they want them,” he says.&nbsp; Despite digitisation, many banks still require paper-based forms and documents. Bankers and customers alike note that it feels archaic, almost absurd, to have to carry multiple copies of documents, sometimes only in Nepali lokta paper, across several family members and fill out what seems to be the same form over and over even though digital files exist. That could soon be changing as well. As more and more Nepalis adopt the National ID, banks have adopted pilot programs that use it to create bank accounts, replacing the myriad documents that customers had to previously present to officials, making all banking transactions more efficient and less of a hassle for the customer.&nbsp; DIGITAL SECURITY As Nepalis move their cash online, digital infrastructure needs to become more secure as well.&nbsp; Bankers spend quite a lot to make sure necessary digital security infrastructure is in place, but some banks could be using pirated software which are not trustworthy.&nbsp; There has to be better regulatory oversight to prevent phishing and fraud as online payments and digital banking spread across Nepal.&nbsp; Banks must also be innovative and ambitious. Says Shakya: “Nowhere else in South Asia are bank loans such a high ratio of the nation’s GDP. &nbsp;This actually points to a well-developed financial system and we have to take advantage of it."&nbsp; Shakya also notes that many bank executives in foreign countries, like Myanmar are actually Nepali, and that banks from Nepal could use their staff and know-how to partner with or acquire banks overseas.&nbsp; While these innovations are all welcome, it is unclear how Nepal's banking sector can jumpstart economic activity in the country. Nepal’s political future looks uncertain and stability is not a guarantee.&nbsp; In the face of continuing progress in hydro electricity and the IT sector seems to be the way forward to stimulate the economy.&nbsp; The GenZ movement was a wakeup call also to financial institutions and the need for greater transparency. Nabil Bank CEO Manoj Kumar Gyawali says the September protests sent a clear message that young Nepalis want an end to corruption, good governance, and real opportunities at home: "The banking sector has a &nbsp;responsibility to direct more lending toward the real economy, sectors that create jobs, build productivity, and strengthen long-term growth," he says.&nbsp; Despite a subdued investment climate, Gyawali is optimistic. "I do see early signs of improvement. Lower interest rates are beginning to restore public and business confidence. Rising remittances provide a safety net and fresh investment capacity for households," he says. "If government capital expenditure continues to improve, it will boost private sector activity."&nbsp;

Cash rich, but poor

It is quite a feat for just two actors on a darkened stage to hold an audience spellbound for more than one hour. Yet, ‘के? Us.’ at Kausi Theatre does just that. It is a thought-provoking but baffling work that leaves the audience questioning reality, the recurring metaphors in this intriguing and powerful dark comedy haunting us for days afterwards.&nbsp; The unsettling sound of deep breathing mingles with percussive drumming and a driving guitar that pulsates amidst a red glow, dimly illuminating shadowy structures charred by fire. A door leads to what is later revealed to be the ancestral home of two brothers which is ‘under renovation’. One of the brothers Ashim (Bijaya Tamrakar) lives in Nepal caring for a supposedly comatose mother who is only depicted by a tree draped with red LED lights that circulate arterial blood corpuscles. Visiting him is a long-lost brother Aaryan (Eelum Dixit) who has returned (deported?) from America.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251202071248_d3050fcd38e1ba471ea48e18fde6a8393a086a5b3afeef71eda190f3e01366e2.jpg" data-media-id="editor_0" data-image-id="20251202071248_d3050fcd38e1ba471ea48e18fde6a8393a086a5b3afeef71eda190f3e01366e2" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Chaos play review"> </figure>  The stage is littered with scattered paper trash, a run-down motorcycle chassis, a tattered sofa, and beat-up table and chairs. The stage is set for a sinister plot. Are the characters to be punished in perdition?&nbsp; It does not take long for the audience to grasp that this is an apocalyptic Nepal that, following absurdist traditions, could exist at any time in the future or the present day <a href="https://nepalitimes.com/editorial/election-vs-escalation">post-GenZ protest state</a>. Ashim and Aaryan Adhikari have reunited after 15 years. Ashim, the younger brother, has been burdened with the responsibility of taking care of their brain-dead mother. Aaryan, returns after having migrated to the US, where he married, had children, divorced, and lost everything. He has been at “minus 20 and is now back to zero”.&nbsp; The brothers have intense back-and-forths that expose their cynicism, the conversation tangentially alluding to Nepal’s unstable political landscape, migration, an economy in shambles, aging population, alcoholism and other mental health issues. Even the sibling argument about the relative merits of momos and burgers seems metaphorical. The stagecraft uses lighting and sound effects brilliantly, transporting the audience to a surreal world in which Tamrakar and Dixit improvise their lines — no two shows are exactly the same, although the overall plotline has continuity.&nbsp; In the first scene, Aaryan approaches the house tentatively, creeping rodent-like, and carrying a briefcase and an old-fashioned lantern. And at the end, Ashim screams, “I am chaos.” Is this the end of the beginning, or the beginning of the end?&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251202071252_a49af0960d3f6f61cd8e9d5ea9c5af64655b89865711f5566f3054b701840da1.jpg" data-media-id="editor_2" data-image-id="20251202071252_a49af0960d3f6f61cd8e9d5ea9c5af64655b89865711f5566f3054b701840da1" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Choas play review"> </figure>  At one point Aaryan seems perturbed by the sound of protest outside (the Gen Z movement?) and the taut atmosphere grips the audience with fear, shock, and apprehension of the recent death and destruction.&nbsp; Throughout the play there is the sound of breathing, as if through a ventilator, a thumping heartbeat, the morbid buzzing of flies and the glowing red LED veins -- signifying the presence of the comatose Aama. She is featured in a prologue-esque home video at the start of the play in which she reminisces about her two sons and rues her failing memory.&nbsp; The sound of breathing gets accentuated each time a brother gets closer to the tree, and it seems to fuel Ashim’s belief that Aama may be brain-dead but she is still among them. This play can go as deep as each individual in the audience wants it to go.&nbsp; The silenced, comatose mother could be Nepali Aama muted by an entrenched patriarchy. Or, she could be the symbol of a helpless country while her children fight over the ruins of what is left. The cake cutting is a delightfully Shakespearean subplot where we wonder if one of the brothers is going to poison, or knife, the other. The message is clear: how can we move forward if it is brother against brother? The stairs signify political transition (elections, constitutional change, new coalitions) promising upward movement, but eventually lead to falls, leaving the nation exactly where it started, or worse. The mother’s terminal illness evokes an ailing state apparatus, hollowed out by corruption and deep-seated social decay. Yet the brothers cling to an irrational hope — instead of confronting the harsh truth and pursuing radical solutions, suggesting a blind faith in the mother.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251202071252_e30df0ea03c2db1759a09e2e3e3111d9d238d5cd5595a68b8052bbbc8e9ec6b3.jpg" data-media-id="editor_3" data-image-id="20251202071252_e30df0ea03c2db1759a09e2e3e3111d9d238d5cd5595a68b8052bbbc8e9ec6b3" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Chaos play review"> </figure>  The brothers are lost. Aaryan climbs up stairs that lead nowhere, Ashim holds on to unrealistic hope that somehow Aama will get better. Tamrakar and Dixit deliver powerful performances, even more remarkable for the fact that they are improvising their lines as they go along. When Aaryan breaks a wall and directly addresses the audience, spectators turn from being passive observers to active participants (‘the society’). The audience then become oglers in this drama, suddenly made self-aware of our role as the scrutinising, cavilling voyeurs that society represents. There is some discomfort of being watched and judged.&nbsp; By asking his brother what he is afraid of while pointing at the audience, Aaryan suggests that the brother's (and perhaps the character's core) fear is not just of the house, or the mother's illness, but of external judgment and societal censure. After the stage goes dark, the applause takes some time. Audience members shuffle out in silence, minds reeling from the collective soul-searching they have just participated in.&nbsp; After ‘के? Us.’ the din at Teku intersection outside sounds different as we wait for our Pathao ride below the खरी tree where <a href="https://www.google.com/search?q=Shukra+Raj+Shastri&amp;client=safari&amp;sca_esv=75e8315709cd5118&amp;rls=en&amp;sxsrf=AE3TifMJhwukjdBBT0n4QcQWe8IYSaEVsw%3A1764648053799&amp;ei=dWQuaYbIMOy94-EPn4ygyAE&amp;ved=2ahUKEwiU1ciogp6RAxXq3TQHHeo9LBIQgK4QegQIARAB&amp;uact=5&amp;oq=nepal+tree+where+martyrs+were+hanged&amp;gs_lp=Egxnd3Mtd2l6LXNlcnAiJG5lcGFsIHRyZWUgd2hlcmUgbWFydHlycyB3ZXJlIGhhbmdlZDIIECEYoAEYwwRIug5QAFiNC3AAeAGQAQCYAc4BoAHrCKoBBTAuNS4xuAEDyAEA-AEBmAIDoALlBMICBRAAGO8FmAMA4gMFEgExIECSBwUwLjEuMqAHzw-yBwUwLjEuMrgH5QTCBwcwLjIuMC4xyAcM&amp;sclient=gws-wiz-serp&amp;mstk=AUtExfCLIneLVW3SFBzxBc964wFcTJ936tcAPSDcvNKljck0PIqDJddMZ_t8Pg610M98MCx14aNdnyLHs9QM0jWLhI7JYmkPhugX1ZHfSQvdCHZE9E5m2_ZQY5Jr893UcGjQfpabtA_C48NfB9Pg56uYMOmTtEBEcGuvz3d96Qaifyb86sI8mAkrRNo_367cv_xmFjLZ55iQkfHtORuOvZSUkIdMvAdpweuf4jPjjI4anbv9lc-uCImdP0JSvtvEGL8ePxwsWWOzYpIbjNP1zofjcWXK&amp;csui=3" target="_blank">Shukra Raj Shastri</a> was hanged in 1941 by the Rana regime. Language and Literature Students, 2026.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251202071252_f2dc03a35cba33b382a66bbd43905206d9d3eb5ec3ebdcf973aeefbb4a50b6b2.jpg" data-media-id="editor_5" data-image-id="20251202071252_f2dc03a35cba33b382a66bbd43905206d9d3eb5ec3ebdcf973aeefbb4a50b6b2" data-rendition-name="original" width="1080" height="1350" loading="lazy" alt="Chaos play review"> </figure>  ‘के? Us.’ Kausi Theatre, Teku Till 7 December (except 2 December) Bookings: +977 9842156109, 9842574607

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