<figure><img width="1570" height="940" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be2179c7e80680e083e89jpeg.jpg" alt=""/><figcaption>Charikot Hospital in 2015 after it was upgraded from a primary health care centre by Nyaya Health Nepal. Photo: Nyaya Health Nepal. </figcaption></figure>In one of the few arrangements of its kind in Nepal, a public-private partnership initiative has handed over to the local government the management of Charikot Hospital which had been run by a private non-profit organisation <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/building-back-better-health-facilities,2980" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/article/Nepali-Times-Buzz/building-back-better-health-facilities,2980&amp;source=gmail&amp;ust=1606125430794000&amp;usg=AOvVaw0J3sDGN8guCJPn5fY-UA5M">ever since the earthquake five years ago</a>. Bhimeswar Municipality took over the hospital from the group Nyaya Health Nepal on 30 October in an innovative and successful DBOT (Design, Build, Operate, Transition) model which is significant in Nepal’s new federal structure where local governments take on more responsibility for grassroots healthcare delivery.This is especially remarkable considering that improving public sector healthcare, especially in rural areas, has been a challenge in Nepal. The country’s already under-resourced healthcare is also under strain because of the Covid-19 pandemic. Nyaya Health signed an agreement with the Ministry of Health in 2015 to rebuild the <a href="https://archive.nepalitimes.com/article/nation/earthquake-survivors-waiting-to-rebuild,2566" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/earthquake-survivors-waiting-to-rebuild,2566&amp;source=gmail&amp;ust=1606125430794000&amp;usg=AOvVaw19bLuxfgcmw9SWnbrzetxq">damaged healthcare facilities</a> in Dolakha and upgrade the primary healthcare centre in Charikot into a full-fledged hospital. The organisation was building on its experience in Achham where it manages <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/&amp;source=gmail&amp;ust=1606125430794000&amp;usg=AOvVaw1qCyHqyny7Q3qtyJjYIfZS">Bayalpata Hospital</a> under a similar partnership model since 2009. Although there are other similar activities in Nepal’s public health sector, especially in the distribution of healthcare products, there are only a handful examples of partnerships that are for overall management of health institutions. The government's readiness to adopt innovations that have been put in place through the partnership is unique, and unprecedented. <figure><img width="1500" height="805" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be21a9c7e80680e083e8ajpeg.jpg" alt=""><figcaption></figcaption></figure>The transfer of management has been smooth -- Bhimeswar Municipality has retained 40 hospital employees recruited by Nyaya Health, and will continue the internal management procedures, monitoring of quality service, and a digital health information system.In the past five years, Nyaya Health provided more than 335,000 people in Dolakha with direct free health care, repaired 19 earthquake damaged health posts, and handed them over to the local government ensuring the delivery of health services. <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be21c9c7e80680e083e8bjpeg.jpg" alt=""><figcaption>The handover ceremony of the Charikot Hospital on 30 October to the Bhimeswar Municpality by Nyaya Health Nepal after a unique private-public partnership project. All Photos: NHN</figcaption></figure>The hospital also saw the introduction of digital patient records, development of a performance based system for staff, training and development, expansion of community health and mental health services, addition of infrastructure, equipment and services, and for the past eight months has been at the forefront of an effective Covid-19 response.As a result, Dolakha’s overall health indicators such as the rate for institutional delivery, neonatal mortality and other parameters have seen marked improvements in the catchment area population in the past five years. <figure><img width="799" height="533" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be21f9c7e80680e083e8cjpeg.jpg" alt=""><figcaption></figcaption></figure><figure><img width="1086" height="724" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be2229c7e80680e083e8djpeg.jpg" alt=""><figcaption></figcaption></figure>Patients in the maternity ward of the Charikot Hospital of Dolakha District where the mother child survival rate has improved in the past five years.What was unique was that the Government of Nepal and Nyaya Health Nepal both invested in strengthening healthcare during the partnership period – the government with a community hospital grant, medicine and equipment, human resources and Nyaya Health put in $6.8 million and managed treatment and care in the hospital.Recently, the Bagmati Province government declared Charikot Hospital a ‘provincial hospital’ and this paved the way for additional local investment from the continuity of ongoing services. Under Nepal’s federal structure, every municipality is allotted a budget specifically to improve the local health system. This has increased access to health care, and raised the health status of the local population. Dolakha’s health care system thus literally ‘built back better’ after the earthquake.Under the terms of the handover, Nyaya Health Nepal transferred to Bhimeswar Municipality all fixed assets and consumables worth Rs62.67 million, its digital systems, and the ownership of all data collected for service management and quality improvement.Even after the handover, Nyaya Health Nepal will continue back stopping the Municipality in some areas like technical assistance in managing the Electronic Health Record (EHR), monitoring and evaluation, and service improvement till the end of this fiscal year. Nyaya Health, in turn can use data from the hospital for research, including for ongoing projects.Specialist services with consultants have also been arranged keeping in view the needs of the patients. The federal or provincial governments need to manage the necessary Rs2.5 million per month for specialist care, which are beyond the coverage of basic health services.The municipality has set up an inter-municipal fund to ensure access to care, particularly for the underprivileged at Charikot Hospital, which is providing services also as a referral hospital for the surrounding municipalities and districts.This handover proves that strengthening healthcare is possible only through a multi-dimensional partnership with short-term support, innovation in healthcare delivery and management, long-term planning and resource management. Ultimately, it is the government’s responsibility to ensure healthcare for all, and partnerships like these are useful to jump-start the process. Nepal has established itself as a modern progressive and welfare state, with the Constitution pledging to make basic healthcare a fundamental right of all citizens. In Dolakha, we took a path of a partnership between the government and a non-government entity to lay the foundation of accessible healthcare for all. The central and local governments have now taken the lead for its continuation. We hope that this will be an example for other municipalities and provincial governments that are trying to strengthen health services, and are seeking a model to follow. <img width="122" height="150" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be2259c7e80680e083e8ejpeg.jpg" alt=""><img width="122" height="150" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be2269c7e80680e083e8fjpeg.jpg" alt="">Bharat Bahadur KC is the Mayor of Bhimeswar Municipality and SP Kalaunee is Executive Director of Nyaya Health Nepal. <a href="mailto:spkalaunee@gmail.com">spkalaunee@gmail.com</a>

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Unique hospital handover in Dolakha

<figure><img width="3510" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a651f9c7e80680e059913jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Nepal’s <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">Bayalpata Hospital</a> has won an international award in the Health Category at the World Architecture Festival held in Amsterdam on Thursday.The hospital in <a href="http://archive.nepalitimes.com/news.php?id=17650#.Xens94Mza72">Nepal’s Achham district</a> is a public-private partnership between the group Nyaya Health and the Nepal government, and is built almost entirely using rammed earth technology using locally available material with an ambitious zero carbon construction.‘This is an example of when architecture provides more than a building. Although modest in scale and architectural expression is delivers a massive leap in healthcare provision in a region with scarce resources,’ jury members of the Global Architecture Festival said in their citation. ‘A great example of an architect listening closely and responding intelligently to site and situation. The building is rooted in its site through its use of onsite materials and has impeccable zero carbon design credentials.’ <img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a65229c7e80680e059914jpeg.jpg" alt="">Bayalpata was <a href="http://archive.nepalitimes.com/news.php?id=17650#.XensoYMza71">started by visionary Nepali and American public health experts in 2009</a>, and took over a defunct government hospital to show that accessible and free medical care was possible in a rural Nepal district that had the highest maternal and child mortality and lowest lifespan.Today, the hospital <a href="https://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/upgrading-health-care-through-public-private-partnership-model,582">treats 100,000 patients a year</a> from Achham and six surrounding mountain districts. Paid for mostly by crowd-funding, the $4 million three-phase expansion of Bayalpata Hospital with its <a href="https://www.nepalitimes.com/banner/starting-nepals-green-school-movement/">state-of-the-art architecture</a> was completed earlier this year.“Our specs were to use local materials as much as possible, keep energy costs low, and respect the local context,” explains Arun Rimal, a Nepali architect with the US-based Office of Structural Design (OSD). “The rammed earth uses local clay and sand from the river. The thick walls give thermal mass for insulation, and the skylights optimise sunlight and ventilation.”  <img width="4416" height="3312" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a65279c7e80680e059915jpeg.jpg" alt="">The reliance on local material turned out to be a huge advantage because the project faced unforeseen logistical problems due to the 2015 earthquake and Blockade. However, the four-year construction was delayed by just six months because it did not rely too much on bricks, steel and other imported material. The facility has a <a href="http://archive.nepalitimes.com/news.php?id=5877#.XWZGkOMzaUk">rainwater harvesting system</a>, treats its wastewater and has a network of greywater-irrigated terraces and bioswales to control erosion and recharge the acquifer. A 100kw solar array on the roof meets most of the hospital’s electricity needs, even powering the facility’s only air conditioning unit in the surgical ward. “It was a deliberate design decision to work with the natural environment as much as possible and also to address the cultural context,” says Tyler Survant from Sharon Davis Design in New York, which also conceptualised the unique Women’s Opportunity Centre in Rwanda. “We had to plan for a different kind of hospital from the West: here you have patients and relatives who have travelled for days on foot to get here.” <img width="640" height="828" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151116/636a652b9c7e80680e059916jpeg.jpg" alt="">Bayalpata has public outdoor spaces and canopied courtyards to serve as comfortable waiting areas, while the operating theatres and wards are recessed. Unlike in the US, staff housing also had to be integrated into the facility since it has fulltime resident doctors, who live with their families.

Bayalpata Hospital in Nepal wins global design award

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179b9c7e80680e02c286jpeg.jpg" alt="" width="1400" height="905"/><figcaption>IN GOOD HANDS: Community Health Worker Bhajan Kunwar checks patient Namsara Tamrakar at her home in Chandika village of Achham. Pics: Marty Logan and Srawan Shrestha</figcaption></figure>Rounding a steep curve on the road to the district capital of Mangalsen a startling set of modular structures comes into view. The modern buildings look out of place in this scenic, but underserved, region of western Nepal.The construction is part of a $4 million expansion of <a href="http://archive.nepalitimes.com/news.php?id=17650#.WreWXNRua70">Bayalpata Hospital</a>, a unique medical facility that is a model for public-private partnership to improve medical care in Nepal’s remote interior.Inside the ward, orthopaedic surgeon Mandeep Pathak is examining an elderly man with a swollen knee. Clearly visible on an x-ray monitor is a short pin inserted by a general practitioner a few weeks ago, after the patient fell and broke his kneecap.https://www.youtube.com/watch?v=SuWvlDGasEAIn the same room with the surgeon today is Community Medical Assistant (CMA) Khagendra Pant, who is wrapping plaster around the arm of a small boy. Thanks to training at the hospital, Pant was able to diagnose the boy’s injury as a clean fracture that did not require an operation.Such training means Bayalpata now has to refer just 10-20% of orthopaedic cases to hospitals in Dhangadi and Nepalganj, compared to nearly 70% two years ago.“I am proud to say that all the basic trauma care can now be done by general practitioners. Plus they can diagnose cases and decide which need to be referred to outside centres,” says Pathak.Training is integral to Bayalpata’s mission, says Director of Medical Education <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Bikash Gauchan</a>: his hospital has continuing medical education for clinicians, and on the job training for future nurses and other staff. General practitioners from various centres learn rural surgery at Bayalpata while mid-level staff come to improve their clinical knowledge.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365179e9c7e80680e02c287jpeg.jpg" alt="" width="1400" height="650"><figcaption> </figcaption></figure>For some <a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">patients who travel many days</a> to reach Bayalpata, access to basic surgery here means avoiding an expensive trip to the city. People whose limbs were fractured as long as three years ago delayed treatment until surgery was available at the hospital because they couldn’t afford the trip to a city hospital.Treatment at Bayalpata and at another hospital in Dolakha run by the non-profit Possible, is <a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">free</a>. The group believes healthcare is a fundamental human right protected by Nepal’s Constitution, and should have no cost at point of delivery.Possible is funded by donations and Nepal government grants, which will grow as its hospitals attain clinical targets, such as the percentage of women who give birth in a facility with a trained clinician. Operating expenses last year were $4.8 million, of which 9% came from the government.Arrivals are registered in the hospital’s Electronic Health Record (EHR), which puts patients’ information at the fingertips of clinicians throughout the hospital, and eliminates bulky paper records.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a19c7e80680e02c288jpeg.jpg" alt="" width="1400" height="823"><figcaption> </figcaption></figure>One patient already on the EHR is Namsara Tamrakar. Sitting cross-legged on a raised, wooden platform outside her home in Chandika village (left), the elderly woman shows visiting hospital staff that she knows how to use her inhaler, but it is empty.Three years ago, a doctor at Bayalpata diagnosed her with chronic obstructive pulmonary disease and prescribed medicine via inhaler. Now Community Health Worker Bhajan Kunwar (see box, left) visits regularly to follow up. Like others, Tamrakar’s house has a small blue metal tag on an outside wall with a unique household ID. The houses are also geo-tagged.Kunwar’s visit is guided by CommCare, a software developed by Dimagi and customised by Possible that includes counselling information and checklists for each patient. Plans are to integrate CommCare with the EHR so that field followups are immediately reflected in the hospital’s system. Eventually, Bayalpata’s EHR will be linked to a national data system.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517a49c7e80680e02c289jpeg.jpg" alt="" width="1400" height="1024"><figcaption> </figcaption></figure>Kunwar takes Tamrakar’s blood pressure: 120 by 80. The woman is happy to hear the news and to see Kunwar again: “She comes, does a check-up, and tells me what sickness I have, and if it is getting better or worse. She insists I go to Bayalpata for a follow-up.”The hospital's <a href="http://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490">community health program</a> focuses on maternal and child health as well as non-communicable diseases such as hypertension, diabetes and respiratory ailments. Possible employs 56 community health workers looking after more than 80,000 people in Achham and Dolakha. It is planning to more than quadruple that number next year.Bayalpata Hospital started in 2009, when the group <a href="http://archive.nepalitimes.com/article/nation/Crowding-it-out,1003">Nyaya Health</a> (now Possible) took over an abandoned government facility. Then it had five beds and treated up to 12,000 patients a year. Last year, Possible saw 86,000 patients at Bayalpata: the goal is to treat 150,000 people annually after the new wards, emergency room, administration building, a dormitory and remaining small houses for on-call staff are added.“Our integrated, hospital-to-home approach will be a model for Nepal, and beyond,” explains Gauchan, “and we will be proving that in a resource-limited setting, health care expansion, providing universal health coverage to people is possible.”But is the Bayalpata model really replicable? Skeptics say that two hospitals could have been built for the cost of the new buildings, which feature rammed earth technology, solar energy and rainwater collection, and that only substantial donor support made the expansion possible.Gauchan admits that the initial investment may seem high but says it will be more cost-effective in the long run.He adds: “The existing infrastructure for rural health care is way less than the minimum needed to address the emerging burden of non-communicable diseases and road accidents as well as infectious diseases. That is why we are investing in a very robust infrastructure.”<h2>Community spirit</h2>In 2011, Bhajan Kunwar (pictured above) was living an “Ok” life with her husband Purna and children in Bhageswor village of Achham when her sister-in-law Shavitra asked for a favour.Shavitra had been hearing rumours that her husband, who was working in India, was having an affair or had even remarried. Would Purna take her to India to find out? Purna agreed, and brother and sister set off with a friend. En route, Purna received a phone call from Shavitra’s husband warning them not to come, or there would be trouble.They continued anyway, and after crossing the border got on a train. That night, a group of men, perhaps including police, boarded the train and took Purna away. He later called Shavitra’s husband to say he had been kidnapped and would be killed unless help came quickly.Police found Purna’s body the next morning, on the roadside in Ahmednagar, east of Mumbai. It looked like he had been run over, but Bhajan believes he was murdered.Widowed at 25 and with two small children, Bhajan spent the mourning period worrying about how she would afford to send the children to school, and if her mother-in-law and community would accept her becoming the breadwinner for her husband’s four younger brothers and sisters and their families. (Her father-in-law had died earlier).That month, Bayalpata Hospital had a vacancy for a community health worker for the area. Bhajan was hired and six years later, still visits on foot the more than 700 households in her catchment area, checking that patients are taking their medicines, and much more (see main article).“This hospital made me strong,” she tells us. "Before I didn’t know anyone in my village and I didn’t know so many things.” Now with a college certificate, Bhajan advises young women to get educated before they get married. “I tell them ‘if I can do it, you can do it too’. I believe in myself and don’t care what others say about me. If you are true and honest, no harm will come to you.”Bhajan says she will never forget her husband. “But I have to live for my children, and control my mind and my heart. If I am strong, they can have a regular life. The hospital is now my husband, I cannot imagine leaving it.”Marty Logan in Achham<h2>Operating remotely</h2>When nine-year-old Samir Tamang was bitten by a dog on his way to school in Rayale village of Kavre last week, he had to take a two-and-a-half hour long bus ride to Kathmandu with his grandfather Suk Bahadur Tamang, for a rabies vaccination at Teku Hospital.Samir missed school and his grandfather, who works as a driver in Kathmandu, had to ask for leave from his employers.“We are relatively close to the capital, but imagine what it must be like for people living in remote parts of Nepal where there are no roads,” says Suk Bahadur.Indeed, despite the spread of basic health care in Nepal, emergency treatment and procedures like mending broken bones or caesarean sections are not yet available in rural areas. This means families have to sell property or borrow from moneylenders to be able to afford treatment in the cities. Studies have shown that many Nepali families are driven to poverty if relatives are referred to private hospitals.Unmet surgical needs in remote districts remain a major public health issue in Nepal, according to a recent study in 39 remote area hospitals commissioned by the Nick Simons Institute (NSI).One day this week, an informal survey of patients at the government-run Bir and Teaching Hospitals in Kathmandu showed that a majority of the patients were from remote districts, some as far away as Piuthan and Jajarkot.The NSI study shows that except for caesarean sections in Dolakha, Lamjung and Panchthar, very few government hospitals elsewhere were able to do simple operations of the abdominal cavity, or even mend broken bones.Nepal’s surgery rate falls well below the Lancet Commission target of 5,000 operations per 100,000 population. If the goal is to have a surgical facility within two-hour travel distance for patients, at present only a third of the population can reach an orthopaedic surgeon, and only 22% have access to abdominal surgery.However, the survey reaffirms that the presence of a medical general practitioner (MDGPs who can perform caesarean sections and other relatively simple surgical procedures) can change this. District hospitals with resident MDGPs can eliminate the need for patients to make expensive and extended trips to the cities for treatment.The minimum personnel at a district hospital should include an MDGP, obstretrics doctor, anaesthesia assistant, staff nurse and biomedical technician. However, Nepal’s density of hospitals with such staffing is very low (0.4-3.1 per 100,000) as against the Lancet Commission target of 20 per 100,000 population.“In the long run we need specialists but placing three of them in each district hospital will take a long time. For the next 5-10 years, MDGPs will be the answer to solve surgical problems throughout the country,” explains Anil Shrestha, NSI’s Executive Director.The study recommends an MDGP-led generalist surgical team with proper staff, drugs and equipment to upgrade emergency surgical care in all district hospitals.Adds Shrestha: “The government has to strengthen strategically located district hospitals and make them functional to take care of surgical needs throughout the year. It is entirely possible to do.”Sonia Awale in KavreRead also:<a href="https://www.nepalitimes.com/editorial/poor-health/">Poor health</a>, Editorial <a href="http://archive.nepalitimes.com/news.php?id=17650#.Wrydky5ubIV">Resurrection Accham</a>,  Paavan Mathema<a href="http://archive.nepalitimes.com/article/nation/aim-for-fewer-patients-in-achham-possible-hospital,2022">Boy walked eight days to treat broken arm</a>,  Tsering Dolker Gurung<a href="http://archive.nepalitimes.com/article/nation/Nation-free-for-all-healthcare,491#.UbrA4ueLA1s">Free-for-all health</a>,  Duncan Maru and Roshan Bista

Marty Logan

State of the art rural hospital

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

Will it be different this time in Nepal?

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

A dead tree tests Nepal's bureaucracy

Sometimes, we need to take a step back to realise what a tectonic movement Nepali politics witnessed this month.
In a region and world ruled by elected authoritarians, Nepalis &nbsp;went to the ballot box freely to express a collective will for change.
These faces in this group photo of the RSP’s 180 freshly-minted MPs at the ballroom of the Royal Tulip Hotel on Wednesday is symbolic of what Nepal has come through.&nbsp;
The ship of state righted itself after the September Storm, installing an interim government that held an election within six months in which voters banished obsolete politicians and their parties into oblivion.
Nepalis, fed up with the inept kakistocracy of the past three decades, took the country into a post-ideological phase — replacing Marxists, Maoists and monarchists &nbsp;with a belief in a new governing culture that rewards delivery and accountability. And they have trusted the RSP to carry it through.
Nepal’s history has never been linear, it jerks ahead in lurches. The polity also tends to take one step forward and two steps back, so the public’s great expectations is tempered by a sense of cautious optimism and guarded pessimism.
This could be the great leap forward that Nepalis have waited for and deserve, but it could also be a Gramscian interregnum in which the old is dead and the new is not yet born. We will have to wait to see whether this transitional period will also see ‘morbid symptoms’.
As disruptor-in-chief, it was the Balendra Shah ‘wave’ or ‘craze’ that propelled the RSP to power. The former Kathmandu mayor needed a party platform, and the RSP’s tainted leader Rabi Lamichhane required a booster. Nepal's voters were looking for a saviour.
Personality-wise Shah and Lamichhane are poles apart: one is Type B and the other Type A. One is enigmatic, the other phlegmatic. But yin and yang do also tend to complement each other.&nbsp;
Kathmandu’s chattering class is already making self-fulfilling prophecies about the two falling out, and are fishing for hints that they already have. Shah’s absence from the RSP’s orientation this week was taken as a clue.&nbsp;
Closing the two-day tutorial on Wednesday, Lamichhane delivered a fiery 30-minute speech that laid out the RSP’s main agenda: to function differently from the old parties, serve the people, avoid middlemen, become true lawmakers without taking the law into their own hands.&nbsp;
“The old political parties contributed to history, we will build the future with a new political contract with citizens,” he said, trying to rise over past controversies and his abrasive rhetoric to sound statesmanlike.&nbsp;
GIVE AND TAKE
Lamichhane is said to be in touch with the reclusive Shah to announce a compact cabinet next week. Its composition will be an indication of how much give-and-take there was, and whether the criteria for selecting ministers is competence or loyalty.
Will RSP ministers behave like rulers or service providers? The new government will dive right into the economic fallout of the West Asia war with soaring fuel &nbsp;prices, inflation and uncertainty about remittance inflows.
On Thursday, Gagan Thapa resigned as NC chair, taking moral responsibility for the party’s election loss. The UML’s unrepentant K P Oli does not share the same sentiment about who is responsible for his own party’s historic downfall.&nbsp;
NCP chair Pushpa Kamal Dahal, who was luckier than his cross-party cohort, is now a comparative relic in a Parliament largely comprised of freshmen and sophomore lawmakers.
But the NC, UML and NCP still control provincial and most municipal governments. The old parties could try to make things difficult for the RSP at the centre, but it is also an opportunity for them to clean up their act ahead of local elections next year.&nbsp;
Another test for the RSP will be dealing with a heavily-politicised klepto-bureaucracy which has to frontend its policy decisions. &nbsp;

People’s power

Deadly floods two years ago along the southern fringes of Kathmandu Valley killed 200 people. Climate change was blamed, but the destruction was magnified by quarries and sand mining owned by local politicians and crony contractors. Disaster mitigation and environmental risk was not a priority for any of the political parties that ran and won Nepal’s election last week. Although the RSP has a supermajority, rural municipalities that grant mining contracts are still ruled by the established parties that supply aggregates and sand to feed &nbsp;Kathmandu’s construction boom. Here in Lele Valley, residents are worried about another monsoon season that will start in June and fear more floods bringing unmanaged gravel from quarries down the Nallu River.&nbsp; The house of Sanumaya Nagarkoti, 65, and ten neighbours were washed away by the flood on the night of 28 September 2024. She and her husband petitioned the ward and municipal council to remove the crushers but no one listened. The slopes above are scarred by landslides from two years ago, and the banks of the river are strewn with bounders the size of cars that were brought down. “We live in constant fear of landslides,” says Chakra Nagarkoti, “the heavy crusher machinery and tipper trucks also constantly shake the house.”&nbsp; Google Earth images show that 24.6 hectares of mountain flanks have been excavated since 2010, and despite the disaster no lessons have been learnt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090348_bdce7f17500eadac0ce0814c32c2b4190d01325976fd4d29db9985148459c0bc.jpg" data-media-id="editor_0" data-image-id="20260319090348_bdce7f17500eadac0ce0814c32c2b4190d01325976fd4d29db9985148459c0bc" data-rendition-name="original" width="1500" height="907" loading="lazy" alt="Lele"> <figcaption>Photo: GOOGLE EARTH</figcaption> </figure>  The RSP might have got a near two-thirds majority in Parliament but decision-making at the community level is controlled by politicians in cahoots with contractors.&nbsp; Along the Mahadev Khola, the Department of Mines cancelled excavation permits for crushers citing flood and landslide risk. Yet there are still 21 contractors mining stones and sand.&nbsp; Nearby Godavari Municipality also instructed operators who had not renewed permits to close down. No action was taken. One of them is Vinayak Multipurpose which delivers aggregate and stones for United Cement. Local ward chair Milan Silwal, has a stake in Vinayak and locals accuse him of taking the side of industry.&nbsp; Another slope is being gouged out near Mahadev Khola, and comparing satellite imagery from 2010 shows that the scar on the mountain is now five times bigger.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090348_21a8f7f7f9d6cc784c35719da737b20283f934bbe16c9de971d91bf01012499a.jpg" data-media-id="editor_1" data-image-id="20260319090348_21a8f7f7f9d6cc784c35719da737b20283f934bbe16c9de971d91bf01012499a" data-rendition-name="original" width="1500" height="1125" loading="lazy" alt="Lele"> <figcaption>United Cement operating near Mahadev Khola. Photo: ARCHANA DARJI</figcaption> </figure>  Nearby stands the lone house of 55-year-old Sabina Tamang, who lives with her husband and daughter. Due to the sound of the stone-breakers, they cannot hear each other speak. “Last year, a landslide destroyed our cowshed and latrine,” she says. “Next it is going to be our home.”&nbsp; DRY SPRINGS Lele gets its water from several perennial springs which have gone dry in recent years. One of them is near where the cement factory quarries limestone. “We hardly get any water, and the little that does flow is murky and red,” says local resident Rajesh Shrestha. A parliamentary committee directive ordered excavation to stop 15 years ago after a similar flood to the one in 2024.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090352_af7da754299116578cc1dd91d5318ec337b69e74b0676599260b7c57c6ec6fd7.png" data-media-id="editor_2" data-image-id="20260319090352_af7da754299116578cc1dd91d5318ec337b69e74b0676599260b7c57c6ec6fd7" data-rendition-name="original" width="1440" height="494" loading="lazy" alt="Lele"> <figcaption>Lele over the years. Photo: GOOGLE EARTH</figcaption> </figure>  United Cement’s manager Hari Upreti says his company has fulfilled all requirements and has permission to mine 15 hectares of its own property and 4 hectares of government land. “We have the Department of Mines permit which is valid till 2036 and extract 1,600 tons of limestone every day,” says Upreti. “The local community knew about the mining and if there is a problem with springs going dry it is not because of us.” Environmental researcher Uttambabu Shrestha, however, says there is a direct correlation between the quarry operation and floods, landslides and dry springs.&nbsp; “Extraction should not be allowed without an environmental impact assessment, and companies must stick to set limits,” he says. Investigation of permits show that there is collusion between local officials and contractors. Godavari-6 Chair Bishnuman Maharjan has investment in two quarries and crusher companies operating along Nallu Khola. A paper trail links Maharjan also to Sagarmatha Stone Crusher and Mankamana Aggregate Industries. IMPUNITY&nbsp; Godavari Municipality published a notice in June 2024, instructing crusher companies to submit environmental reports within two weeks, covering initial examination and impact assessment. It also told them to pay local development fees and clear outstanding dues. The municipality even wrote to the Department of Mines clarifying that it had issued permits to only five out of 27 contractors. Within a month, the Department wrote to the District Administration Office (DAO) and District Police Office instructing them to stop illegal excavation, and sent a copy to the Lalitpur Division Forest Office. The DAO then wrote to Lalitpur Police naming Machindranath Multipurpose as operating illegally and should be shut down. There was no followup. The municipality then issued fines worth Rs 60 million to it and one other company for non-compliance. The companies stalled, disputing the calculations.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260319090356_6e96403d3c5be4aef4d030974d6d92029a0eb396deafd19c511978dae30dd3d2.jpg" data-media-id="editor_3" data-image-id="20260319090356_6e96403d3c5be4aef4d030974d6d92029a0eb396deafd19c511978dae30dd3d2" data-rendition-name="original" width="4000" height="2250" loading="lazy" alt="Lele"> <figcaption>Another site of extraction near Mahadev Khola in Godavari. </figcaption> </figure>  Machhindranath Multipurpose operator Kedar Timalsina Shashi denies doing anything wrong, and says the landslides were collateral damage because of the steep terrain. When contacted Godavari Municipality Deputy Mayor Muna Adhikari declined to comment. It has been 10 years since Rajesh Shrestha, Nikesh Shrestha, and others raised their voices against the environmental destruction caused by the construction mafia. An agreement was finally reached two years ago between locals and mining and transport businessmen, stipulating that stone mines must close permanently by mid-2025. The agreement also stated that check dams must be built to manage mining debris, and damaged structures must be restored to their original state. Trees were to be planted at sites where stone mines had operated. But the mines in the catchment are still in operation with 500 tipper trucks working on the site every day, transporting stones and aggregate. Local youth have continued holding sit-in street protests and at Lalitpur DAO.&nbsp; After one sit-in, the mines closed for about a month but they started back up a month later.&nbsp; Birendra Maharjan owns one of the crusher units, and says he follows all environmental protocols. He told us: “You need stones to build, and we must dig to extract stones. Some trees have to be cut, people get employment, and besides, floods and landslides happen across Nepal.” &nbsp;&nbsp; Centre for Investigative Journalism – Nepal.