<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101152/636b79299c7e80680e0646e8jpeg.jpg" alt="" width="1323" height="891"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Despite a global spread of the COVID-19 pandemic, the question on everyone’s minds is why Nepal has officially had <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">only one infected person so far</a>. According to public-health experts, the answer is that we have not tested enough people yet. Even patients with flu symptoms have been turned away from the Infectious Disease Hospital in Teku, because test kits are in short supply.“Because the case load is increasing in India, with which we have an open border, we have to be vigilant, and we need to test more suspected cases,” admits Teku Hospital chief Anup Bastola. His hospital’s single PCR machine can only test 500 patients a week, and after the first positive case, all others have tested negative.Read also: <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">This is a test</a>, EditorialPublic-health experts say it will be premature to call Nepal coronavirus-free unless vulnerable groups are all tested, as has been done in South Korea.“You cannot pronounce Nepal coronavirus-free by just testing 500 people,” says Biswa Dawadi of the Nepal Medical Council.So far this month, the Teaching Hospital in Maharjganj has admitted just two patients above age 60 with Chronic Obstructive Pulmonary Disease (COPD). But they have not been tested for COVID-19. In the past month, Bir Hospital has recorded the deaths of 22 elderly patients due to various causes, which is about the monthly average this time of year, and none have died in the past two weeks.In Kavre’s Dhulikhel Hospital, there have been no deaths from pneumonia of elderly patients in the past month. Four patients above 65 at Grande Hospital suffering from lung infections tested negative for COVID-19, but there have been a few patients who died of swine flu, of which there is an outbreak in India.“Since there has not been a big jump in fatalities of elderly patients in hospitals, we can conclude that COVID-19 has not yet spread widely,” says Rajendra Koju of Dhulikhel Hospital. “But you can never be absolutely sure unless you test more people. And the public needs to take precautions.”The <a href="https://www.nepalitimes.com/here-now/nepals-economy-already-weak-takes-direct-hit/" target="_blank" rel="noopener">government has restricted movement</a> to stop community transmission, and banned all flights to and from Europe, West Asia, Korea and Japan, including for transit passengers. Flights to Thailand, Singapore, Bhutan, China and India will still operate.

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<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

Is free health care possible in Nepal?

Nepali Congress (NC) President Gagan Thapa's candidacy in Sarlahi-4 has thrust this Madhes constituency into rare national focus. If Thapa wins and the NC emerges as the largest party, Sarlahi-4 will send Nepal's next prime minister to Parliament. But if he does not, Nepal’s grand old party will face the next years in the opposition to fight another day. There is a troubling paradox in Sarlahi-4 where the district bordering the Indian state of Bihar has been a battleground for national politicians with fierce electoral competition, all while remaining one of the region's most underserved and underdeveloped constituencies.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_069cbbc11e971a851b444866dee57f760c0cc611ed40bdf96c627e343e3c0485.png" data-media-id="editor_0" data-image-id="20260305140344_069cbbc11e971a851b444866dee57f760c0cc611ed40bdf96c627e343e3c0485" data-rendition-name="original" width="1802" height="1276" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo: MADHES PAHARA MEDIA</figcaption> </figure>  Ever since Mahant Thakur split from NC in 2008 to form the Tarai Madhes Loktantrik Party, the district has seen rotating political alliances and fragmented votes. Yet, despite 18 years of candidates promising change irrigation schemes remain incomplete, market access for farmers has not improved, unemployment is high.&nbsp; On election day, voters here marked their ballots with fingers stained by dye from the Holi festival the day before. The road leading to Barathawa Bazar was deserted for the most part, except for some youth riding in motorcycles. This is where the high-profile contest between Gagan Thapa and RSP nominee Amresh Singh is being staged. Among the other aspirants is 27-year-old UML candidate Amnish Yadav, the son of former MP Shiv Pujan Yadav. The Yadavs are a political family with considerable caste influence in the constituency. In 2022 Yadav’s daughter Madhumala Yadav received over 14,000 votes here, ranking third overall. Yadav was voted MP from the Maoist party, but defected to the UML this time. His other son is the chair of Sarlahi’s Ramnagar Rural Municipality. Sarhali-4 has 121,012 voters, and the Yadav is banking on the 27,000-strong Yadav vote bank. Sarlahi-4 voter Avishek Sah told us he wanted his vote to go to a young nominee and not someone who has been MP thrice already, like Amresh Singh. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_527c5c2f9aa6a6c7e3bbdfbfe79fdafb0a0b56a62427e9ced86b924c6c563b10.jpg" data-media-id="editor_1" data-image-id="20260305140344_527c5c2f9aa6a6c7e3bbdfbfe79fdafb0a0b56a62427e9ced86b924c6c563b10" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo: AYUSHA CHALISE</figcaption> </figure>  To make local loyalties even more complicated, Amnish Yadav’s uncle, Harinder Yadav is an active NC member and walked side by side with Gagan Thapa during his door-to-door campaigns.&nbsp; The NC is betting on Thapa getting over 60% of the total votes. Amresh Singh’s tally could be limited to 10,000 votes — that too because of the nationwide RSP wave, and the popularity of its prime ministerial hopeful Balendra (Balen) Shah. “Amresh Singh lost his appeal when he played victim after he was denied a ticket by the NC in 2022,” Harinder Yadav says. Voters we spoke to here agreed with this assessment that Singh did not do much for the district once he got elected in the past, and being a part of the RSP seems to be his biggest asset. “The only reason I voted for Amresh Singh is because Balen is in RSP,” local voter Mahendra Gupta from Barathawa. &nbsp;“This is his last chance to return the people’s trust.”&nbsp; Gupta is aware of the institutional presence of the NC here. The party received the most votes in 2022 local elections, adding that the candidacy of someone as high-profile as Thapa is a positive sign for Sarlahi-4.&nbsp; Other voters like Ruby Gupta are rooting for both the NC and the RSP. “I will vote for Gagan and for Balen,” she says, adding that her FPTP vote will go to Thapa while her PR ballot would be for the RSP. RSP supporters are confident that their candidate will win big because even though many voters may not have openly voiced their support they still voted for the party and candidate. The Balen Wave was not limited to RSP voters, but also to UML candidate Yadav, who said in a gathering that he will be “the voters Balen” if they elect him. He touted his party’s track record in government, and largely campaigned on administrative efficiency, infrastructural expansion, and local service delivery. Amresh Singh ran on the RSP’s anti-establishment brand, promising to fight corruption, challenge traditional party politics, improve basic services such as education, health, jobs, and infrastructure, while pushing for stronger representation and development for Madhes.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_982df01801fa7d3532ca0555ecb8a0756e3223be3d93650e08ca82a312dc2ebd.jpg" data-media-id="editor_2" data-image-id="20260305140344_982df01801fa7d3532ca0555ecb8a0756e3223be3d93650e08ca82a312dc2ebd" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo:AYUSHA CHALISE</figcaption> </figure>  Singh’s rivalry with his NC competitor goes beyond the ballot— he allegedly blames Thapa for being denied the NC ticket in 2022, which led him to win the election from Sarlahi-4 as an independent. &nbsp; For his part, Gagan Thapa focused on a more pragmatic development agenda that includes upgrading roads and irrigation, improving schools and hospitals, supporting farmers, and creating employment opportunities with improved governance at the centre. He also promised to build an engineering college in the constituency.&nbsp; Thapa also promoted his own anti-establishment image within the NC, repeatedly reminding voters on the campaign trail that he represents the aspirations of the youth.&nbsp; On Thursday, as voting progressed, there were violent disruptions in two centres where voting was briefly halted. But Sarlahi district police spokesperson Saroj Rai told Nepali Times that there were no major problems. Police in collaboration with the Nepal Army sent the ballot papers to the district’s counting stations, where the votes are expected to be tallied through the night and the winner announced Friday morning.

Sarlahi-4 nervously watches ballot count

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<div class="embed-block"><iframe src="https://election-geo-dashboard.pages.dev/" width="100%" height="700" frameborder="0"> </iframe></div>

Nepal Election live results

As this report is uploaded, the latest results in Nepal’s election show that the Rastriya Swatantra Party (RSP) is headed for an even bigger sweep than most had predicted.
The RSP was leading by large margins in 49 of 165 constituencies, &nbsp;with the UML, NC and NCP trailing far behind. Prominent political figures from the old parties like K P Oli, Minwndra Prasad Rijal, Ishwar Pokhrel, Bishnu Prasad Poudel, Bimalendra Nidhi all seem headed for defeat.
It does look like the RSP’s bell election symbol is ringing right across Nepal — from cities to the remotest districts in the mountains and plains. The party’s blue colour is sweeping the land.
The Nepali people seem to have sent a clear message that they were throughly dissatisfied with the chronic failure of the three main parties to work in the national interest to create jobs and deliver development. It was also an expression of lingering outrage over the the 8 September massacre outside Parliament. &nbsp;
It now looks almost certain that Balendra Shah will get to be Nepal’s next, and youngest, prime minister. Hopefully he will be leading a cabinet of competent and honest technocrats. It remains to seen how the power equation between Shah and the RSP’s leader, Rabi Lamichhane will play out.
Lamichhane is out of jail on bail for fraud cases which he has called political vendetta by the previous regime. Both he and Shah are charismatic and ambitious. Their working relationship will determine Nepal's political stability and whether it can avoid the political cronyism of the past.
This election was not just about casting votes. It was about standing up to principles and a value system, and respecting the hopes and aspirations of Nepal’s youth. It to push for transparent government and against impunity — including for the gunning down of young Nepalis in cold blood.
<div class="embed-block"><iframe src="https://election-geo-dashboard.pages.dev/" width="100%" height="600" frameborder="0"> </iframe>Live election results as winners of candidates are announced.</div>
CAN DO MAN
Shah got mixed reviews as mayor. He was impulsive and ad hoc, but most people inKathmandu and beyond liked his can-do attitude and unconventional style which stood in sharp contract to the legacy leaders. Over his three year mayorship he showed more maturity and planning capacity.&nbsp;
But he always ran headlong into opposition from the federal government over his urban planning and other initiatives to make Kathmandu more liveable. Coming from a civil and structural engineering background, he was involved in building low-cost housing after the 2015 earthquake.
But his public persona is more tied to his irreverent rap lyrics that stood up for the marginalised underprivileged in society, while exposing the high-handedness and apathy of the state. But this also exposed contradictions because he also used his own municipal guards to beat and chase away street vendors and squatters.
But there is no doubt that a combination of the sharp messaging in his rap videos amplified by the algorithms of social media ignited Nepal’s youth to rise up. It was more about optics and emotion than policy and strategy.
He studied Kathmandu district for five years, visiting experts in every field before announcing his independent candidacy for mayor in 2022. Many like me in his own constitunecy did not know who he was and where he came from.
He is a year younger than my architect son, and I saw in him a reflection of my own son’s commitment to serving the nation. I voted for him to be mayor despite his sometimes erratic behaviour, which could be attributed to his youth.
The best sign of his strategic planning, which unsettled septuagenarian and octogenarian politicians, is the he did not grab the first easy option of becoming prime minister in September when GenZ activists offered him the post.&nbsp;
Joining RSP was a masterstroke, as was his challenge to Oli in Jhapa to project national branding. He needed a party platform and Lamichhane needed a popular prime ministerial persona since he himself could not hold the post.
Shah has shown the capacity to take risks when he believes the value justifies the action for the country. Now, he will have to show more strategic thinking on a national scale, as well as understand the delicate geopolitics of Nepal.&nbsp;
He must rise above the kind of crude social media posts that earned him followers on X, but did nothing to erase his erratic and impulsive image.&nbsp;
Some assume that behind his trademark RayBan shades is a closet dictator, and his past remarks about Hitler are still up on social media. He has in the past shown impatience with criticism, unleashing supporters on social media to troll detractors.&nbsp;
Even so, the public seems willing to place their hope on an educated young man with integrity and a proven record for planning at the helm. By tomorrow it will be clear whether the hope Nepalis have held has been fulfilled, and the coming years will show if the RSP will lead Nepalis to a better future.
The voters seem to have shown the door even to the NC despite the fact that under Gagan Thapa, the party had turned a new leaf. A strong government under Prime Minister Balendra Shah heading a carefully selected cabinet and a strong opposition of the NC, UML and other parties for check and balance may be just what we need for a stable Nepal.&nbsp;
Nepalis have collectively always shown maturity in elections. This time they have given a resounding endorsement for integrity and for good governance.

Bells ring all over Nepal

After Thursday’s election, Nepalis are in a wait-and-watch mode. The Election Commission says counting ballot papers will be expedited this time, and the results for the First-Past-The-Post (FPTP) will start being declared within days. In 2022, it took three weeks for the final results to be tallied.&nbsp;
But winning an election is only half the challenge for the parties, forming a government under parliamentary politics is like a complicated mathematical equation.&nbsp;
In 2022, the Nepali Congress (NC) emerged as the biggest party, winning 89 seats. But the UML with 78 seats and the Maoists with 32 formed a minority government. In fact, Sher Bahadur Deuba did not become PM then despite leading the biggest party in Parliament.
This time, there is an unmistakeable Rastriya Swatantra Party (RSP) wave led by its prime ministerial candidate, Balendra Shah. Besides his own popularity, Shah represents change which most Nepalis are clamouring for after decades of corrupt and feckless coalitions that did not deliver.&nbsp;
The past months of campaigning has seen massive youth engagement on social media through memes, AI clips, and viral images. Digital content that appeals to emotion rather than policy debate between candidates shape electoral outcomes in Nepal and elsewhere. &nbsp;
Shah represents GenZ aspirations, and was their candidate for prime minister. It was only when he declined that Sushila Karki was nominated. None of the political parties in the recent past -- new, old, or revolutionary — have won enough seats to go it alone.&nbsp;
The most recent majority government was formed by the short-lived Communist Party of Nepal after the UML-Maoist merger in 2022. But that rare two-thirds majority collapsed after a power struggle between K P Oli and Pushpa Kamal Dahal. The only party to have won a majority was the NC in the 1991 and 1999 elections. But it is near impossible for it to repeat this success now, even with Gagan Thapa's rebranding of the party.&nbsp;
We have compiled these possible scenarios for election outcome in order of likelihood:
RSP gets a majority
RSP hits the magic 138 to form a government entirely on its own. Balendra Shah wins Jhapa-5, and becomes the new prime minister at 35, the youngest ever to hold the office in Nepal. But danger lurks: there could be a personality clash between Shah and Lamichhane who are both equally ambitious. History could repeat itself.&nbsp;
RSP wins but does not get a majority
RSP is likely to sweep the most votes, but what if it does not secure enough seats for a majority? It would need a coalition partner and Nepali Communist Party (NCP) under Pushpa Kamal Dahal could fit the bill, but only if it has the numbers. The RSP is not likely to team up with the UML or NC.
The NCP is relatively untainted by the 8 September events, and also has former UML defectors like Madhav Kumar Nepal and Bhim Rawal who could bag their rural vote banks. After all, there are no permanent foes in politics. If the royalist RPP and Tarai-based Janata Samajwadi have enough seats, those could be options for the RSP. &nbsp;
NC is second
The NC under the new leadership of Gagan Thapa could become the second biggest force and form a government with RSP in a power-sharing deal with Shah. This would be the most stable scenario since the RSP and NC have competent and idealistic young technocrats. Thapa himself embodies a strong combination of both old and new politics to navigate the system for more efficient government. But then Thapa and the RSP's Rabi Lamichhane do not get along.
NC and NCP form a majority
If the NC becomes the largest party but not by a big margin, it could join up with the NCP and Ujyalo. Teaming up with the UML would likely face backlash with the party and outside. If Gagan Thapa becomes prime minister he will face internal pressure from both Deuba loyalists. Same old story.
Minority coalition of NC, UML and NCP
RSP becomes the first party but does not get a majority, paving the way for the three legacy parties to cobble together a minority government. While this is possible in Nepal’s parliamentary system, such a scenario is likely to lead to more instability and dissatisfaction among young Nepalis demanding change, and even trigger street unrest. &nbsp;

private-hospitals

Wait and watch

Is free health care possible in Nepal?

Sarlahi-4 nervously watches ballot count

Nepal Election live results

Bells ring all over Nepal

The magic 138