It's Raining Books

From stone spouts to cast-iron mains, Nepal’s water system and its struggle to provide safe water tells a larger story of power, disease, dependency — and lessons for the future. From 1823 to 1891, the Nepali state made just two notable interventions in Kathmandu’s drinking water system. The first was when Prime Minister Bhimsen Thapa commissioned a stone pout (hiti) to tap groundwater within the valley’s traditional supply system. The second came nearly 70 years later with Nepal’s first industrial-era water system, the Bir Water Works in 1891 under Prime Minister Bir Shumsher Rana. Linking these two milestones was the spectre of cholera. From the 19th century on there were seven global cholera pandemics. <a href="https://www.sciencedirect.com/science/article/pii/S0264410X19309995#bb0325" target="_blank">Originating in Asia</a>, the disease reached Europe and the Americas, the Vibrio cholera bacillus breeding in poor sanitation wherever it found it. The first wave erupted in 1817, followed by others in 1829, 1852, 1863, 1881, 1889 and, finally, in 1961, the seventh pandemic which still lingers on. London, the epicentre of the Industrial Revolution, was repeatedly stricken. In Britain ‘miasma’ foul air was blamed. &nbsp;In Nepal, cholera was seen as divine damnation. By the late 19th century, as Nepal’s relationship with Britain deepened, the Bir Water Works was inaugurated in 1891 as a defence against cholera. Whether cholera also shaped Bhimsen Thapa’s decision in 1823 is less clear. Contemporary records note the commissioning of Sundhara, but do not refer to the cholera epidemic raging at the time. The silence itself is telling: Nepal’s elites were ruling in the shadow of the disease. Bhimsen Thapa first resided in Thapathali Palace, which was built in 1802 by Nain Singh Thapa, father of Mathabarsingh Thapa, who would briefly become prime minister in the 1840s. In 1806, Bhimsen Thapa moved to Bagh Durbar, a new complex on the western edge of Tundikhel. Historians are vague about the water supply in the residences of the nobility, but wells and water hauled from rivers, ponds, canals, and other sources were likely the primary sources. A small hiti north of Bagh Durbar, near today’s Sun Dhara, may have supplied the palace. In 1823, Bhimsen Thapa had it enlarged, making it the last and largest state-built hiti in Kathmandu. Even as Bhimsen Thapa was involved in palace intrigues and border conflicts, Britain was engineering pipelines. By the late 18th century, Sir Thomas Simpson had invented the bell-and-spigot joint, making long-distance pipes viable. Fluid dynamics, dealing with pumps, pipes, and filters, was becoming a foundational discipline. In Kathmandu, the scourge continued. Cholera struck Kathmandu repeatedly, in 1862, 1867, 1872, 1874 and 1875. The 1872 epidemic, <a href="https://nepalitimes.com/news/kathmandu-in-the-time-of-cholera" target="_blank">according to historian Tom Robertson</a>, claimed between 200 and 250 lives a day. On average, cholera killed between 1,200 and 1,500 people annually in Kathmandu Valley, an enormous toll for its small population. The summer of 1885 was especially calamitous: a cholera epidemic ravaged Kathmandu and its periphery from the beginning of June until late August. The disease even breached the royal palace, reportedly killing 23 people, mostly young girls. Records show that 909 people received treatment at the British Residency dispensary, and estimates suggest that as many as 10,000 people perished in a city of 50,000. In November that year, Bir Shumsher seized power in a coup. He inherited not only a premiership but a Valley ridden with disease. Cholera was endemic, and it was accompanied by typhoid, smallpox, goitre, syphilis, and chronic dyspepsia. The The British Residency dispensary at Lainchaur was inadequate. “In a poor country like ours, wealth means health,” Bir Shumsher remarked, an unusually pragmatic admission that epidemics were not divine punishment but structural afflictions of urban life. He soon pledged to expand health care. In 1889, he opened Bir Hospital and staffed it with Indian doctors to treat cholera, typhoid, smallpox, and other prevalent illnesses. PIPED WATER Bir Shumsher also recognised the need for safe drinking water. Between 1866 and 1872, he had served as Nepal’s ambassador in Calcutta, and he must have seen water mains already in operation there, and a filtration plant inaugurated in 1870. Madras had installed such a system as early as 1800, Bombay constructed the Vihar and Tulsi reservoirs in the mid-19th century. In Kathmandu British Residency personalities such as George Gimlette must have urged Bir’s government to quicken the construction of the hospital and water system, yet the archival traces of such exchanges still await historical scrutiny. By the late 19th century, the British had developed a technological ecosystem for water supply, intakes, pipes, fittings, reservoirs, and trained engineers. Bir Shumsher appealed to the British Government in India for engineering assistance. A British engineer named Mr Feigneur surveyed Kathmandu to prepare maps, and estimated the volume of water that could be brought from the Rudramati River. In 1889, a more experienced engineer, Lockhart Matthew Sinclair arrived. He was a Scotsman educated at Wellington College and the Royal Indian Engineering College, with prior experience in constructing waterworks in Jubbulpore and the Viceregal Palace in Shimla. Appointed State Engineer of Nepal (1889–1892), Sinclair reviewed Feigneur’s plans, updated them, and chose the Bishnumati River as the source of the city’s drinking water. Sinclair’s design included a reservoir at Panipokhari, at 1,330m elevation and 30m above &nbsp;Tundikhel, thereby enabling gravity-fed distribution in pipes. With a capacity of 7,327 cubic metres, the reservoir could store nine days of supply.&nbsp; The system was designed to serve about 70,000 residents through both private connections and public standpipes. The reservoir was a single-compartment tank with an arched brick roof covered in earth and turf. Its brick walls were bonded with lime mortar and aggregate, and its floor was dressed with fly stone. Work on the valley’s water supply began in 1888, three years after Bir Shumsher seized power. The following year, Bir Hospital and the Bir Water Works took shape. The project involved some 40km of imported cast-iron pipes, weighing 1.866 million kg and inscribed with the marks of Scottish foundries ‘Ally and McLean’ and ‘Glasgow’. Construction required 620,000 man-days of labour and cost over Rs600,000. Transport costs inflated prices: <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">a load of cement</a> costing Rs10 in Calcutta was worth Rs33 by the time it reached Kathmandu. Bir Water Works was inaugurated in September 1891, six years after the cholera epidemic. Water flowed out of 131 taps, including eight in Lainchaur, six in the royal palace, eleven in the prime minister’s palace, sixteen around Tundikhel, thirteen in Thapathali, seven in Thamel, and two in Naxal. The system’s designation, the term ‘works’ , echoes the Chelsea, Calcutta, and Glasgow Water Works, underlining its industrial pedigree. Water was also supplied to Phora Durbar, Bir Shumsher’s palace of music and dance whose fountains sprayed rose-scented water in a display of opulence. The <a href="https://commons-nepal.com/the-first-kaldhara-in-" target="_blank">Bir Dhara Works</a> was more than an engineering scheme: it was Nepal’s first modern public-health intervention. Safer drinking water curbed waterborne disease, and the number of cholera outbreaks declined, but were not eliminated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254.png" data-media-id="editor_4" data-image-id="20260103020144_d5c22de54c0eaab680a166c5a7482839fdc09b60679109021d0504252a810254" data-rendition-name="original" width="865" height="535" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971.jpg" data-media-id="editor_5" data-image-id="20260103020144_a46075b6d759585df56a2bb8e5a07d85de7d9a69406165c32784fe30012c9971" data-rendition-name="original" width="2791" height="3859" loading="lazy" alt="Cholera and drinking water in Kathmandu"> </figure>  “Now we have water to fight cholera, and I believe cholera will no longer prevail. After four years of piped water, the benefits have been greater than expected,” Bir Shumsher said in a proclamation. Despite this, the prevalence of poor sanitation, open defecation, cramped housing, and malnutrition meant that typhoid, smallpox, and dyspepsia remained endemic. The Bir Dhara system marked Kathmandu’s transition from reliance on wells, rivers, springs, and hiti to piped water, operating for several decades and laying the foundation for the expansion of drinking water services across the country in the late twentieth century. <a href="https://commons-nepal.com/the-first-kaldhara-in-the-four-cities-of-the-valley/" target="_blank">Extensions followed in Patan</a> under Chandra Shumsher, and Bhim Shumsher later added the Tri Bhim Dhara. Piped water systems were subsequently constructed in towns such as Kirtipur, Bhaktapur, Dhankuta, Pokhara, Dhulikhel, and Jajarkot which itself saw a deadly cholera outbreak in 2009.&nbsp; CHOLERA METAPHOR In 1933, Nepal’s first water bureaucracy, the Pani Goswara, was established, formalising state involvement in urban water supply. Yet even till the late 20th century, households continue to rely on a mix of sources, including public water networks, private vendors, rooftop storage tanks, borewells, wells, hiti, and household filtration. The lack of reliable water supply places disproportionate financial, physical, and psychological burdens on low-income households, underscoring how decades of infrastructure expansion have not translated into universal, reliable service. during challenges in governance, investment priorities, and regulation. Bir Shumsher also attempted to introduce <a href="https://www.ukaalo.com/news/cholera-in-kathmandu-1958/" target="_blank">basic hygiene measures</a>, such as pit latrines with squatting slabs. However, there is no record of these facilities being built in his palaces, later built palaces, or elsewhere. Sanitation conditions remained poor for both the elite and the general population. Open defecation or the use of crude pit latrines without proper waste disposal was common. With no drainage or sewer systems, human waste accumulated near homes, contributing to the spread of waterborne diseases. In 2019, Nepal declared itself ‘open defecation free’, a policy milestone, but this achievement masks the persistence of deeper problems. Urban areas generate some 867 million litres of wastewater daily, yet only 7% of it is treated before being discharged. Sewage flows untreated into rivers and streams, spreading cholera, typhoid, dysentery, and other diseases, particularly among children and vulnerable communities. Safe disposal of faecal sludge continues to be a major struggle for many communities and local governments. Besides Jajarkot, Godavari in Kathmandu Valley had a localised outbreak in 2024. This year, Birganj was struck by a cholera outbreak caused by a lethal combination of unreliable water supply, groundwater overpumping, poor drainage and hygiene, and unsafe waste disposal. And Nepal’s peacekeepers deployed after the earthquake in Haiti in 2010 were blamed for spreading cholera that ultimately killed 30,000 people in the Caribbean nation. The Bir Water Works was more than a reservoir and pipes. It was Nepal’s first brush with modernity, mediated through engineering and haunted by cholera. More than 134 years on, cholera remains a threat and a reminder of Nepal’s challenges in water and sanitation governance. The issue is not merely ensuring access to safe water but also building public trust that quality essential services can be delivered equitably, sustainably, and with resilience. Ajaya Dixit is a Kathmandu-based researcher exploring Nepal’s water history since the mid-eighteenth century to inform ethical water and river management in a changing climate.

Life in a time of cholera

As someone born and raised in Patan, I knew that the city was rich in art, architecture and intangible heritage. But I never realised just how rich, and how little I knew about its hidden treasures until this book. Yala Mhasika/Exploring Lalitpur/Lalitpurko Chinari is published by the Lalitpur Chamber of Commerce &amp; Industry and introduces the city to the world, as well as to its own inhabitants. Lalitpur is popularly known as Patan, probably because of the pastures for livestock in its outskirts. Its original name in Nepal Bhasa is Yala, and is a blend of urban and rural, old and new.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_700fb4c7b27d78813f69347846403c492cd1d54e2f62e4ec097013714c4a2022.jpg" data-media-id="editor_0" data-image-id="20260101120152_700fb4c7b27d78813f69347846403c492cd1d54e2f62e4ec097013714c4a2022" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Patan Dhoka</figcaption> </figure>  Like other kingdoms in the valley of Swoniga, the dense urban cluster of houses, temples, monasteries were situated along the higher ground, while the farmlands were on the slopes leading to the rivers below. This unique townscape combined an urban lifestyle within a distinctly agriculture-based rural setting. The fertile soil, replenished by organic nutrients washed down from the streets above, as well as Kathmandu’s location on the ancient trade route between India and Tibet, provided the Valley’s kingdoms with prosperity – and thus the flourishing of art and culture over centuries. Most of Yala’s residents were farmers, traders, or artisans. Chinese visitors who came to Nepal in the 6th century saw that there were more traders than farmers, and more temples than houses. An entire street is inhabited by the descendants of Lhasa traders. Arniko is supposed to have been born in Yala.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_0fb490355fac9b8252c9abfbf5ef1bbac844b29103744a421eb6ef6dbc77dff7.jpg" data-media-id="editor_1" data-image-id="20260101120152_0fb490355fac9b8252c9abfbf5ef1bbac844b29103744a421eb6ef6dbc77dff7" data-rendition-name="original" width="2000" height="1332" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Kwonti area which houses five-storey Kumbeshwar temple dedicated to Shiva and Baglamukhi temple dedicated to Dasa Mahavidya shakti peeth.</figcaption> </figure>  Nepal exported goods and even minted coins for Tibet, and had a virtual monopoly of the major trans-Himalayan trade routes. This prosperity was reflected in monuments and shrines like the Kwa Baha Golden Temple. More so than the other three kingdoms of Swoniga, architecture flourished in Yala making it the centre for metal, stone and wood craft. The name Lalitpur means ‘city of fine art’ but with its sense of community, it might as well be a city of fine living. Legend also has it that the name Lalitpur comes from a farmer called Lalit who helped bring the rain god Karunamaya from Assam when the Valley was suffering a prolonged drought. Lalit’s shoulder beam stands to this day in Jhatapol. Disasters, invasion and <a href="https://nepalitimes.com/here-now/life-in-a-time-of-cholera">epidemics</a> were a recurring theme in Patan.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_b33b1024cb7a46f49fea35ecc9afa2740895907059d7a43c8bd6c463b1be05e7.jpg" data-media-id="editor_3" data-image-id="20260101120152_b33b1024cb7a46f49fea35ecc9afa2740895907059d7a43c8bd6c463b1be05e7" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Ajima of Haugal Tole which is the oldest stone scripture in Nepal with the Gaja Laxmi in Chyasal.</figcaption> </figure>  The book was put together by the heritage expert team of Rosha Bajracharya, Sunil Pandey and Anil Chitrakar and provides a socio-economic and political history of Patan – how it was always food surplus, thanks to sustainable farming until recently. Ground and drone images by Photo Venture Nepal in the book give us a rare new perspective on Patan. There is an entire chapter on the chariot festival of Karunamaya (Machhindranath), a community-managed festival with Barahi carpenters assembling the woodwork, vine engineers Yamva weaving rope and rattan for the 25m tall chariot, and Ghaku drivers controlling the speed and brakes as the structure rolls through narrow streets in the annual festival.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_d27b23aeb4548b0b64ab8ed20f40baa331060498c6b5443e2cb999b876c670af.jpg" data-media-id="editor_4" data-image-id="20260101120152_d27b23aeb4548b0b64ab8ed20f40baa331060498c6b5443e2cb999b876c670af" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Te Bahal in Patan which houses Karunamaya six months a year.</figcaption> </figure>  WALKING, WORSHIPPING The book can help in exploring Patan along five routes starting in Patan Dhoka, Pulchok, Shankhamul, Mahaboudha and Lagankhel with maps and details of the baha and bahil, shrines, ponds, open spaces, dhyochenn, courtyards and phalcha along the way. Because of its coffee-table size and heft, however, the guidebook is not practical to carry around. And despite detailed descriptions of the past and present of each site, readers are left wanting to know more about those places. It is proof of Patan’s vast treasures that even this book barely scratches the surface.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_31a597b7dc1bcc9f67b4f6a66b8c1c0e0a9406727389699e6aed9ac6c3c50901.jpg" data-media-id="editor_5" data-image-id="20260101120152_31a597b7dc1bcc9f67b4f6a66b8c1c0e0a9406727389699e6aed9ac6c3c50901" data-rendition-name="original" width="2000" height="1332" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Patukodom where visitors can view what remains of the ancient Kirant palace.</figcaption> </figure>  Some of the lesser-known must-visit sites include Patukodom which is all that remains of a palace of the original Kirat inhabitants of Patan. An archaeological dig here would surely unearth hitherto unknown facets of pre-Newa Patan. Then there are the slightly out of the way shrines like Mahabouha, a replica of a temple in Bodhgaya which houses 3,341 terracotta Buddhas with 90 big statues and which took 35 years and four generations to complete.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_ffb657dc254f707dc1755f6f13b1ef67bb7183b6573da9678c54482129fb3878.jpg" data-media-id="editor_6" data-image-id="20260101120152_ffb657dc254f707dc1755f6f13b1ef67bb7183b6573da9678c54482129fb3878" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Mahaboudha is a replica of a temple in Bodhgaya.</figcaption> </figure>  In a recent Patan by Night heritage walk, we learnt that Pim Bahal was the labour of love of a lakhe demon (now popularised as masked dancer) who had fallen for a local girl, and he dug the pond so she would not have to walk to a faraway spout to collect water. Nearby is the Charumati Chaitya, built by the daughter of Emperor Ashoka when she visited the Valley in the 3rd century BCE to spread Buddhism in Nepal. Interestingly, if Kathmandu is a city of temples, Patan is the centre of monasteries which represent a unique Tantric melding of Buddhist and Hindu forms. Examples are: the Tadham Cuka with relocated Licchavi-era chaityas symbolic of the four major events in Buddha’s life, Ajima of Haugal Tole which is the oldest stone scripture in Nepal with the Gaja Laxmi in Chyasal, and Bignantak Ganesa temple which is a manifestation of Shiva mingled with Vajrayana Buddhism.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_17a500e77f06b9881f684329e41d3482f6f6a639ffb929d8bb44e5af7934c61c.jpg" data-media-id="editor_7" data-image-id="20260101120152_17a500e77f06b9881f684329e41d3482f6f6a639ffb929d8bb44e5af7934c61c" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Bignantak Ganesa temple.</figcaption> </figure>  &nbsp;Besides spatial descriptions, the book also explains the temporal by curating a detailed cultural calendar of Lalitpur with dates and places of jatra, rituals, devotional dances and festivals that weave the agricultural cycle with the zodiac.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_b8e1cc03653fea85dec84a7abee4fd594c35c6ad553769f37905eb5b38774e08.jpg" data-media-id="editor_8" data-image-id="20260101120152_b8e1cc03653fea85dec84a7abee4fd594c35c6ad553769f37905eb5b38774e08" data-rendition-name="original" width="2000" height="1125" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Mipwa Lakhe of Patan which create fire in mid aid during performance.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120152_442e10bff842214e8c7522ebf6e63663599768db73bb57d999deff9de1b59375.jpg" data-media-id="editor_9" data-image-id="20260101120152_442e10bff842214e8c7522ebf6e63663599768db73bb57d999deff9de1b59375" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="Exploring Lalitpur book review"> <figcaption>Gan pyakhan or Astamatrika dance which is performed in Patan Darbar Squre during Dasain. </figcaption> </figure>  The very last chapter is dedicated to water and nature, what sustains lives and civilisations, and how Lalitpur continues to be the city it is because of the water supply system our ancestors left behind which function still, despite encroachment and pollution. ‘In the history of the world cities have been built, they thrived for some time and then became archaeological sites because they were not able to maintain the quality of air, water, and its soil,’ the authors write. ‘This led these cities to depopulate and ultimately die and are only referred to in history books. Lalitpur is not going to make the same mistake.’ &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260104080132_3f403388d57da82b499d6c489a8f095002bf69f11e515e92fa96fb5ca3af69e9.jpg" data-media-id="editor_10" data-image-id="20260104080132_3f403388d57da82b499d6c489a8f095002bf69f11e515e92fa96fb5ca3af69e9" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Exploring Lalitpur"> </figure>

YALA

Nepal has made dramatic progress in expanding health services, yet millions of people still do not fully benefit from their Constitution-ensured right to basic medical service. Many of those deprived of accessible and affordable healthcare are in remote far-flung areas of the country, but increasingly they are also among the urban poor who have migrated to the cities and live in the margins. In both areas there are gaps in service quality, health workforce availability, and governance capacity. Out of pocket expenses for medical treatment of a family member can push families into absolute poverty and debt. The 2025 WHO–World Bank Global Monitoring Report on Universal Health Coverage underlines this challenge -- financial hardship from health spending remains a major barrier to equity, even where medical coverage has improved. In Nepal, rising demand for better and more affordable healthcare and workforce shortages due to outmigration of medical personnel and other factors mean that the government is unable to bridge these gaps through public provision alone. Well-governed and accountable public-private partnerships (PPPs) aligned with national priorities offer <a href="https://archive.nepalitimes.com/article/nation/Crowding-it-out,1003" target="_blank">a practical pathway from policy commitment to real-world impact</a>. The experience of the non-profit Nyaya Health Nepal (NHN) in partnership with the Sudurpaschim Province is an example of where this has worked well. Through <a href="https://nepalitimes.com/banner/altruistic-healthcare-models-in-nepal" target="_blank">public ownership and non-profit management</a>, <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=17s" target="_blank">Bayalpata Hospital</a> in Achham and <a href="https://nepalitimes.com/news/unique-hospital-handover-in-dolakha" target="_blank">Charikot Hospital in Dolakha</a> strengthened service delivery, supply chains, health workforce management, and digital health systems, while keeping all services free at the point of care.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20251231101244_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  NHN managed Charikot from 2016-2020 and handed it over to Bagmati Province, and Bayalpata was handed over to Sudurpachim after 17 years in August 2025. These partnerships reduced out-of-pocket spending, improved trust in public facilities, and directly addressed financial concerns of citizens. The WHO–World Bank Global Monitoring Report emphasised that universal health coverage requires strengthening primary health care, providing free services at the point of care, and protecting families from financial hardship. Public–nonprofit partnerships like NHN and others in Nepal provide a model to directly address these challenges. By improving access to quality care, supporting local health workers, and keeping services free, these partnerships help reduce health costs for families, build trust in local health facilities, and narrow the gap between rural and urban health services, <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">turning </a><a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">policy commitments into real improvements for communities.</a> The experience of <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata and Charikot hospitals</a> show that effective PPPs are governance-driven, not market-led. Clear agreements, transparent data sharing, performance-based management, and strong government oversight guaranteed that public institutions were strengthened rather than sidelined. Bayalpata and Charikot successfully transitioned leadership and full management to Sudurpaschim and Bagmati provincial governments, proving that public-private partnerships can build lasting government capacity, not dependency.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8.jpg" data-media-id="editor_8" data-image-id="20251231101244_a8821faa2059498bbd3318386a1bea25b7cfe7a36600c2e2ce250e97caed51e8" data-rendition-name="original" width="1570" height="940" loading="lazy" alt="Charikot hospital"> <figcaption>Charikot hospital in Dolakha.</figcaption> </figure>  This model combined facility-level operational flexibility with public stewardship, and tackled long-standing weaknesses in Nepal’s health system, from workforce retention to evidence-based decision-making. Scaling such models through a national, gap-focused partnership framework is now an urgent opportunity. Replicating Bayalpata model partnerships in selected hospitals and primary health care centers could rapidly advance the three pillars of universal healthcare: equitable access, quality services, and financial risk protection. Institutionalising public-private partnerships within the Ministry of Health and Population and &nbsp;linking it to national health insurance reforms could help fulfil the promise of Article 35 of the Constitution guaranteeing basic healthcare to all citizens. For development partners and donors, this could represent a high-impact, evidence-informed investment aligned with the WHO–World Bank call to reduce financial hardship while strengthening healthcare systems. If Nepal is serious about leaving no one behind, strategic public–non-profit partnerships must move from the margins to the mainstream of health system reform. By <a href="https://nepalitimes.com/opinion/is-free-health-care-possible-in-nepal" target="_blank">scaling the NHN model</a> at Bayalpata and Charikot nationwide, Nepal can build a resilient, equitable health system where every community regardless of location or income has access to quality care, financial protection, and the opportunity to succeed. Investing in well-governed PPP models is not only essential to protect the health of the Nepali people but also to safeguard the country’s economic stability and long-term resilience. &nbsp; Srijana Devkota is Director of Program and Partnerships at <a href="https://nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal</a> (NHN). <a href="https://www.youtube.com/watch?v=xJdxLD0hBqo&amp;t=3s" target="_blank">Watch a video of Bayalpata Hospital.</a> <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=_gSoClqwmI-ecSxh" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>

A healthier, wealthier Nepal

For daring to demand democracy, the Rana regime hanged activist Shukra Raj Shastri at midnight on 24 January 1941 by the side of the road at Teku. Across town in Siphal, Dharma Bhakta Mathema was also hanged. Four days later, Dasrath Chand and Gangalal Shrestha were executed by firing squad. These four young revolutionaries were members of the underground Nepal Praja Parishad that led the anti-Rana revolution with plans to assassinate key figures of the dynasty. The four martyrs sacrificed their lives for an unfulfilled cause. Monuments were put up in their honour (Shahid Gate) and their names glorified by the Shah monarchy that itself went on to ban political parties and persecute democracy activists. In 1950, the newly-formed Nepal National Congress launched an armed uprising against Rana rule after King Tribhuvan sought refuge at the Indian embassy to flee from the Rana regime. In 1951, the Ranas, Nepali Congress and King Tribhuvan signed a tripartite agreement that brought an end to 104 years of Rana rule.&nbsp; Thus began contemporary Nepal’s cycles of unfinished revolutions. Some 75 years later, on a sunny September morning, Nepal’s young and hopeful took to the streets demanding an end to the nation’s corrupt polity, envisioning a better democracy. They organised through digital platforms, played songs, danced, and chanted slogans. A few hours later, commandos fired on the protesters, massacring dozens. Over 8 and 9 September 2025, the government was overthrown, constitutional bodies were literally reduced to ashes, and 74 Nepalis were martyred.&nbsp; Nepal’s periodic revolutions have been ignited by anger against rulers, they have begun with great promise, spread with enthusiastic popular support despite rulers trying to crush them — but ultimately they have always fallen short of the expectations of citizens demanding reform. Through decades of dissent, Nepal’s periodic revolutions have remained incomplete, with the nation caught up in a cyclical search for stability.&nbsp; In 1960, king Mahendra staged a coup and overthrew an elected government led by prime minister B P Koirala -- a royal revolution against democracy. Mahendra is reported to have famously said to Koirala: “Nepal is not big enough for the two of us.” For the next 30 years Nepal resembled a one-party state under the absolute monarchy of the Panchayat. Elected leaders languished in jail or exile, political parties were banned, and the press controlled. This was the most frigid period of the Cold War, with Nepal’s neighbours India and China at war. Geopolitics was bound to have an impact. “After the 1816 Sugauli Treaty with British India, external forces magnified internal power struggles as outsiders played divide and rule,” explains editor and political analyst Rajendra Dahal. “Movements did not reach a logical conclusion because domestic politicians were forced to compromise.” Indeed, the departure of the British from India in 1947 meant that the days of the Anglophile Rana regime were numbered. Successive prime ministers sought patronage in Delhi, and the monarchy tried to counterbalance it with a policy of equidistance with China. The neighbours showed a keen strategic interest in Nepal’s domestic politics. “The Panchayat system did not deliver what it promised,” says Santosh Sharma Poudel of Nepal Institute of Policy and Research. “Nepalis suffered administrative and governance failure, politics was centralised in Kathmandu, leaving out the rest of Nepal.” With mainstream political parties and leaders were &nbsp;underground between 1961 till 1990, student activists became proxies for political parties. As pressure for change grew, a student-led pro-democracy movement spread across Nepal in 1979. In response, King Birendra announced a referendum to allow Nepalis to choose between the status quo and a ‘reformed’ Panchayat &nbsp;system.&nbsp; The Panchayat won by a slim margin with questions about the legitimacy of the plebiscite. The reforms never materialised and it would be another decade before street anger boiled over again. As the People’s Movement for democracy spread, king Birendra again relented, unbanning political parties and Nepal became a constitutional monarchy. Inspired by Mao Zedong, a faction of Nepal’s Communists felt that western-style parliamentary democracy was too slow to end a feudalist monarchy. They launched an armed struggle in 1996, and the war lasted ten years (editorial, page 2). “If the democratic government post-1990 had performed better, and brought real reform, the Maoists would not have a reason to launch a revolution,” says Poudel. After nearly a decade of bloodshed that left 17,000 dead and thousands still missing, the Maoists joined forces with the democratic parties that they had been fighting, to pressure king Gyanendra through street protests in 2006 to restore democracy. In 2008, an elected Constituent Assembly abolished the monarchy. &nbsp;Recalls Rajendra Dahal: “The second people’s movement did not aim to abolish the monarchy. In fact, the reinstated parliament even granted equal rights for royal daughters to be crowned queen. But eventually, the monarchy no longer fit the political framework that the parties envisioned.” It took two elections over the next eight years to draft a new Constitution that reflected Nepal’s socio-cultural and geographic diversity and met the demands of the Maoists. The new federal Constitution was finally promulgated in 2015, but failed to satisfy India and the aspirations of the Madhes communities for autonomy. The state’s effort to crush the Madhes movement cost 45 lives. The promise of the new Constitution was squandered over the next decade with rotating leadership of the NC, UML and the Maoists — all of whom had forgotten the sacrifices made in the name of revolution. Cronyism and corruption was the order of the day. And it was this never-ending cycle of political opportunism and malgovernance that brought Nepal’s youth to the streets on 8 September.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260101120128_bc50f6370ff80a6758199ea7ba9f4c214656a9322a8d2ba1c97e6cdfb88f7f62.jpg" data-media-id="editor_0" data-image-id="20260101120128_bc50f6370ff80a6758199ea7ba9f4c214656a9322a8d2ba1c97e6cdfb88f7f62" data-rendition-name="original" width="3372" height="1371" loading="lazy" alt="timeline"> </figure>  1951 Revolution against the &nbsp;Rana regime 1960 King Mahendra's coup, jails B P Koirala and launches the partyless Panchayat system 1979 Student protests for democracy, King Birendra announces referendum&nbsp; 1980 Continuation of the partyless Panchayat system narrowly wins plebiscite&nbsp; 1990 People’s Movement I 1996 Maoists launch armed struggle&nbsp; 2000 Royal Massacre 2005 King Gyanendra's military-backed coup&nbsp; 2006 Comprehensive Peace Accord and Parliament restored 2008 Monarchy is abolished 2015 Madhes Movement, New Constitution promulgated 2017 First 3-tier election under federal system 2022 Second elections under federal Constitution&nbsp; 2025 GenZ protests BRK ALLIANCE “The socio-political change sought in all these movements never matched the people’s expectations, because the central issue of clean and efficient government never materialised,” says Poudel. The post-September political landscape has injected new personalities and alliances still relatively new to politics, as evidenced by the new electoral partnership of the BRK — Balen Shah, Rabi Lamichhane, and Kulman Ghising (page 1).&nbsp; These leaders are not without flaws, but they have become the effective flag-bearers of the GenZ movement, hoping to represent Nepalis disillusioned by decades of democratic decay. The March election will pit them against the legacy parties. There is already criticism that BRK is behaving just like male-dominated opportunists of old parties. The troika is resembling the triumvirate of Oli, Deuba and Dahal and its culture of patronage and quid-pro-quo power-sharing between alpha males. Will this also be another unfinished revolution? Says political scientist Sucheta Pyakuryal: &nbsp;“The kind of destruction that happened after the revolution should have been followed by a ground-breaking shift in Nepal’s political ecosystem, but that did not happen. Today the situation is a lot grimmer because we have players who have learned how to use the democratic facade to sound ‘equitable’ and ‘accountable’. But look closely and you see how the same political chauvinism, cronyism and nepotism still continue.”&nbsp;

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