<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66739c7e80680e059980jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo : BIKRAM RAI</figcaption></figure>There used to be a time when the main public health threat in Nepal was from infectious diseases like <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, encephalitis, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a> and typhoid. Whether vector-borne or transmitted through contaminated air or water, the most cost-effective way to address them was through prevention. Communication was the first line of defence against communicable diseases.Things have changed. Awareness has grown because literacy rates are up. Most Nepalis now suffer from non-communicable ailments like cardiovascular diseases, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">renal failure</a> and malignancies. These need treatment in medical facilities at a time when the over-commercialisation of hospitals has made healthcare unaffordable for a majority of the population. In fact, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">poor health</a> is making Nepalis poorer.Read also:<a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37821&amp;preview_nonce=9ce6a7c55d&amp;preview=true" target="_blank" rel="noopener">Federalism leaves Nepal’s medical sector ailing,</a> Sewa BhattaraiAlso, communicable diseases have not been completely overcome. Diarrhoeal dehydration and other water-carried infections are still major killers. One of the reasons Nepal’s progress in reducing child mortality has stalled is because of the state’s failure to ensure adequate and safe drinking water in remote regions. In this paper we have also reported on <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener">stunting and wasting among children</a> due to malnutrition.In addition, <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">worsening air pollution</a> has caused an epidemic of chronic obstructive pulmonary disease (COPD), which has led to lung infections in all age brackets and causing terminal pneumonia and other complications in the elderly. At current levels of PM2.5 concentration in the air, studies show, the average lifespan of city dwellers in Nepal could be reduced by up to four years.Read also:<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all of the change in world health"</a><a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialNepal’s burden of non-communicable diseases and injuries has doubled in the last 25 years, with nearly 15% caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a> or natural disasters. Traffic accidents are now the second biggest killer of young Nepalis. Just in the past three weeks, 90 people have been killed on highways due to poor road condition or carelessness.A vivid indication of the threat of non-communicable diseases is today’s prevalence of diabetes. South Asians are genetically more susceptible to cardiovascular diseases and diabetes, but there are now new risk factors caused by increasing rural to urban migration. While the world prevalence average for both types of diabetes is 8%, research has shown that 14% of people in Dharan suffer from the disease. Taplejung, from where many have migrated to Dharan, has a rate of only 1%. The reason is clear: increased intake of carbohydrates and a more sedentary lifestyle when people move to cities.To meet these challenges, Nepal desperately needs <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">affordable and accessible medical care</a>. At the moment, hospital treatment is neither. The poor in remote, underserved areas of the country are disproportionately vulnerable. As our report from Bajura shows, the problem is further complicated because confusion over federalism, budget and jurisdiction has left most rural government hospitals underfunded and underserved. It is imperative that the government act quickly to resolve the retention crisis caused by medical staff getting themselves transferred out of their jobs in remote areas.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 is not as easy as it looks</a>, Sonia Awale<a 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 BhattaraiA survey last year showed that half of all <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical expenditure of Nepalis families</a> is out-of-pocket, and 60% of that is for treatment of non-communicable diseases and injuries. The federal government allocates only about 10% of its budget to health care, and the focus is still on communicable diseases. Donor priority is also not on non-communicable diseases and injuries. A study of government hospitals by the Nick Simons Institute shows a huge unmet need in remote areas for basic surgery like caesarean sections and orthopaedics.One bright spot ahead is the success of pilot insurance schemes being tried out in various parts of the country. In a <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">commentary this week</a>, S P Kalaunee of Nyaya Health, an NGO that helps the government manage hospitals in Achham and Dolakha, presents a proven 60:25:15 formula of health insurance. In this arrangement, non-profits, the private sector and all three levels of government can make medical care affordable to all Nepalis, if upscaled. Under the scheme, 60% of the cost of care comes from insurance, provincial governments pay 25% and municipalities take care of the remaining 15%.Parts of the scheme are being tried out in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a> (which last week <a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/" target="_blank" rel="noopener">won the Global Architecture Festival award</a> in Amsterdam for its design). Insurance reimbursement 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. Internationally, this has become an issue with 12 December marked as Universal Health Coverage Day.Nepal’s constitution now guarantees basic and emergency healthcare as fundamental rights of citizens, and puts the responsibility on to the state. The government  can no longer keep passing the buck on providing universal insurance for its citizens.<h2>10 years ago this week</h2>Nepali Times <a href="http://archive.nepalitimes.com/issue/480" target="_blank" rel="noopener">issue #480 of 11-17 December 2009</a> carried an <a href="http://archive.nepalitimes.com/news.php?id=16572#.XfId7ZMzaUk" target="_blank" rel="noopener">interview on page 1 with Baburam Bhattarai</a>, who was then vice-chair of the Maoist party.  Excerpts:‘From the very beginning, we have said that the basis of the federal system should be nationality. In Marxist terms, nationality means a common language, geography, economy and psychological make-up. A group of people that shares these qualities is called a nationality.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66769c7e80680e059981jpeg.jpg" alt="" width="392" height="600">On this basis we have proposed to constitute federal autonomous units in Nepal and we also practised this during the People’s War. Since the very beginning we have been consistent that federalism should be along the lines of nationality.’

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POOR HEALTH MAKES NEPALIS POORER

<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?

<a href="https://nepalitimes.com/news/ball-in-balen-s-court">Nepal’s newly-installed Prime Minister Balendra Shah</a> unveiled his Council of Ministers after taking the oath of office on Friday in Kathmandu.&nbsp; Besides Nepal's pre-existing problems, his team will immediately have to deal with the fallout of the West Asia conflict to satisfy an electorate impatient for change. The Rastriya Swatantra Party (RSP) won a majority in the 5 March election and capped the Cabinet size at 15. Shah, a structural engineer and musician, himself has taken charge of the Defence and Industry Ministries. There has been an attempt to make the Cabinet inclusive with women in five of the new portfolios.&nbsp; After much negotiation, the powerful Home Ministry, a bone of contention between Shah and RSP Chair Rabi Lamichhane, has gone to Sudan Gurung, a hitherto little-known figure who <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">rose to prominence after the September GenZ protest</a> and won the election from Gorkha-2.&nbsp; Gurung will be in charge of Nepal’s internal security apparatus and maintaining law and order. And with Gurung, a close ally of the Prime Minister, in charge, some note the Home Ministry will be a hook for Shah if Lamichhane, with his share of controversies, steps out line.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a.jpg" data-media-id="editor_2" data-image-id="20260327090324_c7725ea5fb9ffbf96df25a7b3122520b7ae3ee10548aed3f37781a7e5440e51a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Notable RSP leaders, including vice-chair DP Aryal, were said to have been vying for the portfolio.&nbsp; Gurung is the founder of the non-profit Hami Nepal, which worked primarily in earthquake relief in 2015, and emerged onto the national stage during negotiations to appoint Sushila Karki as interim PM after the unrest. He was also involved in key negotiations that cemented Balendra Shah and Rabi Lamichhane’s political partnership in the runup to the election.&nbsp; Most new Cabinet members are not just first-time ministers, but are also freshmen lawmakers. Many are experts in their fields. Finance Minister Swarnim Wagle is an <a href="https://nepalitimes.com/here-now/nepal-needs-to-rebrand-itself">economist </a>with degrees from the London School of Economics and Harvard, and was previously Chief Economic Advisor at the UNDP Regional Bureau for Asia and the Pacific, and also served in Nepal’s National Planning Commission.&nbsp; Previously a member of Nepali Congress, Wagle exited the party in 2023 following differences with top leadership, and joined the RSP. Wagle won a by-election from Tanahu-1 in 2023 and won again from the same constituency in this month’s election.&nbsp; Shishir Khanal, who heads RSP’s foreign affairs department, has been appointed Minister of Foreign Affairs. &nbsp;Khanal is co-founder of Teach For Nepal, was briefly Education Minister when the RSP was part of the the Pushpa Kamal Dahal-led coalition government in 2023.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42.jpg" data-media-id="editor_4" data-image-id="20260327090324_b1a670bac12e2bf4df955134f58c8de7718d48f6be4e1f2df7c7c52f82e36e42" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Law Minister Sobita Gautam is a lawyer by profession and worked in governance and public policy before she was elected as the youngest MP in the 2022 election.&nbsp; Health Minister Nisha Mehta is a nurse and became a lawmaker under the Proportional Representation system in this election which swept the RSP to power with a near two-third majority.&nbsp; Education Minister Sasmit Pokharel, a first-time MP elected from Kathmandu-5, served as an aide to Balendra Shah when he was mayor of Kathmandu and a was member of the KMC City Planning Commission.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f.jpg" data-media-id="editor_5" data-image-id="20260327090324_5ed794d7bf0cac2844277521810225c4355746b9c3f7369f70cacc878c94641f" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Biraj Bhakta Shrestha is Energy Minister, and also served as the Minister for Youth and Sports in the Dahal-led coalition government in 2024. Before joining RSP, Shrestha was elected to the Bagmati Provincial Assembly in the 2017 elections representing the r<a href="https://nepalitimes.com/here-now/rsp-s-activist-dna">eformist Bibeksheel Sajha Party</a>. He will immediately face the challenge of addressing the <a href="https://nepalitimes.com/news/rough-road-ahead-for-new-nepal-rulers">impact of the West Asia war,</a> including rising petroleum prices and a shortage of cooking gas. Sita Badi, who was elected through the PR system, is Minister for Women, Children and Senior Citizens. She was born and brought up in the underserved and marginalised Badi community in Surkhet and has been advocating for the rights and welfare of women, children, and minority communities. Other ministers include RSP spokesperson Pratibha Rawal as Minister for Federal Affairs and General Administration as well as Land Management, and Gita Chaudhary as Minister for Agriculture, Sunil Lamsal is Physical Infrastrucutre, Transport, and Urban Development Minister, Khadka Raj (Ganesh) Paudel as Tourism and Civil Aviation Minister. Dipak Sah is the Labour and Employment Minister, and Bikram Timilsina is Communication Minister.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed.jpg" data-media-id="editor_8" data-image-id="20260327090324_b67c2d199d4897031583a5b7ec7ce43e88771167696e6161665eeb5fca25d3ed" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  Meanwhile, RSP vice-chair DP Aryal, who many thought would be home minister because of his proximity with Rabi Lamichhane has been proposed as Speaker of the House.&nbsp; Aryal previously served two brief stints as the Minister of Labour when RSP was part of the RSP’s coalition governments in 2023 and 2024. As minister Aryal came <a href="https://nepalitimes.com/editorial/skeletons-in-the-cabinet-k5x6py1v">under scrutiny </a>for his involvement in an employment agency that was investigated for illegal acquisition of wealth in 2020. If appointed House Speaker, Aryal will be expected to play a neutral and non-partisan role in Parliamentary affairs. &nbsp; With the full Cabinet announced on Friday, Prime Minister Shah and his team now have their work cut out for them. &nbsp;The government’s first priority will be ensuring the safety and long-term security of the almost two million <a href="https://nepalitimes.com/here-now/migrant-workers-in-wartime">Nepalis living and working in the Gulf</a> amid the ongoing conflict in the region, and taking steps to cushion Nepal’s economy from the Israel-US war on Iran. The new leaders will also be tasked with implementing the findings of the Karki Commission report on the September violence that paved the way for the election and the rise of the RSP. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_11" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> <figcaption>Snapshots from PM Balen Shah's swearing-in ceremony</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d.jpg" data-media-id="editor_12" data-image-id="20260327090324_69b36bc62737e44ade4080be36688f9c2f92201356e1df2072cef8ecc6a9be5d" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a.jpg" data-media-id="editor_13" data-image-id="20260327090324_8646d490883154f696bcdc6e2375084419f2eefaaf0ef0c7e2710aa6e2d94a8a" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c.jpg" data-media-id="editor_14" data-image-id="20260327090324_89d17d6584593be1eb23eb1d4872c3b7c600e1620f3aca48dbff4838364a1e3c" data-rendition-name="original" width="1440" height="960" loading="lazy" alt="Balen Shah swearing in NT"> </figure>  &nbsp;Full list of ministers: Prime Minsiter: Balendra Shah Home Minister: Sudan Gurung Finance Minister: Swarnim Wagle Foreign Affairs Minister: Shishir Khanal Law, Justice and Parliamentary Affairs Ministry: Sobita Gautam Energy, Water and Irrigation Minister: Biraj Bhakta Shrestha Education Minister: Sasmit Pokharel Physical Infrastrucutre, Transport, and Urban Development Minister: Sunil Lamsal Communication and Information Ministry: Bikram Timilsina General Administration Minister: Pratibha Rawal Women, Children and Senior Citizens Minister: Sita Badi Health and Population Minister: Nisha Mehta Agriculture Minister: Gita Chaudhary Culture, Tourism and Civil Aviation Minister: Khadka Raj (Ganesh) Paudel&nbsp; Labour Minister: Dipak Sah

Nepal swears in new Cabinet

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

Rivers have been the lifelines of civilisations with their dynamic ecosystems providing vital services for human survival and ecological balance through the ages.&nbsp; But accelerating anthropocentric footprints are causing severe, and often irreversible, damage to river systems across the world, including those across High Asia, a region that sustains nearly a fourth of the global population downstream. An example is the <a href="https://nepalitimes.com/here-now/how-the-bagmati-civilisation-is-becoming-uncivilised" target="_blank">Bagmati River</a> that courses through Kathmandu, crosses the Himalayan foothills to join the Ganga in India. A river that once shaped the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/when-it-comes-to-water-pollution,3196" target="_blank">Kathmandu Valley Civilisation </a>is now a polluted and biologically dead water body constricted by urban sprawl, choked by construction debris, chemical waste and untreated sewage.&nbsp; The loss of a sacred river is tragic enough, but its hazards related to health, life and livelihoods are not limited to the Valley, nor is its enormity fully gauged by the metrics of fatality, income loss, flood return periods, runoffs, embankment failure.&nbsp; It is a systemic collapse of ecological integrity, socio-economic stability and cultural heritage, affecting its downstream users as well. The death of Bagmati is a peril for a population size way bigger than circa 5 million residents of Kathmandu Valley. The degradation started in the 1980s and has accelerated. Why has not enough been done to save this iconic river that runs through Nepal’s capital?&nbsp; The Bagmati River Basin Improvement Project (BRBIP) was designed to make headway in restoring the river with a sewage treatment plant, dams for storing water to support dry-season runoff, recharge groundwater, creation of <a href="https://archive.nepalitimes.com/page/resurrecting-bagmati-the-river" target="_blank">green biodiversity corridors</a> along the river bank to also serve as recreation areas, reduce the urban heat island effect, and also provide cultural continuity. The project also envisages collection of hydrological data for managing Bagmati multipurposewater systems and providing flood forecasts and early warnings aimed at protecting lives and property, among other things. Most importantly, the project takes the integrated water resource management approach, which, in principle, is a holistic and collaborative way of managing all elements of the water cycle to ensure water security, public and environmental health and amenity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c.jpg" data-media-id="editor_3" data-image-id="20260329040336_9605240fa8c7d649ce49fbe43565130e3187e979338ccf959c4e9b8c581b7a4c" data-rendition-name="original" width="2126" height="1577" loading="lazy" alt="Bagmati NT"> </figure>  This should pave the way for managing a river as a connected ecological, social, and economic system by enabling coordination across agencies and disciplines, stimulating technological innovation and financial investment. The success of this approach depends on long-term political will and commitment that transcend political cycles, but also needs strong community and civil society in defining issues and proposing solutions, creating and sharing knowledge, taking independent action to inform practice, monitoring and evaluating policies, and participating in public decision-making. Civil society, especially, in making the <a href="https://archive.nepalitimes.com/page/encounter-with-bagmati-river" target="_blank">revival of the Bagmati River</a> a pressing governance issue. The Bagmati Action Plan 2009, a precursor to the BRBIP, was designed in response to lawsuits filed in 2000 and 2004 by an independent legal practitioner of Kathmandu against waste dumping in the river.&nbsp; It took him almost two decades of legal battle for Nepal’s Supreme Court to pass orders for mandatory septic tanks in all homes in Kathmandu Valley, relocation of squatters from Bagmati river banks to government-built houses, and embargo on dumping and burying garbage on the banks of the river and its tributaries. Despite court orders, however, actual results have been unsatisfactory. Restoration of Bagmati barely made it to any political debate or electoral manifesto this time. Treatment plants have not been operational for years, yet no one is held accountable. The population ignores waste segregation or single-use plastic rules to check littering.&nbsp; The current condition of the river therefore seems to have more to do with the lack of public awareness and behaviour change than the failure of various master plans. Why does the deep danger of a dead river fail to arouse widespread civil society concern, let alone action? The apathy is perhaps underlined by an innately anthropocentric understanding of the river as a mere resource to be exploited, rather than the backbone of existence.&nbsp; Such a paradigm shift is possible when river or river systems are understood to be necessary for &nbsp;a harmonious coexistence with human populations. The more pertinent question is not whether a dead river can be restored because there are many examples from around the world where that has been successfully achieved. It is whether we choose to restore our rivers for intergenerational equity. This would require a holistic perspective and political will to revive reverence for a river system so that its symbiotic relationship with human settlements can be restored. Roshni Gurung is Research Assistant, River Basins at the International Centre for Integrated Mountain Development (ICIMOD).

A lifeline becomes liability

On Friday, Balendra Shah is taking his oath of office as Nepal's prime minister in a capital city of which he was a mayor till six months ago.
At 35, he will be among Nepal’s youngest prime ministers. His reticence and reclusiveness have reinforced his brand as a doer rather than a talker. This was a persona he cultivated as mayor of someone who cleaned up the city by managing garbage. But he also chased off sidewalk vendors in an effort to ‘beautify’ the city.&nbsp;
After being elected, Shah did not attend RSP events in official capacity, and he was absent at an MP orientation last week.&nbsp;
His refusal to engage with the press, and even stopping to post on social media, have added to the air of reclusiveness. But as prime minister, he may have to communicate more even if it just to stop conspiracy theories and intrigue.&nbsp;
The people he will now represent would like to know, and have a right to know, what he is up to. Otherwise the feeling will grow that Nepal is entering uncharted territory. Governance, the economy and investment do not like uncertainty.
Political scientist Pyakuryal notes that calling Balen a 'man of few words' may serve as a useful epithet if he governs with quiet efficiency rather than fanfare. "But as Prime Minister, he must engage the nation’s will, not simply manage from above," she says.
She adds: "The real test lies in his choice of style: will he lead exclusively, keeping decisions close, or inclusively, opening space for dialogue and shared ownership of governance?"
Nepal's newly-elected lawmakers were sworn in on Thursday. And once sworn in as PM on Friday, Balendra Shah is set to appoint a ‘minimalist’ Cabinet. Although the Constitution caps the size of the Council of Ministers at 25, the party has decided to stick to maximum 18 and not split ministries to accommodate loyalists as was done in the past.&nbsp;
&nbsp;"The Cabinet must support the leadership of the Prime Minister while ensuring accountability to the Parliament,” notes political scientist Sucheta Pyakuryal. “But the questions that come to mind are: will the RSP MPs readily submit to Balen’s leadership and is Balen’s absence from the party’s official events an unwillingness or hesitation to submit to the party?”
Prime Minister Sushila Karki and her ministers ended their interim tenures this week, and she was lauded for upholding her commitment to hold a free, fair and peaceful election. But her image was tarnished for her reluctance to release the investigation report on the September violence, as well as recommending her Home Minister Om Prakash Aryal for a National Assembly seat, and her personal secretary to the National Trust for Nature Conservation. President Ram Chandra Poudel has put Aryal’s nomination on hold. &nbsp;
The Investigation Commission report leaked on Wednesday said the state failed to stop the firing on protestors by Police on 8 September and blamed the Army for not preventing the arson next day. It recommended the prosecution of prime minister KP Oli, home minister Ramesh Lekhak, and Police chief Chandra Kuber Khapung.
Notable names said to be in consideration for the Cabinet include many who are experts in their fields, and RSP wants a young lawmaker as Speaker. The new government will plunge headlong into the economic fallout of the West Asia war.
RSP, with its near two-third majority, does not have to placate any coalition partner, so Nepal is at long last expected to have a stable government after 35 years. Despite hopes that there will not be the usual horse-trading this time, there is tension between supporters of RSP chair Rabi Lamichhane and Balendra Shah. The two have been negotiating in hotel rooms for Cabinet posts for loyalists.&nbsp;
Shah’s larger-than-life online persona and nationwide appeal delivered the RSP its overwhelming electoral victory this month, and this makes the party’s core leadership beholden to him. To what extent is Shah willing to meet Lamichhane’s demands is the critical question, and we will know the answer by this weekend.
Says Pyakuryal: “Because this election showcased personality politics rather than the regular party politics, the dangers of ego-clashes, power-tussles and intraparty realpolitik become very real and this kind of equation can greatly hamper the spirit of democracy, representation and collective good."

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 <figcaption>Animation: ANUP TAMU</figcaption>
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A dead tree tests Nepal's bureaucracy

A lifeline becomes liability

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