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  • Published: 02 June 2021

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

  • Komal Raj Rijal 1   na1 ,
  • Megha Raj Banjara 1   na1 ,
  • Binod Dhungel 1 ,
  • Samarpan Kafle 1 ,
  • Kedar Gautam 1 ,
  • Bindu Ghimire 1 ,
  • Prabina Ghimire 2 ,
  • Samriddh Dhungel 2 ,
  • Nabaraj Adhikari 1 ,
  • Upendra Thapa Shrestha 1 ,
  • Dev Ram Sunuwar 3 ,
  • Bipin Adhikari 4 , 5 &
  • Prakash Ghimire 1  

Scientific Reports volume  11 , Article number:  11554 ( 2021 ) Cite this article

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  • Antimicrobials
  • Microbiology
  • Policy and public health in microbiology

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

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Introduction.

Over the last 50 years, antibiotics have been widely used in human and animal as prophylaxis, therapeutics, and growth promoters 1 . Nonetheless, widespread and inappropriate use of antibiotics has led to the emergence of antibiotic resistance—a condition in which pathogenic bacteria develop resistance to the specific antibiotic prescribed against it 2 , 3 . Emergence of drug resistance became even more prominent since the end of twentieth century when the declining efficacy of antibiotics were increasingly reported worldwide 4 , 5 . Increasing AMR constrains therapeutic options, prolongs hospital stays and mortalities, lowers quality of life, and adds to the economic burden 6 .

Antimicrobial resistance is a growing global health threat with multifaced phenomenon 7 . Infection with drug resistant microbes increases the morbidity, mortality, length of hospitalization and treatment cost of patients 7 , 8 . Such scenario will continue to affect low- and middle- income countries as they suffer from high overuse and misuse of antibiotics 9 , 10 . A multitude of factors contribute to the development of antimicrobial resistance. Increasing demands for food from animals and environment for a growing population has further added pressure in the eco-system. Also, increasing food and environmental links has facilitated the rapid transfer of drug-resistant pathogens 11 . In response to these challenges, a holistic ‘One Health’ approach has been advocated in recent years that aims to include the health of human, animal and the environment 12 . One health approach can be utilized to enhance risk analysis on emergence, spread and control strategies of AMR at the human-animal-local environment interfaces 13 .

A number of previous studies conducted in low- and lower middle- income countries (LMICs) have documented a poor level of knowledge, attitude and practice (KAP) on antibiotics prescription with remarkable over-the-counter (OTC) use which can ultimately lead to increase in AMR 10 . LMICs are adding more burdens to the ever-increasing AMR in comparison to the developed countries 14 , 15 . In LMICs, less than 40% of the patients attending public and private healthcare centers receive treatment according to the WHO guidelines 16 . Worryingly, healthcare professionals do not follow standard antimicrobial guidelines such as WHO guidelines and often prescribe broad spectrum antibiotics without laboratory evidence 17 .

Common to most LMICs, Nepal experiences an extremely huge burden of infectious diseases such as respiratory tract infections, enteric fever (typhoid, paratyphoid fever), urinary tract infections and other bacterial infections 9 . Researchers have reported high burden of drug resistant/multidrug resistant bacteria in Nepal 18 , 19 , 20 , 21 , 22 , 23 . Discrepancy between prescription and OTC use of antibiotic is found to contribute to the rise of AMR in Nepal 10 . Nonetheless, much less is explored around how behavior related to the use of antimicrobials in various sectors have contributed to the rising trend of AMR in Nepal 9 , 10 .

AMR surveillance in Nepal was commenced in 1999 by National Public health Laboratory (NPHL) with technical support from Bangladesh 24 . However, the AMR surveillance among animal pathogens started only in 2011 by joint efforts of NPHL and other veterinary laboratories 24 . Researchers have investigated different components of antimicrobial use and AMR in Nepal such as use of antibiotic in primary health care 25 , awareness of antibiotic use and its resistance in the general population 26 , 27 and self-medication (with antibiotics) among medical students 28 . Nonetheless, these efforts have not been successful in documenting true burden of AMR in the country as these reports did not encompass all the sectors that used antimicrobials in various proportions. Traditionally, much of the focus has been invested in exploring the use of antimicrobials in humans, and use of antimicrobials among food animals is persistently neglected. To address these gaps in effective surveillance program, a Fleming fund has initiated a multi-disciplinary one health approach to tackle antimicrobial resistance in Nepal 29 , 30 . To the best of our knowledge, there are no KAP surveys on prescription and use of antibiotics through a comprehensive one health approach in Nepal. The main objective of this study was to explore knowledge and practices of antibiotics prescription and uses in various sectors utilizing a one health approach in eight districts of Nepal.

Materials and methods

Study settings.

This study was conducted in selected eight districts of Nepal. Nepal is a landlocked mountainous country that shares 1800 km porous border with India in the east, west and south while it shares northern border with China 31 , 32 . It covers an area of 147,516 km 2 between 26 \(\circ\) 22′–30 \(\circ\) 27′N and longitudes 80 \(\circ\) 04′–88 \(\circ\) 12′E. With varying population densities, the population of the country was 26.4 million in 2011 33 . Currently, Nepal is divided into seven provinces with 6 metropolitan cities, 11 sub-metropolitan cities, 276 municipalities, and 460 rural municipalities. The health system of Nepal is divided into three parts: Federal, Provincial and Local level health facility. In addition, private hospitals, private diagnostic centers, nursing homes, polyclinics and private drug dispensaries serve a large population in all seven provinces of Nepal. This study was conducted in tertiary hospitals and primary health care centers, private drug shops around the hospitals, laboratories (private/public), and food producing farmers and two rural primary health centers (PHC) from the selected eight districts of Nepal (Fig.  1 ). There are, a total of 4,863 public health care facilities in Nepal. The distribution of public health care facilities based on the provinces are: province 1 (n = 816), province 2 (n = 822), Bagmati province (province-3) (n = 934), Gandaki province (province 4) (n = 635), Lumbini province (province-5) (n = 741), Karnali province (province-6) (n = 404) and Sudurpashchim province (province-7) (n = 511) different health care facilities. In our study, 17 different health care facilities in seven different provinces were selected to represent the entire nation.

figure 1

Study sites of selected eight districts of Nepal. The map was created using ArcGIS desktop version 10.8. The shapefile of the administrative districts and location for Nepal was obtained from the Government of Nepal, Ministry of Land Management, Survey Department website and were publicly available for unrestricted use ( http://www.dos.gov.np/nepal-map )".

Study population

Knowledge, Attitude and Practice (KAP) surveys were conducted among five groups (clinicians, patients, private drug sellers, livestock and poultry farmers and diagnostic laboratories) of key informants. A total of 550 participants were approached for the survey out of which (93.8%; 516/550) responses were received. 516 respondents in this study included clinicians and health workers (n = 87), private drug dispensers (n = 33), patients (n = 324), laboratory head/or representative of selected laboratories (n = 23), government hospital/ primary health centre (n = 17) and livestock farmers (n = 32).

Study design

This was a descriptive cross-sectional survey using a previously validated and reliable WHO questionnaire between May 2017 and October 2017.

Participant recruitment

This study was led by a research assistant in each province and supervised by co-investigator/principal investigator. At first a national and sub-national list of hospitals, pharmacies, and farms were obtained. Using a proportional sampling method, a proportional sample size for each category was calculated. Based on the sample size required for each category (hospitals/health facilities, pharmacies and farms) respondents were chosen using a simple random sampling. At the hospitals, patients were first requested and explained about the study. Broadly, patients who were willing to participate regardless of their illnesses were included in the study. They were also introduced about the procedure, risks and benefits of the study. All patients who agreed to participate in the study were included. The procedure was repeated for other categorical respondents. A written informed consent or thumb print from each participant or their guardian in case of children below 16 years was obtained. Written informed consents were obtained from health care workers, private drug sellers, Laboratory personnel, hospital/PHC pharmacist and food producing farmers from the list prior to the interview.

Questionnaire development and pre-testing

Questionnaires were used following the WHO guidelines, publications and consultation with experts. Four different questionnaires for medicine prescribers, drug dispensers, patients and farmers were developed. Developed questionnaires were pre-tested during the orientation of the research assistants. Knowledge survey among HCWs consisted of three sections: firstly, on causes of emergence of antibiotic resistance, secondly on their existing know-how on treatment and development of drug resistance, and lastly on the mechanisms of antibiotic resistance. Pre-testing was conducted in hospitals and few sites within Kathmandu valley which were precluded from the data for this study.

Methods of data collection

Six research assistants having a qualification of Masters of Science (M.Sc.) in Microbiology were recruited for this study. A week-long workshop was organized in Kathmandu to discuss about the study, protocol and pre-testing of the questionnaire. They were proportionately deployed in the study sites for data collection, enumeration and data entry. Principal and co-investigators provided the complete guidance during the entire study.

This study involved data collection at different levels—individual patients, healthcare providers, pharmacists, farms, and healthcare facilities. KAP on antimicrobial resistance were explored using standardized and pre-tested questionnaires adapted to each type of respondents 34 . Interviews were conducted with patients visiting health centers. All the participations were voluntary and were not provided any forms of incentives. The survey was conducted in collaboration with National Public Health Laboratory (NPHL) and the hospitals, data on AMR in different settings were collected from available reports which were tracked through laboratory registers/Laboratory Management Information System (LMIS) and were analyzed to assess AMR patterns. Assessment of recording, reporting and LMIS systems on antimicrobial resistance and review of the registers were also conducted in the laboratories. Information on morbidity and mortality related to AMR, through review of medical-records data were examined.

Data management and analysis

All the questionnaires were screened for completeness, and errors; and were processed for data analysis. First, all the data were entered into Epi-data version 3.1 and were imported into SPSS software version 24.0 (IBM; Chicago, USA). Descriptive and univariate analysis was carried out using Chi-squared tests/Fisher’s exact test and are presented in supplementary files. Statistically significant variables based on the univariate analysis and research question were selected and were analyzed using multivariate logistic regression models. Various independent variables were controlled and evaluated to calculate adjusted odds ratio predicting the outcome variables that included knowledge of antibiotic and antibiotic resistance. A difference with p-value less than 0.05 was considered as statistically significant.

Ethics approval and consent to participate

This study received ethical approval from Ethical review board (ERB) of Nepal Health Research Council (NHRC), (Reg No. 68/2017). Written informed consent was obtained from each participant for their voluntary participation in the study. This study was conducted in accordance with the Declaration of Helsinki.

Demographic characteristics of respondents

Of the 87 health care workers, 75.9% (66/87) were male and 24.1% (21/87) were female. Majority of health care workers were medical doctors (90.2%;79/87). More than two-thirds of the health care workers belonged to age group 25–50 years (63.2%; 55/87), followed by age group (0–25) years (23%; 20/87) and > 50 years (13.8; 12/87). Of 324 patients interviewed, 72.8% (236/324 were male and 27.2% (88/324) were female. Half of the patients were from 26–50 years age group (50%; 162/324), followed by 0–25 years (32.7%;106/324) and > 50 years (17.3%; 56/324). Of 32 livestock farmers, 87.5% (28/32) were male and 12.5% (4/32) were female (Table 1 ). Their distribution in selected eight districts is summarized (Supplementary Table S1 ).

More than eighty percentage (range 80–96%) of the HCWs thought the role of various underlying factors (listed in questionnaire) on the emergence of resistance. Almost 40% of them were aware and had encountered different drug-resistant bacteria including extended spectrum beta-lactamase producing Escherichia coli , penicillin-resistant Streptococcus pneumoniae (PRSP), multi-drug resistant Pseudomonas aeruginosa, and Methicillin-resistant Staphylococcus aureus (MRSA). Of the listed mechanism of development of drug resistance in questionnaire, majority (69–91%) of the HCWs had sound knowledge (Supplementary Table S2 ).

Hospital patients were first asked about possibility of antibiotics in curing some bacterial and viral diseases. Nonetheless, in this study, we did not ask patients what they understood by the term ‘antibiotics.’ Out of 324 patients interviewed, 42.9% (139/324) of them thought that fever can be treated with antibiotics; more than one third (35.2%; 114/324) believed that antibiotics were used for treatment of cold and flu; 17.3% (56/324) believed that antibiotics can be used for treatment for sore throat, and 22.2% (72/ 324) believed that antibiotics cure headache and skin or wound infection. This study also assessed about their knowledge on terminologies related to resistance such as AMR, superbugs, drug-resistance, and drug-resistant bacteria. Of 324 patients, majority (84%; 272/324) of the respondents had never heard anything about antibiotic resistance and related terms and only 16% (52/324) of the patients had heard about different terms for antibiotics. Of the total (324) patients, 5.6% (18/324) heard about AMR and its related terms from media (newspaper, TV, radio); 3.7% (12/324) heard from family members and friend; 3.1% (10/324) heard from doctor or nurse; and a few (1.2%; 4/324) heard from pharmacists. Final section of the questionnaire explored on the perception on the drug resistance. Out of 324 patients interviewed, 75% of the respondents were not aware on anything related to antibiotic resistance issues (Supplementary Table S3 ).

Of 33 private drug sellers interviewed, majority (87.9%; 29/33) of them had heard about antibiotic resistance. However, a few (18%; 6/33) of them thought that antibiotics could treat all sorts of diseases listed in the questionnaire. Of 33 respondents, more than half (51.5%; 17/33) responded that antibiotics were used for treatment of bacterial diseases and oral thrush. Surprisingly, 23.3% (9/33) and 12.1% of them responded that antibiotics can be used to treat viral diseases and general weakness (Supplementary Table S4 ). Among livestock farmers, a few (12.5%; 4/32) of them had heard about antibiotic resistance. They had heard it mainly from the doctors or nurses (50%; 2/4), and pharmacists (50%; 2/4) (Supplementary Table S5 ).

Majority of HCWs (76/87) believed that antibiotics are overused all over the country; and majority (82/87) of them were in support of a more controlled policy for antibiotic use. Almost two-thirds of them (63.3%; 55/87) thought that AMR has already become significant problem in their hospitals. Out of 87 participants, majority (92%; 80/87) believed that prescribing broad spectrum antibiotics can aggravate the problem of resistance (Supplementary Table S6 ).

Most of the participants (92.6%; 300/324) believed that antibiotics should be used only when they are prescribed by a medical practitioner; exactly equal proportion of them also stressed on the fact that HCWs should prescribe antibiotics only when it is needed. Out of 324 patients, most (98.1%; 318/324) were well-informed on the hand hygiene practice. Nearly two-thirds of the participants (65.7%; 213/324) agreed that farmers should use antibiotics as minimum as possible. When they were asked on immunization, majority (96.6%;313/324) of the participants were certain that parents should ensure up to date vaccinations to their children. When it came to antibiotic resistance, they were unaware about this issue as 78.7% (255/340) of the respondents were either unaware or rejected the problem of AMR as one of the global crises. Nearly half of the respondents (161/324; 49.7%) were unsure about whether the AMR crisis has hit them individually. More than half (58.6%;190/324) were unsure on whether correct use of antibiotics could avoid AMR crisis at individual level. Another important finding was that 71.3% (231/324) of the individuals had no idea about their role in combating AMR crisis (Supplementary Table S7 ).

Out of 87 HCWs, majority (71.3%; 62/87) reported that they prescribed antibiotics at least once a day, and only a few (13.8%; 12/87) prescribed at least once a week (Supplementary Table S8 ). Out of 324 patients interviewed, majority (79%; 256/324) of the respondents were purchasing antibiotics for themselves while 61.7% (200/324) respondents were currently taking antibiotics. Findings regarding the use of antibiotics among patients revealed that a few (18%; 58/324) of them used antibiotics without prescription (self-medicated); and few others (14.8%; 48/324) complained that they were not advised by HCWs on how to use the antibiotics. Almost half (46.3%; 150/324) admitted that they had the habit of discontinuing antibiotics (did not complete the prescribed dose) after they felt better (Supplementary Table S9 ). On patient’s response (multiple choice) to buy medicine from particular outlet, 51.9% (168/324) bought medicines from near the health centers and 43.2% (140/324) bought from near the residence (Fig.  2 ).

figure 2

Patient’s responses to buy medicine from particular outlet.

Multivariate analysis

Multivariate analysis of people's knowledge on antibiotics showed that gender, age, person buying drug were not significant predictors. As the education level increased, the knowledge of patients on antibiotics also increased. Education level of patients was associated with the knowledge of antibiotics: literate only [ AOR = 1.4 (95% CI = 0.6–4.4)], primary education (1–7 grade [AOR = 1.0 (95% CI = 0.4–2.3)], secondary education (8–10 grade) [AOR = 1.8 (95% CI = 1.1–3.4)], Higher secondary (11–12 grade) [AOR = 1.6 (95% CI (0.8–3.1)] and bachelor and above [AOR = 2.0 (95% CI = 0.9–4.6)] (Table 2 ).

Related to knowledge about antibiotic resistance among patients, adults (41–60 years) were apparently more aware of antibiotic resistance. Knowledge of AMR on age group (21–40) years [AOR = 0.6 (95% CI = 0.3- 1.1)], age groups (41–60) years [AOR = 0.7 (95% CI = 0.3–1.5)].and > 60 years [AOR = 0.2 (95% CI = 0.07–0.73)]. Knowledge of antibiotic, person purchasing the drug were not associated with knowledge of antibiotic resistance; however, age of the patient was found as a predictor of knowledge of antibiotic resistance (Table 3 ).

The existing condition of LMIS on AMR in hospital/laboratories

A total of 17 Hospitals/Primary health center were selected to gather information on antimicrobial use, morbidity and mortality related to AMR. Out of 17, all hospitals/primary health center had medicine by generic name and had an essential formulary list of medicines. Out of 17, only 35.2% had last revision of the essential medicine list with in one year and 17.6% had drugs and therapeutics committee. None of the hospital/PHC had protocols or norms for surgical prophylaxis, record of AMR in previous years and AMR related mortality (Fig.  3 ).

figure 3

Hospitals provisions on antimicrobial use and morbidity and mortality related to AMR from Hospital/ PHC Record.

A total of twenty-three laboratories were assessed for performance, reporting and recording of AMR. More than half (13/23) of the laboratories were not purchasing ready-to-use culture media, thus were preparing those media manually as per routine requirements. In addition to this, 78.3% (18/23) of the laboratories did not have an automated blood culture system and relied on conventional procedures. Majority (69.5%; 16/23) of the laboratories did not have trends of performing biochemical assay for the confirmation of pathogenic organisms. Twenty laboratories were reliant on convention disk diffusion method (Kirby-Bauer method) for antimicrobial susceptibility testing (AST); only two laboratories adopted minimum inhibitory concentration (MIC) determination method for AST. However, majority (69.5%; 16/23) of the laboratories were following CLSI guidelines for interpretation of the result while all (100%; 23/23) of the labs did have AST recording system of the strains by clearly indicating them as resistant, intermediate or sensitive (Supplementary Table S10 ).

Rational use of antimicrobials is dependent on its main stakeholders that include patients, clinicians, veterinary professionals, drug retailers and farmers. It is essential to explore how these stakeholders interact, practice and use the antibiotics. A number of factors such as easy access to over the counter (OTC) use of drugs, lack of clear policy guiding empirical treatment regimens, poor literacy level among a major proportion of the population in the country, pressure among healthcare professionals for prescriptions, lack of proper diagnostic facilities, and other socioeconomic constrains were found to augment the irrational use of antimicrobial drugs 35 .

Participants Knowledge on Antibiotics

Although this study did not explore what patients understood by the term ‘antibiotics’, majority of patients are not aware of what constitute such type of medicine, their scientific rationale and uses despite that ‘antibiotics’ were familiar term among the patients 35 . More than two-fifth of the patients still believed that fever was cured by antibiotics and echoed with previous studies from Nepal 27 and Indonesia 36 . Around one-third of the respondents believed that viral diseases such as cold and flu, measles and HIV/AIDS could be treated with antibiotics. The widespread beliefs that antibiotics can treat a wide range of illnesses (ranging from non-specific body aches to the life-threatening viral diseases) may have multiple consequences including undermining the medical professional’s role in prescription and guidance 37 . In addition, beliefs that antibiotics could treat all diseases may have promoted buying of over-the-counter medications (self-medications), and also may have exerted pressure on HCWs to provide/prescribe antibiotics 9 , 10 .

In the context of basic knowledge on antibiotics, our study showed that the news media were reported to be the major source of information about the antibiotics in generating mass awareness 38 . A report published by the WHO also underscores the role of televisions, radios, internets, and press in spreading knowledge of antibiotics among general population 37 . Heightened awareness among participants regarding hand hygiene (98.1%) and immunization (96.6%) was observed in our study. The improved knowledge and practices may have been contributed by the mass media and vaccine campaign that served the population at the household over the last two decades 39 and are reflected in previous studies from Nepal 40 , 41 , 42 , 43 , 44 , 45 .

Knowledge on AMR

Overall, majority (84%) of the respondents had never heard about AMR while more than three-fourth of the total participants had no any idea on AMR related issues. This finding is similar (88.6%) to the previous study conducted in Nepal 46 . The poor knowledge on antibiotics may have impact on their attitude towards the use of antibiotics. Unlike their responses on knowledge questions, majority (93%) of the people stressed the need for the use of antibiotics by health professionals’ prescription only. When it came to the use of antibiotics, eighteen percentages of them were purchasing antibiotics over-the-counter (OTC) and were often driven by the distance, cost and perceived benefits. This finding is similar (24%) to one conducted in Bhutan 47 . Nonetheless, these responses suffer from social desirability bias (as patients very well knew that medicines ought to be taken with the prescription), and we believe OTC is way more prevalent than the reported percentage in this study. Even so, this trend highlights the urgent need for strict rules and regulations to discourage the OTC use of antibiotics 10 . Nearly half of the respondents (46.3%) in this study explained that they would not comply to the complete dose of medicines. Several previous studies have also concluded that the self-medication remains as one of the commonest practices in Nepal 48 . Most of the patients do not adhere to the treatment therapies as prescribed by the clinicians 49 and thus do not follow a complete course of antibiotic therapy. Patients stop taking medicines once the disease symptoms begin to fade away and they stockpile the remaining drugs for future use. They often recommend such drugs to their family members, relatives and peers, which augments the rapid spread of the resistance 50 , 51 .

High prevalence of OTC medication practices could also be attributed to the low number of doctors to patients (1:1724) ratio in Nepal, which can inevitably oblige patients to rely on range and types of health workers available thus shaping the treatment seeking behavior 33 , 52 . Doctors are disproportionately distributed in Nepal. For instance, the Kathmandu valley has one doctor for 850 individuals but in rural zones the number is one doctor for each 150,000 individuals 53 . Moreover, Nepal is predominated by high proportion of rural and inaccessible areas where tertiary care centres are heavily constrained 54 , 55 . Therefore, the majority of the rural people rely on health assistants, quacks (unqualified persons pretending to have medical skills), and poorly trained drug dispensers for their treatment decision(s) 56 . Nonetheless, drug shops are a popular choice for OTC medication in both rural and urban regions and are affected by accessibility and functionality of the formal health services 35 . Despite that this study was conducted in a relatively urban areas, patients represented rural regions too. Follow-ups in patients from rural region were heavily constrained by their poor socio-economic conditions 57 .

Factors influencing on KAP

Prescriber’s decisions may be affected by various factors such as lack of adequate professional knowledge on rational use of drugs, lucrative intensions often guided by themselves and/or pharmaceutical companies’ offer and/or hospital administration’s pressure, fear of losing clients (patients), patients’ self-demand, prescribing practices even for non-bacterial infections, and inappropriate doses and route of administration of the drugs 46 . Similarly, patients’ decisions on the use of antibiotics might be influenced by self-medication, sharing drug among family members, relatives and peers, ignorance of proper dose during medication, and lack of trust on medical professionals 58 . More importantly, poor infection control and augmented use of antibiotics in clinics, livestock and poultry farming, agriculture and aquaculture have aggravated the onset and rapid transfer of AMR globally 58 .

Education level of the respondents affected the knowledge and attitude related to antibiotics and AMR. Previous studies from Nepal 27 , India 59 , Bhutan 47 , Saudi Arabia 60 , Hong Kong 61 , Malaysia 62 , South Korea 63 , Oman 64 , Greece 65 , and Lithuania 66 have echoed with our findings on the role of education. With higher education, respondents perhaps had good knowledge about proper use of antibiotics and adversities such as antibiotic resistance. As majority of them belonged to the age group of 25–50 years, their education level may have role rather than their age in affecting the KAP on antibiotics.

Healthcare workers, especially physicians are an integral stakeholder of antibiotics prescription and the AMR. Driven by the demand, and high prevalence of infectious diseases, health care workers are also one of the main facilitators of irrational prescriber of antibiotics 10 , 49 . In our study, more than eighty percentage (80–96%) of the HCWs had the knowledge on antibiotics, and AMR, and mechanisms leading to the emergence of resistance. This finding was slightly higher than a previous finding in Nepal 67 , India 68 , and was similar to other previous studies conducted in Egypt 69 , Zambia 70 and Pakistan 71 . Improving knowledge and practice related to antibiotics might be attributable to the improved education and mass awareness carried out by media, activists, government, and NGO(s)/INGOs. In addition to this, improved status of surveillance, enforcement of law and orders could be other factors to be considered.

The majority of HCWs agreed that there is an overuse of antibiotics all over the country and almost two-third (63.3%) of them believed that AMR has already become a challenge in their own hospital(s). Similar findings were reported in USA in which 88% and 72% of the physicians agreed that AMR was a challenge in general and in their hospital 72 . In Egypt, 94% and 80% of the clinicians believed the AMR as a problem in their country and in their hospital 69 . Similar finding was reported in Nepal in which 87% of the physicians believed that antibiotics were overused throughout the country 67 . A previous study conducted in Nepal has reported that almost half the doctors (50.2%) used to prescribe antibiotics more than once a day 67 .

Previous studies have well documented that some of the healthcare professionals unnecessarily prescribed broad-spectrum antibiotics 73 . Minor health problems such as colds, coughs and diarrhea can be conservatively managed (without antibiotics). Nonetheless, clinicians prescribe antibiotics to these non-specific illnesses 50 . In addition to this, incorrect dose(s) and misleading guidance are also frequently observed in practices 50 . Similarly, pharmaceutical companies visit clinicians with lucrative offers which adds pressure on antibiotics prescriptions 74 .

Unwarranted demands from the patients’ side for any specific drug is another leading factor for irrational prescriptions. Such practices are predominant in the low-and middle-income countries (LMICs) 71 . Above all, poor infection control practices in the LMICs are often neglected but significant factor in the rapid spread of drug-resistant pathogens 48 .

Policy implications

Findings from this study bear policy implications, particularly related to high rate of antibiotic prescription, OTC use of drugs, physicians’ neglect on AST guided therapy, and lack of knowledge on regulating policies for use of antimicrobials 48 . Common to resource constrained settings, Nepal suffers from scarcity of laboratory infrastructure, particularly in rural regions, which can inevitably lead to high empirical treatment 10 . Government should aim to establish laboratories with well-resourced with equipment and trained lab personnel 48 .

Nepal’s unique geographical landscape, population and urban–rural distribution of health services further affects the treatment seeking behavior including the (over-)use of antibiotics 75 , 76 . Aligning with these reports, HCWs also suggested for the culturally and geographically tailored guidelines for antimicrobial use in addition to the national guideline 68 . In addition, Nepal also suffers from disproportionate physician to patients’ ratio and should be properly addressed 77 . For example, by establishing the health care structure in rural regions and incentivizing the health care workers to serve the rural regions in addition to other developmental works 77 , 78 . At the same time, patients in remote regions of Nepal with simple infectious conditions should not be restricted to utilize antibiotics where qualified health care workers including doctors and tertiary care centers can be days away 9 . In addition, counselling on rationale use of antibiotics, and its adversities should be essential elements of prescription by health care workers which can be a sustainable method to increase the public awareness 10 .

Patients’ pressure also plays crucial role in the prescription and use of antibiotics which may be well reflected in the primary health centers where treatment options are limited and drugs are easily available OTC 10 . In such geographically remote regions, there is a good relationship between healthcare providers and community members, which creates pressure in prescription and sell of the antibiotics asked by patients rather than the appropriate ones 10 , 79 , 80 , 81 . Although policy guidelines demand for use of antibiotics based on the identification of causative agents, in practice, the empirical and over the counter use of antibiotics are high 9 , 10 .

As the positive roles of mass awareness and media are reported from several studies, promotion and incorporation of effective media/programs and routine trainings to HCWs are highly recommended. The importance of education and mass awareness in promoting the rational use of antibiotics are also supported by several previous studies in Nepal 82 , 83 in India 83 and in Europe 84 .

Antibiotic stewardships aligning with the ‘One Health’ approach need to be considered in future efforts in Nepal 85 . Lack of protocols for surgical prophylaxis, and record of AMR and associated mortality in this study implies need for investment in protocol development and robust surveillance in all the health care institutions. National and sub-national AMR surveillance agencies, hospitals, organizations and all stakeholders working in the sector of human health, livestock and agriculture can utilize the findings of this study to forge future strategies against AMR in Nepal. Collaborative efforts between ministry of health, ministry of agriculture & livestock development, WHO and their stakeholders are essential to implement ‘one health approach’. Government of Nepal (GoN) together with the leadership of WHO can forge ‘one health approach’ in national action plan on AMR.

Strengths and limitations

Although this study explored knowledge, attitude and practice related to antibiotics uses among patients, healthcare workers, and farmers; using quantitative methods alone constrained us to understand the deeper reasons behind the responses including extent and nature on how they affect the use of antibiotics in Nepal. Future studies utilizing qualitative methods are critical to disentangle how these factors interact in various sectors to facilitate the use of antibiotics. For example, future ethnographic studies can explore why and how patients choose distance to the health center (against other factors) as an influence in buying antibiotics over the counter. This study was conducted in a select of districts/hospitals and inevitably constraints us to generalize the findings for the entire country. Although respondents in all categories were attempted to be balanced, number of pharmacists, and farmers were limited due to their proportion. In future, studies exploring farmers and pharmacists in greater proportion can help understand the true burden of antibiotic use in these sectors. Only 12.5% of farmers in our study had heard of AMR. This suggests need for more engagement with the animal and livestock sector in the future. Furthermore, this study did not include some of the underlying factors such as the extent of patients’ pressure in prescription, physician’s knowledge on microbiology laboratory reports, commercial interests in selling the antibiotics, pharmaceutical companies’ competing offers to clinicians. This survey may have incurred recall and social desirability bias. Data collected through prescription audit, observation and in-depth interviews were precluded in the analysis due to inconsistencies in their collection and inadequacy of the data which affected data saturation. Triangulation of various methods could have enriched our findings. Nonetheless, this study serves as a reference to the context and situation of AMR knowledge, attitudes and practices in Nepal.

Although the level of knowledge, attitude and practice related to prescriptions and use of antibiotics apparently seems improved compared to previous studies, the prescription and overuse of antibiotics are unregulated in the study areas. Antibiotic stewardship programs in Nepal can at first address these gaps through health education, awareness and mass campaigns to mitigate the inappropriate use of antibiotics. Importantly, reformation in policy related to use of antibiotics should consider the multiple stakeholders that shape demand, supply, and compliance, including a ‘One Health approach’ to ensure animal health considerations are also taken into account.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Antimicrobial resistance

Auxiliary Nurse Midwife

Antibiotic Susceptibility Test

Clinical Laboratory Standard Institute

Essential Medicine List

Extended Spectrum Beta Lactamase

Health Assistant

Health Post

Knowledge, Attitude and Practice

Logistic Management Information System

Methicillin Resistant Staphylococcus aureus

National Public Health Laboratory

Primary Health Care Center

Statistical Package for Social Sciences

World Health Organization

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Acknowledgements

We thank all of the staffs of entire health centers under study. We are grateful to all the patients, farmers, drug-sellers and laboratory personnel for their involvement in the study. Lastly, we would like to express our sincere gratitude to Dr. Reuben Samuel and Dr. Sophie Goyet (WHO-Country Office for Nepal) for their technical support.

The research presented was supported by WHO- country office for Nepal. We declare that this study is free from any sort of interests of the funding source. We are responsible for the entire contents and thus do not necessarily represent the views of the funding agency.

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Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

Komal Raj Rijal, Megha Raj Banjara, Binod Dhungel, Samarpan Kafle, Kedar Gautam, Bindu Ghimire, Nabaraj Adhikari, Upendra Thapa Shrestha & Prakash Ghimire

Nepal Medical College, Jorpati, Kathmandu, Nepal

Prabina Ghimire & Samriddh Dhungel

Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal

Dev Ram Sunuwar

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Bipin Adhikari

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

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Conceived and designed the study: K.R.R., M.R.B., P.G. Performed the study/Data Collection: B.D., S.K., K.G., N.A., U.T.S., P.G., S.D., D.R.S. Analyzed the data: K.R.R., M.R.B., B.D., B.G. Map creation: K.R.R., B.A., D.R.S. Wrote the original draft: K.R.R., B.D. Reviewed edited and finalized the draft: K.R.R., B.A., P.G.

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Rijal, K.R., Banjara, M.R., Dhungel, B. et al. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep 11 , 11554 (2021). https://doi.org/10.1038/s41598-021-90812-4

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We are very pleased to introduce a second special issue of HIMALAYA in 2023, in this instance titled “Writing with Care: Ethnographies from the Margins of Tibet and the Himalayas”. Curated by guest editors Harmandeep Kaur Gill and Theresia Hofer, this issue is an important contribution to a relatively recent, more conscious, effort to diversify and deepen the discourse within area studies, emphasising the voices and perspectives of ordinary people, and especially of those living at the margins of mainstream society.

The guest editors have brought together a collection that challenges and rearticulates social categories like gender, class, and disability. They emphasize the need to look beyond fixed generalizations and to embrace the complexities and contradictions of individual lives. This approach, rooted in feminist and decolonial methodologies, not only enriches our academic understanding but also connects us more deeply with the human aspects of the subjects we study. Writing with care, as the guest editors put, is to ‘enable the reader to connect with people as individual personalities and not merely as members of social and third-person categories.’

In the loving memory of Mo Samdrup Drolma who is featured on the front page and passed away 22nd of November 2023

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Special Issue Guest Editorial

Writing with care ethnographies from the margins of tibet and the himalayas, special issue foreword, the politics and poetics of himalayan lives, special issue research article, amulets as infrastructure enabling the ordinary for children in mugum, western nepal, tibetan writing from the socio-linguistic margins of tibet deaf students, tibetan literacy and wechat at the lhasa special school, working out in “sunlight happiness gym” fitness, well-being, and temporal rhythms in the contemporary tibetan city, resistance to marriage, family responsibilities, and mobility a turbulent life story from kyidrong, thuenlam keeping ‘harmonious relations’ through the lens of hosting and hospitality in bhutan, tsering authenticity and dependent origination in a portrait of a tibetan woman, special issue artwork, གལ་སྲིད་ང་རང་གཞན་ཡུལ་དུ་ཤི་ན། - "if i were to die in exile" and སུ་ཡིས - 'who would", cotton singers, special issue photo essay, old tibetan hands, special issue afterword, stories are reasons, review of anthropological perspectives on education in nepal: educational transformations and avenues of learning edited by karen valentin and uma pradhan, review of places in knots: remoteness and connectivity in the himalayas and beyond by martin saxer, review of himālaya: exploring the roof of the world by john keay.

HIMALAYA: The Journal of the Association for Nepal and Himalayan Studies

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HIMALAYA is a biannual, open access, peer-reviewed journal published by the Association for Nepal and Himalayan Studies.

Interdisciplinary and trans-regional in scope, HIMALAYA covers all aspects of Himalayan studies, including the humanities and creative arts.

HIMALAYA publishes original research articles, short field reports, book and film reviews, reports on meetings and conferences, alongside literature and photo essays from the region.

Celebrating 50 years in 2022, HIMALAYA is the continuation of the Himalayan Research Bulletin (1981–2003) and the Nepal Studies Association Newsletter (1972–1980).



   

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Is research in peril in Nepal? Publication trend and research quality from projects funded by the University Grants Commission-Nepal

Affiliations.

Institutions of higher learning are critical in promoting a knowledge-driven economy through research and training. Nepali universities receive funding from the University Grants Commission, Nepal (UGC-N) to support for impactful research. UGC-N requires grantees to publish research results as journal articles. We reviewed papers published through UGC-N funded research projects over a 10-year period (2008-2018) to assess the trends of article publication in terms of frequency and quality (based on journal impact factor and SCImago journal ranking). At most, 17% projects (n = 325) had publications and the majority of articles were published in journals that had neither SJR rank (74%, n = 240) nor impact factor (86%, n = 279). Most importantly, 10% of articles (n = 23) published in the non-ranked journals appeared in predatory journals. Although there were increasing trends of grants and research article publications in the last 10 years, journal-level quality metrics showed no improvements and suggested decreasing trends during the last half decade. The publication output varied among grant categories. Master research grants and PhD research grants performed better than those of faculty research grants in terms of publication in quality journals. We call for an increased commitment from political and academic leadership to promote quality research in Nepal.

Keywords: Research productivity; publication ethics; research in developing countries; research integrity; science funding; science policy.

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Nepal Journal of Science and Technology

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Nepal Journal of Science and Technology An Official Journal of Nepal Academy of Science and Technology

Current issue.

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Editorial Message

Board members, table of content, list of reviewers and editors, towards creating smart cities in nepal, covid-19, a complex emotional well-being challenge: a path to recovery in nepal, ecosociocentrism: the earth first paradigm for environmental sustainability and sustainable development, munaa agriculture market: connecting home to abroad, first-principles study of defected single layer hexagonal boron-nitride (h-bn), capacity enhancement in rock and tunnel engineering in nepal, covid-19: knowledge, attitudes, and practices among the scholarly cohorts of nepal, implementation of national science technology and innovation policy 2019: assessment of challenges in government organizations of nepal, comparative analysis of diffusers for micro wind turbine, spring water sources assessment and forest area dynamics in roshi and melamchi watersheds, the two worlds of palliative care: bridging the gap with nepal, complementing food and nutrition security using toxin minimizing dry chain and integrated pest management: a review, food green cities: a pathway to sustainable urban development of nepal.

Nepal Journal of Science and Technology (NJST) is a peer reviewed open access journal that aims to serve as a forum for scholarly and professional communication among scientists, policy makers and general people. NJST publishes papers from the broad academic disciplines of science and technology. Preference will be given to multidisciplinary research that has national and global scope. Manuscripts submitted to this journal must not have been published or accepted for publication, or be under consideration elsewhere.

The journal includes all major subject areas of S &T. The major areas include but not limited to physical and mathematical sciences (e.g., chemistry, engineering, and physics) and biological sciences (e.g., biochemistry, biophysics, cell biology, ecology).  Papers covering social sciences will be considered for publication provided that they have strong elements of basic and applied sciences as mentioned above.  In addition to standard research papers, NJST publishes Reviews that offer a detailed and up-to-date discussion. NJST also publishes Short Communication that provides important research findings. Perspective articles provide a platform for authors to present their personal views on the direction of applied research that has broader policy implications.

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Home > Museums and Research Centers > Nepal Study Center > Himalayan Research Papers

Himalayan Research Papers Archive

Submissions from 2023 2023.

A Chinese Fallacy of Communist Lynchpin and American Retort in Nepal , Ashis Adhikary

Current Developmental Challenges in Nepal: How Can The Diaspora Help? , Ambika P. Adhikari

Promoting Urban Farming for Creating Sustainable Cities in Nepal , Keshav Bhattarai and Ambika P. Adhikari

Reframing the Buffer State in Contemporary International Relations: Nepal’s Relations with India and China , Bibek Chand

Re-situating the Buffer State in International Relations: Nepal’s Relations with India and China , Bibek Chand

State of Urbanization in Nepal: The Official Definition and Reality , Keshav Bhattarai, Ambika P. Adhikari, and Shiva Gautam

Submissions from 2022 2022

An Anatomy of Nepal's Remarkable Export Decline , Rishi Sharma

A Review of Environmental Vulnerabilities Related to Nepal’s Graduation Process from Least Developed to a Developing Country Status , Ambika P. Adhikari, Keshav Bhattarai, and Basu Sharma

A Review of Nepali Diaspora and their Role in Nepal’s Development and Lessons for Developing Countries , Ambika P. Adhikari

Effect of COVID 19 pandemic on Pharmaceutical Industry in terms of Inventory and Logistics Management , Shubhabrata Basu and Rimu Chaudhuri

Hegemonic Instability? India’s Himalayan Hegemony in Theoretical and Historical Perspective , Philip Hultquist Ph.D. and Prakash Adhikari Ph.D.

Minimizing surface run-off, improving underground water recharging, and on-site rain harvesting in the Kathmandu valley , Ambika P. Adhikari and Keshav Bhattarai

Nature Of Health Insurance Demand In India , Brijesh C. Purohit Ph.D

Summary report of discussions at the forum “Nepali Diaspora Organizations in North America: Achievements, Opportunities, and Challenges”, Coppell, Texas, USA July 2022 , Ambika P. Adhikari

The Continuation of Civil War by Other Means? Post-Conflict Peacebuilding in Nepal, Supplemental Materials , Prakash Adhikari Ph.D., Wendy L. Hansen Ph.D., and Adnan Shahid

The Vortex: A True Story of History's Deadliest Storm, an Unspeakable War, and Liberation , Jason Miklian

Submissions from 2021 2021

An Impact Evaluation of COVID-19 Training Program: Knowledge and Awareness of Public Health Professionals of Province Five, Nepal , Alok K. Bohara, Swati Thapa, Siobhan K. Yilmaz, and Spencer H. McBee

Climate Change and Community Resilience , Mani Nepal, Pranab Mukhopadhyay Dr., Md Rumi Shammin Dr., and AK Enamul Haque Dr.

Colonial Institutions and Civil War Indirect Rule and Maoist Insurgency in India , Shivaji Mukherjee

The Economics of Solid Waste Management and Drainage: A Sustainable Approach for Making South Asian Cities Climate-Resilient , Mani Nepal

Towards Creating Smart Cities in Nepal , Ambika P. Adhikari and Keshav Bhattarai

Submissions from 2020 2020

Covid-19 Pandemic and Nepal: Issues and Perspectives , Basu Sharma and Ambika P. Adhikari

Forest carbon stock assessment in selected red panda habitats in Ilam and Panchthar districts, Nepal , Trilochana Basnet, Niroj Timalsina, Rajesh Bahadur Thapa, Damber Bista, Basant Pant, Bhaskar Singh Karky, and Kai Windhorst

Issues and Perspective on the Covid-19 and Nepal: An Introduction , Ambika P. Adhikari and Basu Sharma

Sustainability, Urban Planning and Development: Sustainable and Self-Reliant Urban Development in Post- Pandemic Nepal , Ambika P. Adhikari and Keshav Bhattarai

Urban Development in Nepal and the Impacts of Covid-19 , Ambika P. Adhikari and Keshav Bhattarai

Value of cleaner neighborhoods: Application of hedonic price model in low income context , Mani Nepal and Rajesh K. Rai

Submissions from 2019 2019

A Pilot Study on Adolescent Mobile Phone Use, Indirect Mental Health Costs and Cultural Context Considerations – REPORT , Siobhan K. Yilmaz and Alok Bohara

Conference Summary Report, International Conference Role of Nepali Diaspora in Higher Education in Nepal , Ambika P. Adhikari, Govinda P. Dahal, Basu Sharma, and Dinesh Gajurel

Diaspora’s Role in Nepal’s Development: Summary of the Forum held at the Nepali National Convention. Baltimore, MD, USA. July 5-7, 2019 , Ambika P. Adhikari, Diwakar Dahal, and Rajendra Khatiwada

Sino-Indian Relations and EU Development Policies in Post-Conflict Nepal , Bibek Chand

Submissions from 2017 2017

Challenging Hegemonic Gender Norms through STEM Education in Nepal , Todd Wallenius and Barbara Grossman-Thompson

Disaster Relief as a Political Tool: Analysing Indian and Chinese Responses after the Nepal Earthquakes , Bibek Chand

The Effect of School Construction on Educational Outcomes among Females: Evidence from Nepal , Animesh Giri and Vinish Shrestha

Violence Against Children in Nyarugusu Refugees Camp: Reporting and Perceptions Across Generations , Erin K. Fletcher, Seth R. Gitter, and Savannah Wilhelm

Submissions from 2016 2016

Extension Service and Farm Productivity in Nepalese Agriculture , Dadhi Adhikari and Naresh Nepal

Submissions from 2015 2015

Education, Health and Inequality: Schooling infrastructure and educational outcomes in Nepal , Vinish Shrestha

How are School Dropout Rates Related to Household Characteristics: Analysis of Survey Data from Bangladesh , Nusrat Farah

Implications of the Dragon’s Rise for South Asia: Assessing China’s Nepal Policy , Bibek Chand and Lukas Karl Danner

Labor market changes and human capital investment: Evidence from migration boom in Nepal , Rashesh Shrestha

Sustainable Livelihood Systems in Nepal: Principles, Practices and Prospects , Ambika P. Adhikari, Govinda P. Dahal, Ishara Mahat, Bishwa Regmi, Kalidas Subedi, and Bharat Shrestha (eds.)

Submissions from 2014 2014

Reversing the Flood of Forced Displacement: Shedding Light on Important Determinants of Return Migration , Prakash Adhikari Ph.D. and Wendy L. Hansen Ph.D.

Submissions from 2013 2013

Can Improved Cooking Stoves Work? The Nepal Chulo Experience , Dipika Gawande, Bijendra Shrestha, and Amarsingh Gawande

Household-level Effects of Electricity on Income , Brandon Bridge, Dadhi Adhikari, and Matías Fontenla

Submissions from 2012 2012

Healthy Mothers, Healthy Children: Does Mothers' Demand for Antenatal Care Matter for Child Health in Nepal? , Nafisa Halim

Papers, Abstracts, and Proceedings of the Seventh Annual Himalayan Policy Research Conference , Vijaya R. Sharma, Mukti P. Upadhyay, Jeffry Drope, Naresh Nepal, and Alok Bohara

Submissions from 2011 2011

Building Community 'Gegran' Beneficiary Group: a case of Lothar Khola Watershed Chitwan, Central Nepal , Ramesh M. Tuladhar

Effectiveness of Some Local Baits for the Managment of Hornets in Apiaries of Kathmandu Valley , Chet Prasad Bhatta and Aananda Shova Tamrakar

Submissions from 2010 2010

An Opportunity to improve Service Delivery in Nepal through Local Governance , Yam Sharma and Abd Muwonge

A Proposal for an Open University of Nepal for Providing Higher Education to the Rural and Marginalized People , Pramod Dhakal, Ambika Adhikari, and Drona Rasali

Conflict Resolution and Institutional Arrangements for Flood Disaster Management on Indo Nepal Fringe: Focus on Kosi Basin , NMP Verma

Economic Growth and Human Development in South Asia: Experience of Selected Countries , Ranjit Singh Ghuman and Amarjit S. Bhullar

Economics of Sedimentation Management in Large Reservoirs , Biswo Poudel

Geographic Isolation and Poverty among Indigenous Peoples in Nepal , Gyanesh Lama, Marth N. Ozawa, and Palsang Lama

Impact of Industrial Environment on Socio-economic Conditions of Mine Workers: A study of Coal Industries in Odisha , Abhaya K. Naik and Krupasindh Pradhan

Local people's perception on Climate Change, its impact and adaptation practices in Himalaya to Terai regions of Nepal , Krishna R. Tiwari, Kashab D. Awasthi, Mohan K. Balla, and Bishal K. Sitaula

Media Contribution in Transfer of Power in Nepal , Binod C. Agrawal

Micro-level Estimation and Decomposition of Poverty and Inequality in Nepal , Mani Nepal and Alok Bohara

Micro Small and Medium Enterprises (MSME) and Economic Development of Odisha , Krupasindh Pradhan and Santosh Kumar Munda

Moving out of Chronic Poverty: Community Level Study on Poverty over the Time , S.A.N.C. Samaraweera and N.R. Abeynayake

Prospects of a Trilateral Trans-Himalayan Economic Cooperation Agreement (THECA): China, Nepal, and India , Alok K. Bohara

Protection and comparative advantage of rice production in Bangladesh: A policy analysis matrix , Abu Hayat Md. Saiful Islam and Dieter Kirschke

Swine Flu: A Preliminary Study of the Planning and Policy of Nepal to Combat the H1N1 Pandemic , Rojee Rajbanshi

The Economic Cost of Health Problems due to Indoor Air Pollution at the Household Level in Tamil Nad , B.P. Chandramohan, T.K.S. Villalan, and S. Karthikeyan

Use of Modern Technology in Rural Development — A case study of National Rural Employment Guarantee Scheme (NREGS) in Odisha , Abhaya K. Naik and Sukhamaya Swain

Submissions from 2009 2009

E-Prostitutions and its Impact in Society , Rashida Valika

Experience of Nepali Families with Foreign Remittance: Evidence from the Nepal Living Standard Survey , Udaya R. Wagle

Submissions from 2008 2008

Bullets, Ballots and Bounty: Maoist Victory in the Twenty-first Century, Nepal , Mahendra Lawoti

Cooperative Federal Structure: A Workable Political-economy Approach for a New Nepal , Alok Bohara

Determinants of Awareness and Usage of Best Available Local Maternal and Child Health Care Facility by Women in a Selected Rural Area of Nepal , Vijaya R. Sharma and Tirshana Sharma

Determinants of Deforestation in Nepal's Central Development Region , Keshav Bhattarai

Factors Affecting Application of New Public Management Oriented Reforms for Reforming Nepalese Public Administration , Bharat Raj Gautam

Faithful Leisure, Faithful Work: Religious Practice as an Act of Consumption in Nepal , Charis Boke

Financial Management of the Small Municipalities of Nepal: Sustainability Issues , Mahesh Baral

Heritage Conservation in Nepal: Policies, Stakeholders and Challenges , Neel Kamal Chapagain

Natural Disaster and Sickness Shocks: Evidence of Informal Social Insurance from Bangladesh , Pallab Mozumder

POLITICAL CONFLICT AND MIGRATION: How has Violence and Political Instability Affected Migration Patterns in Nepal? , Nathalie Williams and Meeta S. Pradhan

Reproductive Health Services: An Entry Point to Reach Labor Migrants and Their Wives for Providing HIV and STI Services in Nepal , Laxmi Bilas Acharya

Rural Poverty Analysis: A case study of a district of Nepal , Uddhab Bhandary

The Limits of Success? NGOs, Microfinance and Economic Development in Pakistans Northern Areas' , Feisal Khan

The Role of Land Reform in Reducing Poverty Across Nepal , Chandra Adhikari

Towards Developing Indicators of Environmental Sustainability for Kathmandu, Nepal , Ambika Prasad Adhikari

Submissions from 2007 2007

A Community Based Micro Hydro: A Promising Technology for Rural Development in Nepal , Bishwa Koirala

An Assessment of the Causes of Conflict in Nepal , Bishwa Nath Tiwari

Community based integrated natural resource management: Policy options and areas of intervention , Sabita Thapa, John Soussan, Dhruba Pant, Umesh Nath Parajuli, Khem Raj Sharma, and Binod Bhatta

Coping with Unreliable Water Supplies and Willingness to Pay for Improved Water Supplies in Kathmandu, Nepal , Hari Katuwal and Alok Bohara

Domestic Health Hazard and Indoor Air-Pollution: An Approach to Find Alternative Energy Source for Rural Bangladesh to Minimize the Threat , Reazul S.M. Ahsan and Jinia Afrin

Economic Inequality in the Democratic' Nepal: Dimensions and Implications' , Udaya R. Wagle

Effects of Deforestation on Tree Diversity and Livelihoods of Local Community A Case Study from Nepal , Krishna Karkee

Identification of natural resources at watershed level: an initial step of mainstreaming of the Federal restructure in Nepal , Madan Koirala

Inequality, Polarization and Violent Conflict: The Maoist Insurgency in Nepal , Mani Nepal, Alok K. Bohara, and Kishore Gawande

Peoples Perceptions of Green Space Park in Pokhara, Nepal' , Murari Suvedi, Krishna Shrestha, Bishwo Kallyan Parajuli, and Padam Giri

Political Participation and Civic Literacy in Bajung: An Empirical Study with Correlation Analysis , Khadga K.C.

Political predictions in Nepal , Aditya Man Shrestha

Poverty, Inequality, Violent Conflict, and Welfare Loss: Micro-Level Evidence from Nepal , Mani Nepal

Prioritizing and Estimating Hydropower Project Construction Risks: A Case Study of Nyadi Hydropower Project , Kamalesh Panthi

Pursuing Democracy: Explaining Political Transitions in Nepal , Prakash Adhikari and James D. Timberlake

Recruiting Rebels: Indoctrination and Political Education in Nepal , Kristine Eck

"Retainer" Bureaucracy: An Impediment to the Process of Democratic Governance in Nepal , Sucheta Pyakuryal

Rural Vulnerability and Tea Plantation Migration in Eastern Nepal and Darjeeling , Sarah Besky

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Safeguarding Nepal: National Security Landscape & Challenges

23 References

External influence and challenges of state-building in nepal, nepal worldview: foreign policy and diplomacy, japan's comprehensive security policy: a new east asian environment, population and housing census, south asia china geo-economics, non-traditional security : state, society, and democracy in south asia, thinking about national security: defense and foreign policy in a dangerous world, related papers.

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, by Karl-Heinz Krämer. Khabarhub, June 3, 2024 [a similar version of this article has been published in , June 1, 2024] , by Karl-Heinz Krämer. Khabarhub, April 12, 2024 [Based on the article " ", Nepal Observer 86, April 6, 2024]
, by Karl-Heinz Krämer. Nepal Observer 85, March 4, 2024. , by Karl-Heinz Krämer. Nepal Observer 84, November 27, 2023. ]
, by Karl-Heinz Krämer. Nepal Observer 83, June 19, 2023. [A slightly revised version of this article has been published on 19 June 2023 on the online portal ] , by Karl-Heinz Krämer. Nepal Observer 82, May 9, 2023
, by Karl-Heinz Krämer (see also 30/03/2023) 21/02/2023]
, by Karl-Heinz Krämer. Nepal Observer 80, 3 February 2023 [see also 05/02/2023]
, von Karl-Heinz Krämer. Nepal Observer 79, 13. December 2022
, by Karl-Heinz Krämer. 27 November 2022 [see also 29/11/2022]
, by Karl-Heinz Krämer. 14 November 2022
, by Karl-Heinz Krämer (see also , October 24, 2022) ., by Karl-Heinz Krämer.  Nepal Observer 75, June 6, 2022
, von Karl-Heinz Krämer. Südasien 42:1,57-60 (April 2022)
, by Karl-Heinz Krämer. Khabarhub, April 17, 2022
, by Karl-Heinz Krämer. 6 December 2021 (Translation of a lecture given by the author on 5 December 2021 at the Nepal Day of the Deutsch-Nepalische Gesellschaft in Cologne)
, by Karl-Heinz Krämer. Nepal Observer 71, August 20, 2021
, by Karl-Heinz Krämer. Khabarhub,  June 19, 2021 , by Karl-Heinz Krämer. Nepal Observer 69, May 22, 2021
) of Hindu politics, by Karl-Heinz Krämer. Khabarhub, May 18, 2021
, by Karl-Heinz Krämer. Khabarhub, May 1, 2021
, by Karl-Heinz Krämer. Khabarhub, April 18, 2021 [See also ] , by Karl-Heinz Krämer. Nepal Oberver 65, April 8, 2021
, von Tsak Sherpa. Nepal Oberver 64, 2. Februar 2021 , by Karl-Heinz Krämer. Nepal Observer 63, January 25, 2021
, by Karl-Heinz Krämer. Nepal Oberver 62, December 25, 2020 , by Karl-Heinz Krämer. Nepal Observer 61, September 20, 2020

Editorial comment

(30 March 2023) How inclusive is the Nepali state? Let's ask the 2021 census!

Since 1990, the Nepali state has committed itself in its constitutions to multiethnicity, multilingualism and religious diversity in its society. This reality was reaffirmed in the current constitution of 2015. At the same time, another commitment was added, namely that of ending the existing unequal participation of diverse social groups in the state. In 2006, during Jana Andolan II, this had been one of the most urgent concerns of the people and had subsequently been declared a priority goal by all political parties. Yet this concern was not entirely new in 2006. It had been raised by members of disadvantaged groups as early as 1990, but had not really been heard. The Nepal Janajati Mahasangh, now Nepal Adivasi Janajati Mahasangh, the alliance of representative organisations of ethnic groups, was still in its infancy at the beginning of the 1990s. Similar representations of the interests of the Madheshi and Dalits were more or less nowhere in sight. Historical manipulations of the census In order to be able to estimate the extent of the participation of the various population groups today, one must first know how high the population share of the respective groups is in the total society. Until now, a look at the published data of the census, which has been published more or less regularly every ten years since 1911, has provided information on this. For a long time, the last well-founded census with detailed data on ethnic groups/castes, languages and religions had been the 1961 census, which was compiled immediately after Mahendra's royal coup in 1960 and was still largely free of the manipulations of the panchayat system. The party-less royal panchayat system focused on faking a cultural unitary state in the decades that followed. The impact of this policy can be seen in the published data of the 1971 and 1981 censuses. The number of ethnic groups listed constantly decreased, as did the number of mother tongues and their speakers. At the same time, the pretended number of practising Hindus rose to almost 90 per cent. The evidence for the obviously fake data was provided by the censuses after the democratisation of 1990, according to which the proportion of Hindus fell to around 80 per cent (2001). The proportion of native Nepali speakers fell from 58.4 per cent (1981) to 44.6 per cent (2011). While 44 mother tongues were counted in 1952/3, their number dropped to 17 (1971). In the 2011 census, 123 mother tongues were then listed by name. All this was to be seen as a positive development with regard to the appropriate inclusion of all social groups. Shortcomings of the 2021 Census And now the census of 2021, whose data was published barely one and a half years after it was collected. However, if you look for the latest data on the aforementioned social and cultural areas, you will be surprised to find that there are absolutely no figures. This did not even happen under the royal panchayat system, although this system actually aimed at avoiding such data. At best, a justification is provided by point 13.5 of the introductory notes of the new census, which states: "People’s aspirations and expectations have been elevated by the new Constitution. Issues of identities and capturing government’s attention are high. As a result, some interest groups tried to manipulate the respondents’ independent answers and dictated the enumerators to write a particular response. But this was independently verified and a press note was released from the CBS no fying all the concerned parties for possible legal action if they did not seize campaigning with prejudice. Moreover, a number of interest groups especially related to caste/ethnicity, religion and language have shown serious concern on census results and presented their specific demands which need to be dealt with higher government or political level." This explanation is very significant in many respects. First of all, the very special importance of identity is emphasised. This can only be emphatically confirmed. It gives people a very individual personal position in the multi-ethnic, multi-lingual and multi-religious state of Nepal. Beyond that, however, it also has very special political and administrative significance. Let's just take the right to vote, which in the proportional system refers to the very figures published in the census for percentage allocation. The figures must also be made public in order to comply with the inclusion regulations in the political and administrative sphere. Then the above quote goes on to say that some vested interests have tried to manipulate the data collection in this regard. Nepal's constitution guarantees the fundamental right to information. If the CBS makes such allegations in such an important document as the census report, then these vested interests must be named and legal action must be taken immediately. While the CBS speaks of having threatened such legal action, it remains unclear whether it has been initiated. In this context, there is talk of "concerned parties". Does this refer to political parties or to "groups" in general? The next sentence talks about "interest groups related to caste/ethnicity, religion and language", which obviously had concerns about such social data. Who are these groups and what are the reasons for their concerns? The bottom line is that, while passage 13.5 of the introductory remarks to the census explains problems encountered during the survey, it does not explain why, for the first time, the census does not include any data on ethnicity, languages and religions. In view of the special political, electoral and administrative significance of such data, the Census loses quite considerably in value, however good and informative the data now published may be. Here, the public interest of the population and the state is clearly to be valued higher than possible reservations of certain groups or individuals. So to return to the initial question: What has been achieved so far of the inclusion promised by all political parties in 2006? For this, the public would not only have to be provided with new basic social data on ethnicity, languages and religions, but the respective proportion would also have to be shown for all possible areas of public life. It would be one of the most important tasks of the census in general to provide such data. In order to recognise that male Khas Arya, especially Bahun, hold many times the posts and functions in the state system that are appropriate to them on the basis of their population share, new census data is not necessarily needed. But it is also important to recognise changes in the field of inclusion. This is also and especially important for classifying possible positive changes with regard to traditionally excluded population groups. So the vague hope remains that the missing data will still be supplied. There is no indication of this. Such data should actually be taken into account and integrated in the tables already published. But this is hardly likely to happen. Only then would it be possible to see whether the various social groups in the areas covered by the census are affected or involved differently. The question remains: Are there specific reasons why the social data were swept under the table? Possibly, they could prove the failure of the previous inclusion policy and, on the other hand, give impetus to demands of the excluded groups to remedy deficiencies.

(19 February 2023) Let's celebrate National Oligarchy Day!

In Nepal, they celebrate Democracy Day for three days, whatever there is to celebrate. 72 years ago, the then King Tribhuvan returned to Nepal from exile in India and promised the people democracy, which is still celebrated today. In reality, of course, it was all stink and lies, as we all know. In the years that followed, the monarchy did everything it could to regain and secure its absolutist power, which ultimately ended in the almost 30-year-long party-less Panchayat system. The last king, Gyanendra, who was deposed in 2008, has just once again proposed a cooperation between the monarchy and political parties, for the "preservation of democracy", as he explained. The question remains why an institution that has been rightly abolished is allowed to speak at all; this only exacerbates the crisis. What is celebrated today as democracy is in reality an oligarchy of a few ageing politicians, all of whom have failed repeatedly, but who still consider themselves irreplaceable. Twice since 1951 it looked like democracy would prevail: in 1990 after the first people's movement (Jana Andolan I) and in 2006 after Jana Andolan II and the ending of Gyanendra's coup. The new constitution of 2015 was the work of the top politicians of the major parties and brought no real democratic advantage for the people; it served primarily to secure the power of the aforementioned party elites. In recent weeks, symbols and ideals of Nepali history that had long been hoped to be overcome have been repeatedly celebrated. On 11 January, for example, the birthday of Prithvi Narayan Shah, the founder of modern Nepal, was officially celebrated for the first time in years. This may have been a gesture towards the increasingly vocal supporters of a return to monarchy and the Hindu state. After all, the party that had taken up this unconstitutional cause had to be integrated into the allegedly Maoist-communist government for reasons of securing power. The Rastriya Prajatantra Party (RPP) was founded in 1990 as a rallying point for the top politicians of the party-less royal Panchyat system, has split and merged again and again, and is bobbing along in elections in low single-digit percentages. So much only for the significance of this party. Prithvi Narayan deserves credit for unifying the country to a certain political greatness with his brutal campaigns of conquest. Otherwise, Nepal would probably not exist today. However, he did not do this out of great political foresight, as is repeatedly claimed, but simply for reasons of personal power and economic advantage. But this nation-wide seizure of power by the Shah dynasty of Gorkha also had very serious disadvantages for the people in the conquered areas, which are generally kept quiet: Destruction of traditional local land tenure rights, granting of ethnic land to supporters of the monarchy, suppression of ethnic and regional cultures and languages, integration of these groups at a lower level into the Hindu caste system, to name but a few. This laid the foundations for the unitary state later sought by King Mahendra and his son Birendra: one language, one religion, one culture, one ethnicity, all united by the glorious bond of attachment of the "subjects" to the Shah monarchy. The next big celebration this year was the anniversary of the Maoist uprising on 13 February. Prime Minister PK Dahal has now declared it a National Holiday for the first time because of the glorious achievements of the uprising. The uprising, which was marked by heavy losses and serious crimes and human rights violations by both Maoists and state security forces, has brought few significant changes, some of which are increasingly being challenged: Secularism, federalism, republic. The social inclusion promised by all political parties in 2006 is more distant than ever. Thousands of victims of the uprising continue to wait in vain for justice. Only a few perpetrators from the time of the uprising have been convicted so far. It is significant that one of those perpetrators has now been pardoned as part of the usual action on the occasion of Democracy Day. And so now, three-day celebrations of democracy, that is, the rule of the people. These people have recently expressed in elections what they want and what they do not want. For example, they have made it clear that they no longer want this old failed guard of male Khas Arya politicians, including those of the previous ruling alliance, who had tried to maintain their power through extreme anti-democratic manipulation of the electoral system, or those who in 2020/21 had accepted the destruction of Nepal's parliamentary system in order to maintain their personal power. Only the PR system allows a statement on the status of the political parties and here the losses of the three big parties were clear: Nepali Congress -7%, CPN (UML) -6.3%, CPN (MC) -2.5%. At the same time, parties that offered themselves as alternatives experienced a huge boost. Unfortunately, after the elections, some of these alternative forces turned out to be renewed kingmakers to keep the failed old politicians in power, instead of finally forcing them to make a generational change. Nepal has already experienced something similar after the 2017 elections, when the Bibeksheel Sajha Party managed positive approaches of an alternative political force before its leader Rabindra Mishra then outed himself as a monarchist, who is now a member of the RPP. Positive approaches like those of the Rastriya Swatantra Party (RSP) obviously lose their impact as soon as the traditional power merry-go-round of the ruling oligarchy takes effect. Thus, Nepal now has a prime minister whose party received just 11 per cent of the vote and which won at least some of the direct mandates only thanks to the manipulative electoral alliance of the then ruling parties. So Dahal is prime minister thanks to the direct votes of, for example, traditional NC voters, but this has forced it into opposition, which this party, in turn, does not see that way. Democracy in Nepal supposedly does not need an opposition. At the same time, the strings in the background of the current government are pulled by KP Oli, who two years ago led Nepal's political system to the brink of ruin. It took his removal by the Supreme Court to stop him and his state president who was loyal to him. And Oli would not be Oli if he did not focus everything on his quick return to power. A year and a half ago, Dahal had played a decisive role in Oli's downfall, allegedly because he no longer considered him tenable. Now, however, the post of prime minister was more important to Dahal than his blather of yesterday. But Dahal was to pay dearly for his post. Oli insisted on about a third of the ministerial posts for his party. In addition, he wanted all important new state posts to be reserved for the UML. At some point, Dahal must have realised that he was only a puppet in Oli's power game. Since Dahal knows better than anyone else how to fly his flag with the wind and to throw away yesterday's promises, the signs within the governing coalition are now pointing to a storm. Oli and Dahal have agreed that the post of prime minister should switch to Oli after two and a half years, however this is to be handled legally, but constitutional rules do not interest Nepal's failed top politician anyway. Of utmost importance for Oli is that he then has a state president at his side who will rubber-stamp his every potential executive decision unchecked, as Bidya Devi Bhandari has willingly done repeatedly. So Oli still needs this post of state president for his party to have the state machinery more or less under his control. Within no time, Oli would then be back where he was dishonourably dismissed in 2021. Why the latter did not have further political consequences for him remains incomprehensible anyway. If the election of a new state president were in the interest of the country and its people, then this choice would fall on a neutral personality from the realm of civil society. But as it is, it is once again an important element in the power game of the failed political elites and parties. Nepal remains an oligarchy and not a democracy. So let's celebrate National Oligarchy Day!

(25 December 2022) The dishonesty of Nepal's top politicians Free and fair elections are the best non-violent way for the citizens of the country to express their views to the politicians and their parties. Despite tremendous manipulation and restriction of the freedom of choice through the formation of electoral alliances, especially those of the ruling parties, the voters managed to express a few things clearly;     - They did not want "business as usual".     - They did not want the same old failed politicians.     - They wanted a generational change in political responsibility. And the signals were clear. The electoral alliance of the five governing parties was voted out because it could no longer obtain the number of MPs needed to form a government. The main opposition party CPN (UML) led by former two-time prime minister KP Oli also lost not only 36 direct mandates compared to 2017, which was probably due to the electoral alliance of the ruling parties, but also 6.3 per cent of the PR votes, which was a significant drop in terms of voters' favour. Similarly, the CPN (MC)'s support dropped again by 2.5 per cent to only 11.1 per cent of the PR vote, a trend that has continued unabated since 2008. Presumably, this party was only able to win many of its 18 direct mandates thanks to the electoral alliance, in which the other participating parties asked their voters to vote for the candidate of the Maoist party. And what was the reaction of the ageing leaders of these three parties to the clear statement of the voters? They saw themselves as winners despite their defeats, a phenomenon that is not entirely untypical after elections worldwide. A compromise solution might have been to transfer the responsibility to a younger generation. With Gagan Thapa, a certainly suitable candidate had come forward. But the old, failed top politicians rigorously ignored this option. Instead, the parties in the Deuba government, for example, tried to bring other parties on board in order to come up with the number of MPs needed to continue the government. At the same time, a fierce battle began between two top leaders of the ruling coalition, PK Dahal and SB Deuba, for the post of the future prime minister. Meanwhile, the opposition leader KP Oli pretended to accept defeat and to remain in opposition. In reality, however, he did not miss any opportunity to drive discord into the government coalition by repeatedly calling for a coalition of left parties, preferably under his leadership. These power struggles over the new government formation had one thing in common. They showed that the top politicians of the three big parties were once again not concerned with the welfare of the state and society, but solely with fulfilling their own personal claims to power. In this respect, PK Dahal's statement on 25 December that he now had to change sides because SB Deuba had broken his promise when he refused to accept Dahal as the new prime minister is striking. Yet the voters had expressed that they no longer wanted either of them. It is shocking that Dahal justifies his switch to the Oli camp by saying that he was cheated by Deuba. But how should the voters who voted for the candidates of the ruling alliance feel, even if these candidates came from parties they would never have voted for if their freedom of choice had not been so restricted by the agreements of the top politicians of the alliance? So now a politician whose party was elected by just 11 per cent of the electorate, and thanks to the direct mandates won by his alliance pledges came a distant third, allows himself to be made prime minister at the head of a completely different coalition. If anything is fraud, it is surely this, and it is fraud against the electorate! Now Nepal gets a new prime minister who long ago testified that he was responsible for 5,000 deaths during the Maoist insurgency. For long, he has not held any top office. Nepal's top politicians, regardless of party, usually only accept the office of prime minister for themselves. Otherwise, they prefer to pull strings in the background. So now someone who has pleaded guilty to a capital crime has taken over the highest executive office. This is only possible because KP Oli, with his 78 MPs, supports Dahal as prime minister. In view of Oli's past, the legitimate question remains how long this will be. At the same time, Oli is also an extremely questionable figure after all that he afforded himself in 2021. Both parliamentary dissolutions at the time were unconstitutional, as the Supreme Court has confirmed, but Oli still does not accept this. At least the second parliamentary dissolution was nothing but a coup, which was only made possible thanks to the active support of the state president. It is also questionable to look at the other parties that want to participate in the new government. There is, for example, the RPP, which fundamentally rejects secularism and federalism and instead strives for a return to the Hindu state and monarchy, i.e. a clearly unconstitutional proposal. And in general, the question arises how such a party and a party that calls itself revolutionary-Maoist can sit together in a government. Then there are three parties that were elected to parliament by many voters primarily because they had contested as alternative political forces, notably the Rastriya Swatantra Party, which got only 0.4 per cent less PR votes than Dahal's CPN (MC), but also the two regional parties, Janamat Party and Nagarik Unmukti Party. These three parties are now actually admitting to ensuring the stay in power of old failed politicians. Do these parties actually believe that they can initiate the changes they promised to their voters from within the government? Not one of the top politicians of the major parties has ever explained why he had to become prime minister. What they have all been spreading is merely empty phrases that are out of touch with reality and have been delivered monotonously for years.

(27 November 2022) Attempt of a first election analysis The national and provincial elections have been held and have sent shock waves. Despite massive manipulation in the nomination of candidates, continued blatant disregard for social inclusion, utopian and fairytale-like election manifestos and the subversion of democratic principles, the eternally same and long since repeatedly failed ageing party leaders have not succeeded in deceiving the electorate once again. The top politicians were only concerned with one thing: they wanted to have their personal position of power confirmed once again by the elections so that they could continue their state-destroying power struggles for five years afterwards. All according to the motto: Keep it up, it has always worked so far.

But it didn't this time. The voters were, to put it bluntly, fed up and taught the top politicians and their parties a lesson. The fact that this did not turn out even more clearly is due to various circumstances. For one thing, the insane electoral alliances led to the competition between the parties in the constituencies, which is typical of a democratic system, being considerably restricted. Voters could no longer decide freely. They had to be satisfied with the candidates that the party leaders had chosen for them, basta! Or else they had to resort to a protest vote. In some constituencies, a not inconsiderable number of independent candidates have favoured the re-election of prominent top politicians. The nationwide cadre system of the major parties also had a supportive effect on incumbent politicians. Another plus for them is the so-called Constituency Development Fund, through which only directly elected MPs can specifically promote development projects in their constituencies and thus already work towards re-election during the ongoing legislative period. Finally, it is also worth mentioning the effort to weaken or exclude potential competitors through accusations or even lawsuits already in the run-up to the elections. Sometimes, the Election Commission seems to have supported such processes while turning a blind eye to the misconduct of many established politicians. Unfortunately, even a week after the elections, not even the FPTP votes have been fully counted. Regarding the PR system, only constantly updated figures are published on the Election Commission's website, although it is precisely here that percentage figures could already reveal a trend. If you want to get this one, you have to calculate the expected PR seats yourself. It is therefore too early to draw up a comprehensive analysis, but some things can already be clearly seen. First, there is the winner of the 2017 elections, the CPN (UML), whose chairperson had announced in his grandiloquent manner that his party would emerge from the elections with an absolute majority of seats. In 2017, the party had won 121 of the 275 seats in an electoral alliance with the CPN (MC). This time, it will be about 40 MPs less, mainly due to losses in the FPTP system. But even in the proportional system, the party is expected to drop by about six percent to just over 27 percent. In this system, however, the CPN (UML) remains ahead with about the same lead over the Nepali Congress (NC) as five years ago. So, under the PR system, the NC also loses about six per cent compared to 2017. Hence, it is only in the PR system that one can make out the status of the parties among the electorate. The FPTP system this time was all about manipulation by the electoral alliances. Thus, the declared aim of the alliance of the five ruling parties [NC, CPN (MC), CPN (US), LSP and Janamorcha Nepal] was to ensure a continuation of the ruling coalition after the elections by means of their electoral alliance. For this purpose, the re-election of as many leading politicians of the coalition as possible was to be made possible. This plan has obviously failed. Thanks to candidate manipulation, at least the NC was able to gain almost as many seats in the FPTP system as the CPN (UML) lost compared to 2017. Together with the seats from the proportional system, the party is likely to have around 90 MPs in the new House of Representatives. For a governing majority of at least 138 MPs, the other four governing parties would thus have to bring in around 50 more MPs, but it does not look like that will happen. Pushpa Kamal Dahal's CPN (MC), still an alliance partner of the CPN (UML) in 2017, is the second big loser of these elections. The number of its FPTP seats will be halved compared to 2017, with an expected 18. Just as a reminder: as early as 2008, voters had placed great hope in this party and gave it exactly 50 per cent of the 240 direct mandates at the time. Since then, the party has been declining from election to election, which is certainly also due to the fact that it has forgotten almost all of its former ideals. In the PR system, too, it will drop by another two percent, with only about eleven percent. In total, this will probably mean 33 seats in total. Madhav Kumar Nepal's CPN (US), which emerged from the CPN (UML), is contesting elections for the first time. The election results make it clear that this party has not yet reached the electorate. Although it is the third strongest party in the ruling coalition with 10 direct mandates, it fails to clear the three-percent hurdle in the PR system. The Loktantrik Samajbadi Party (LSP), which recently replaced the Janata Samajbadi Party (JSP) in the ruling coalition, has only four direct seats, while Rastriya Janamorcha has only one direct seat, as in 2017. These two parties did not win PR seats either. From this point of view, a continuation of the current governing coalition seems at least difficult, if not impossible. Four parties can be described as election winners due to their significant gains. First and foremost is the Rastriya Swatantra Party (RSP), founded by Rabi Lamichhane in June 2022. It has won eight direct mandates and, thanks to a good eleven per cent of the PR votes, is expected to win another 15 seats through the PR system. As the party's name suggests, it wants to establish itself independently of the political quagmire of the major parties, and this seems to have resonated with the electorate, despite all the defamation campaigns against this young party. KP Oli nevertheless describes the emergence of this party as a trivial matter. The question arises whether this expresses arrogance or sheer shock. The winner from among the established parties is the RPP, which many had already seen as a outdated model in 2017 in view of only one direct mandate and its failure to clear the three-percent hurdle in the PR system. In 2022, the party won seven direct mandates and, thanks to six per cent of the PR votes, has a total of 15 MPs. The party stands for a return to Hindu state and monarchy, a clearly unconstitutional aspiration. The improved popularity in the PR system is probably largely due to a protest against the manipulations of the major parties. However, the mere six percent or so of the PR vote also makes it clear that the RPP's aspirations do not enjoy broad popular support, contrary to what is claimed at rallies of this party. The two smaller winners of these elections are based in the Tarai. One is CK Raut's Janamat Party (Referendum Party). Raut has long advocated an independent Madheshi state in the Nepali Tarai, which of course also contradicts the constitution. Although Raut's movement did not always establish itself with greater militancy, the state often dealt with him quite harshly. In 2019, the then Prime Minister KP Oli concluded an agreement with Raut, which, according to Oli, meant that Raut would distance himself from his separatist aspirations. This was countered by Raut's immediate formation of his Janamat Party, which, as its name suggests, wants to achieve the creation of a Tarai state not through militancy but through a referendum. CK Raut has now won the direct mandate in his constituency with a large majority. More than 2.5 per cent of the PR votes are also remarkable. The party is also winning a number of seats in the provincial elections, which will not be discussed further here. The second smaller party from the Tarai that successfully attracted attention in the elections is the Nagarik Unmukti Party (NUP). In the PR system, like the Janamat Party, it achieved a good 2.5 per cent of the votes and also three direct mandates. It was equally successful in the provincial elections. The party was not officially registered until January 2022. Its initiator is Resham Chaudhary, who is currently serving a life sentence. He is considered a prime suspect in the Tikapur riots, in which eight policemen and a child were murdered in 2015. Chaudhary was elected to the House of Representatives in 2017, although he was officially in hiding. His appeal against his conviction and its rejection by the Dipayal High Court has been pending before the SC for some time. He had wanted to run himself in 2022, which was rejected. The rise of the two aforementioned Tarai parties can be seen in the direct context of the decline of the two successful Tarai parties of the 2017 elections. The Rastriya Janata Party (RJP) and the Sanghiya Samabadi Forum (SSF) managed to win 5.45 per cent of the PR votes each and a total of 33 assembly seats at that time. In the intervening period, the two parties even merged to form the Rastriya Janajata Party Nepal (RJPN), which meant a strong presence of the Tarai people in parliament. At times, Baburam Bhattarai, who had won a direct mandate through his Naya Shakti Party, also became involved in this party. The infighting among the top leaders of the major parties in recent years also left its mark on the Tarai politicians. First, the RJPN broke into the Janata Samajbadi Party (JSP) and the Loktantrik Samajbadi Party (LSP). Initially, the JSP became a member of the ruling coalition. When this party felt disadvantaged in the electoral alliance, it switched to an alliance with KP Oli's CPN (UML). Within the government coalition, the LSP then took its place. In the end, it became apparent that the top politicians of the Tarai parties were also primarily concerned with their own power and chances of personal re-election and not with the concerns of the people they claimed to represent. They have now been taught a lesson by the electorate in the parliamentary elections. The share of the PR vote fell by more than 1.5 per cent for the JSP and by a good 3.5 per cent for the LSP. The JSP lost six seats, the LSP 13, the latter even failing to clear the three-percent hurdle. In the Tarai, too, people seem to be voting more consciously. It remains to mention that the Nepal Majdur Kisan Party was able to defend its direct mandate in Bhaktapur. Five independent candidates were also elected. This, too, may be seen as a sign of voter dissatisfaction with the major parties and their misguided and, in some respects, anti-democratic policies. What do the elections mean for political stability? What might a future government look like? The new House of Representatives will include twelve parties and five independents. In 2017, only five parties had more than one MP; this time there are nine. The then governing coalition of CPN (UML) and CPN (MC) did not bring any political stability to the country, despite a near two-thirds majority in parliament, but rather exacerbated the chaos and infighting. Rational coalition governments with a clear majority of MPs are not in sight at all this time. Only a coalition of NC and CPN (UML) could have a majority of about 60 percent of the MPs. But such a coalition makes no sense whatsoever if it is led by the failed prime ministers of the previous legislature, who might then also want to take turns in office. If the voters have expressed anything definitively, it is that they want a new beginning with fresh faces in positions of responsibility. The RSP was also so successful because it relied on a much younger generation of politicians. At best, it can be criticised for not having considered the aspect of social inclusion much better than the established parties (for example, only 12 women among 131 direct candidates). But this party is still very young and this should not be overrated here. Calls for a generational change have also been on the agenda of the numerical winner of these elections, the NC, for some time. Immediately after his re-election, Gagan Thapa, a younger politician, laid claim to the office of the future prime minister. Within the party, several politicians from the old guard will challenge his claim. Apart from the incumbent Prime Minister and party president Sher Bahadur Deuba, these are at least Ram Chandra Poudel, Shekhar Koirala, Shashank Koirala and Prakash Man Singh. With a turn towards the younger generation, there may finally be options for a more hopeful political future of the country.

(21 October 2022) The declared ideals of 2006 and today's political impasse

The scorn of Nepali politicians knows no bounds. The top leaders of the ruling coalition, for example, repeat in monotone that their electoral alliance is necessary to preserve the constitution, stability and prosperity. Yet, the ruling coalition has failed miserably on all these three aspects in a similar manner as the Oli government before it.

In reality, the leaders of all the major parties are only concerned with securing their re-election. If only one candidate from the camp of an electoral alliance stands in a constituency, his chances of re-election increase enormously. Only independent candidates can counteract this speculation, if voters realise in sufficient numbers that the same failed top candidates cannot be re-elected under any circumstances in the interest of the country, the people, democracy and the constitution. Another complicating factor is that this alliance system extremely reduces the number of potential alternative candidates of a party. Only the same old and long-since failed people are up for election.

None of the so-called top politicians respects the constitution and laws. Indeed, they obviously do not even know them. Should they intentionally violate them, they would have to be brought to justice immediately. Their behaviour would be highly malicious and therefore not covered by any passage in the constitution and subordinate laws.

The failed "top politicians" are a collection of male, predominantly high-caste politicians who want nothing to have to do with their own slogans of 2006, namely advocacy of social inclusion, democracy, federalism and secularism. For all of them, only their own very personal interests in power and all the privileges that go with it count.

16 years have passed since 2006. There can be no talk of social inclusion at all. It may have been in evidence at the time of the first Constituent Assembly election in 2008, but it was systematically dismantled thereafter. Even the inclusion provisions of the interim constitution were fundamentally disregarded. With the adoption of the new constitution in 2015, this was taken further in a decisive way. For example, the provision of the interim constitution to respect inclusion in the selection of direct candidates, which was never respected anyway, was removed altogether. Their proportion, mostly hand-selected males from predominantly so-called high Hindu castes, was increased at the same time. Only 110 of the 275 MPs are now elected by the people through the proportional representation system (PR). The latter is increasingly misused by top politicians in a nepotistic manner to infiltrate relatives, associates and friends into parliament. Since hardly any women are nominated as FPTP candidates, the prescribed 33 percent share of women in parliament must be ensured via the PR system. For example, putting the prime minister's wife on the PR list guarantees her safe election to parliament. In view of the fact that most of the FPTP candidates are men from the Tagadhari castes or Khas Arya (societal share of these men = 15 per cent), it seems downright grotesque that another 30 per cent Khas Arya are elected to parliament via the PR system. In this way, an adequate inclusion of "all" social groups, as pompously promised by the top politicians in 2006, will never be achieved. They don't even want this, and in 2006 they only talked about it like so many other things that they still pompously promise today but never really mean.

Democracy means the rule of the people. The alliance politicians declare in all seriousness that they are standing up for this when they form an alliance. In reality, however, this is a paternalism of the voters. They are obviously to be declared too stupid to recognise which politicians are best suited to represent their interests and the needs of the state. Therefore, the alliance politicians take this agony of choice away from them. Voters are only supposed to cast their votes for the common candidate that the top politicians have previously negotiated in weeks of discussion, regardless of which party that candidate belongs to. That is not democracy, that is oligarchy and the dumbing down of voters.

The idea of federalism was brought up in the 1990s by stakeholders of the Janajati groups and the then insurgent CPN (Maoist). Considering the fact that Nepal had hitherto been an extremely centralised state and that numerous regions and social groups were not really participated, this proposal seemed rational and later found its way into the basis for discussion in the Constituent Assembly. When the top politicians realised that the proposals put forward on the federal state threatened their privileges and state control, they increasingly took over the constitutional discussion themselves. Their disagreement on the issue of federalism ultimately led to the failure of the first Constituent Assembly. It was only with the change of majority in the second Constituent Assembly that the NC and CPN (UML) were able to push through their ideas of the federal state, which were more oriented towards the system of the Development Regions of the Panchayat period and denied any historical and ethnic reference even in the naming. Then, when the constitution was adopted, the inclusively elected representatives in the assembly were not allowed to introduce the concerns and ideas of the social groups they represented anyway.

Article 3 of the 2015 Constitution defines Nepal as a multi-ethnic, multi-religious, multi-lingual and multi-cultural state. Such a state cannot possibly be linked to the religion, language and culture of a single one of these social groups. In this respect, it was obvious to declare Nepal a secular state. A look at the history of modern Nepal from the days of Prithvinaran Shah to the last days of the monarchy makes it clear that the close linkage with Hindu political ideas and ideals has been one of the main causes of social inequalities, discrimination and participatory exclusion. Despite the now official commitment to secularism in the constitution (Article 4), there are repeated calls for a revival of the Hindu state. These come not only from those circles that are party-ideologically committed to this albeit unconstitutional idea, such as the RPP groups, but there are also a number of politicians within the major parties who occasionally flirt with this idea and closely link their notion of Nepali nationalism to Hindu ideals. The best example of the latter has been provided by former Prime Minister Oli on different occasions. This may also be related to the fact that most top politicians belong to a cultural environment that is closely linked to Hindu values and ways of thinking and lack necessary understanding of the multi-ethnic society. If adequate social inclusion had taken place since 2006, democracy, federalism and secularism would certainly not be questioned today.

(24 October 2021) Worsening of the national crisis

The crisis of the Nepali state is progressing. After the coup-like dissolution of parliament twice and his removal by the Supreme Court, KP Oli with his CPN-UML continues to "successfully" prevent parliament from working. His successor as prime minister, Sher Bahadur Deuba (Nepali Congress, NC), is still not getting anything done after more than 100 days in office. A partly anti-democratic approach and cracks are also emerging in this government, the latter not least because of the possible signing of the MCC agreement with the USA, strongly advocated by Deuba.

With his appointment of a brother-in-law of the Chief Justice (CJ) as minister, Deuba has also brought the Supreme Court under criticism. Assurances by the CJ that he strongly advised Deuba not to do so look implausible. The Bar Association is on the barricades, as are the CJ's colleagues in the Supreme Court. The judiciary has been permanently damaged.

The NC party convention, which legally should have taken place by March 2021 at the latest, keeps being postponed. The upcoming party convention of the CPN-UML also seems to be experiencing problems. All four major parties are showing that they are not willing to learn. According to schedule, new elections are due in autumn 2022 at all three levels of the federal system. Moving them up significantly has long been called for by the CPN-UML and is now also being discussed by the ruling parties.

But no matter when they are actually held, nothing is likely to change in the messy situation. The old and long-since failed leaders of all parties do not want to give up a millimetre of their power and control. In the NC, only veteran politicians, some of them 75-76 years old, are fighting for the leadership of the party for the next five years and, of course, for their candidacy for prime minister next year. Oli claims to have set in motion a huge rejuvenation process in the CPN-UML, but has enforced that the maximum age for election as party president and for candidacy for prime minister is 70. He himself will be 70 in February, so he is on the safe side. Meanwhile, the question of whether Oli has any legitimacy for state and party office after his attacks on parliamentary democracy, the constitution and the rule of law remains undiscussed.

Pushpa Kamal Dahal's CPN-MC has forgotten all its once revolutionary claims. It has become a mainstream party whose leaders have long been concerned primarily with their own profit and power influence. The ideals they stood for in the ten-year militant uprising no longer count. Not only the Maoist fighters who put their lives and health at risk for these ideals feel betrayed, but also all those who had hope for the promised social and political changes and who in 2008 voted the Maoist party as by far the strongest political force in the first elections to a Constituent Assembly. Nothing is left and nothing will come.

What remains of the major parties is the recently formed CPN-US (Unified Socialist) led by Madhav Kumar Nepal, which recently split from the CPN-UML. This party is still too young to really classify it. At best, one can see that even in this new party, the traditional patriarchal orientations have been preserved in the nominations to the various party bodies. At most, it will be interesting to see how many votes the two moderate communist parties, CPN-UML and CPN-US, will lose in the next elections. In 1998, the CPN-UML had already split over personal power claims. In the 1999 parliamentary elections, the two groups together received the most votes for the first time, but in the fight for seats in the then single-majority system they took the decisive votes from each other and helped the NC to an absolute majority of seats despite losing votes.

The question remains: What will the next elections bring for the country and for the people? All indications are that the voters will once again have no real choice. They will probably only be allowed to decide which of the numerous failed high-caste male top politicians they will vote for. Hopeful younger politicians of both sexes and with a view to balanced social inclusion will probably continue to be few and far between. The old heads in all parties will ensure that. It already seems certain that no party will win an absolute majority of seats. And Nepal has not been able to cope with such a situation so far.

(10 October 2021) Will everything be better with PM Deuba?

Exactly 90 days ago today, Sher Bahadur Deuba was sworn in as Prime Minister for the fifth time. The background is well known. KP Oli had tried to cover up his incompetence in an authoritarian manner. Several breaches of the constitution, repeated contempt of court and subversion of basic democratic norms ultimately left the Supreme Court with no choice but to remove Oli. Previously, Oli saw no reason to resign, neither in a clear vote of no confidence by the House of Representatives, nor in the explicit provisions of the Constitution, nor in the crumbling support within his own party.

In a democratic state, these would be ample reasons to deny KP Oli the right to hold political office for all time to come. But Oli does not care about any of this. Internally, he has preferred to divide and possibly weaken in the long run his CPN-UML, which had developed into a formidable left force over the past decades - definitely not to Oli's credit. At the national level, even after his ouster, he has continued his efforts to destroy parliamentary democracy. Most notable here is the continuous blockade of both houses of parliament, sometimes enforced with considerable militancy. With hollow slogans, Oli and his closest confidants are trying to give the impression that an overwhelming electoral victory for the CPN-UML in the next elections is beyond all doubt. Actually, a clear age limit was supposed to initiate a rejuvenation process in the party. But in a recent amendment to the constitution, Oli ensured that the age limit with regard to running for political office was only set at 70. In February 2022, Oli will turn 70; before that, of course, he wants to be confirmed as party leader for another five years at the party convention in November and then also be his party's top candidate in the upcoming parliamentary elections in 2022.

For about a year, Oli as prime minister had blocked the legislative work of the people's elected representatives because he could be less and less sure of majority parliamentary support for his increasingly abstruse policies. With the help of the president, who was compliant with him in every respect, laws were no longer passed by parliament, but were signed by Oli and then by the president in the form of ordinances. Oli's latest coup was the second dissolution of the House of Representatives despite an explicit interdict by the Supreme Court. In doing so, the PM and President knowingly and single-mindedly disregarded the fact that a majority of the members of the House of Representatives had expressed in writing their support for replacing Prime Minister Oli with Sher Bahadur Deuba. Only another Supreme Court ruling could put an end to their unconstitutional action.

So, Deuba has been Prime Minister for three months now. On 18 July, he was confirmed in office by a narrow two-thirds majority of MPs in a vote of confidence. What has changed since then? In short, remarkably little. It was clear that Deuba's power would depend on support from several opposition parties or party factions.

In his vote of confidence, he had even received some votes from the Oli faction of the CPN-UML. At that time, the Supreme Court had explicitly ruled out negative consequences for voting in a way that deviated from the party line. But after that, the Political Party Act of 2017, in which top politicians had given priority to a party line constraint over a free vote of conscience by MPs on votes, was again in effect. In the worst case, the party leadership can revoke the status of MPs who disobey the party leadership's voting instructions. All that is needed is a simple notification to the secretariat of the House of Representatives. In order for a party's faction to split from the parent party without the MPs losing their parliamentary status, it had to get at least 40 per cent of the MPs behind it.

This arrangement was critical for Madhav Kumar Nepal's UML faction MPs. They could not support Deuba, nor could they possibly agree to an amendment to the Political Party Act in parliament. However, without such an amendment, they could not separate.

In this situation, Deuba resorted to the method previously practised by Oli and rightly criticised harshly. Deuba abruptly ended the session of the House of Representatives, changed the number of MPs required for a party split to 20 per cent by ordinance signed by the president, and reconvened the parliamentary chamber. Shortly after, the faction of MK Nepal split as CPN-US (Unified Socialist). As the opportunity was favourable, the faction around Mahanta Thakur also split from the Janata Samajbadi Party-Nepal (JSP-N), which also supported Deuba, under the name Loktantrik Samajbadi Party (LSP). Soon after, the Deuba government withdrew the ordinance amending the Political Party Act, so the law is again in force in the form it was before the party splits. Deuba had, after all, achieved what he wanted. With the parties supporting him, he could now hope for the necessary majority of MPs in votes. But this had nothing to do with democracy and constitutional procedure.

Even after this "clarification" of the majority situation, however, it was to take weeks before Deuba could complete his rudimentary cabinet - four ministers had been sworn in together with him, and later Narayan Khadka was also added so that he could represent Nepal at the United Nations General Assembly. The reasons now lay in the dispute between the coalition partners over the respective number of ministerial posts and the division of the portfolio.

It was only 88 days after he was sworn in that Deuba was able to complete this process. His cabinet now comprises 25 people, 22 ministers and three ministers of state. His NC has nine ministers and one state minister, while the CPN-MC, as the second strongest coalition party, has five ministers. The CPN-US and the JSP-N each have four ministers and one minister of state; after protests, the NC had given another ministerial post to the CPN-US.

The fact that there are five women in the cabinet this time can be seen as a positive development to a limited extent. This corresponds to a share of 20 percent. This is the highest figure, at least since the Council of Ministers was limited to a maximum of 25 persons by the new constitution. However, Nepal has set itself a target of at least 33 per cent women at all levels of the state, so this is still a long way off.

The high proportion of members of the Newar caste of the Shrestha is striking. They make up about one percent of the population. As Newars, they actually belong to the Janajati groups, but in the Hindu hierarchical thinking of the state elite on the basis of the Muluki Ain of 1854, they are classified as Tagadhari (bearers of the sacred string), to which above all the Bahun, Thakuri and Chhetri belong. Including the Shrestha, the Council of Ministers once again includes 16 Tagadhari (64 per cent, share in the total population around 30 per cent). In this respect, therefore, little has changed compared to previous governments. The Janajati are only reasonably represented according to their share of the population if the Shrestha are also assigned to them. The Madhesi are only involved through the JSP-N and are also slightly under-represented. Surprisingly, once again there is a Dalit as a minister (through the CPN-MC) Since about 12 per cent of the population is Dalit according to the 2011 Census, this continues to be an extremely blatant exclusion.

Of course, it is difficult to put social participation in the Council of Ministers in relation to social shares. In view of the traditional imbalance, however, one can still speak of a continuation of the previous personnel policy. At most, it is still noticeable that the share of Bahuns in the Council of Ministers has declined significantly compared to the Oli government, although they continue to be overrepresented. Perhaps this is also related to the fact that the prime minister himself is a Chhetri this time. Given their population share, to have not more than two Bahuns in the Council of Ministers would be appropriate.

The completion of the cabinet was overshadowed by another affair. Even before the final nomination and swearing-in of ministers, there were strong rumours that Chief Justice Cholendra Shamsher JB Rana was trying to gain influence over the composition of the executive. There were already strong protests from the media, civil society and lawyers about this mixing of the judiciary and the executive.

Unfortunately, the ministerial list reinforced these initial fears. Gajendra Bahadur Hamal, a brother-in-law of the Chief Justice, was appointed Minister of Industry, Commerce and Supplies. He was not even a member of parliament and came from the district level of the Nepali Congress, so if in doubt, he would have had to become a member of parliament within six months if he wanted to retain his post. Another shadow fell on him because he had clearly advocated a return to the Hindu state in the past. But he is not alone in this in the NC; even general secretary Shashanka Koirala has repeatedly expressed this view. In view of the escalating turmoil, Hamal resigned from office on the second day after his swearing-in.

There is fierce criticism over the composition of the Council of Ministers both within the NC and the JSP-N. Deuba, in any case, has already amply demonstrated that he has not changed compared to previous terms. Clearly, he is well on his way to his fifth failure as prime minister.

(5 July 2021) Constitutional crisis : Can it be solved?

Corona infection numbers may temporarily decline. However, in view of the unchanged low tests, the lack of vaccines and the global developments, it is to be feared that a third wave will soon hit. The vaccination optimism spread by Prime Minister Oli seems misplaced.

Meanwhile, the political situation is escalating. The Supreme Court has already rejected unconstitutional measures of the Oli government in various cases. Perhaps outstanding is the decision that the personnel change in the Council of Ministers was clearly defined as unconstitutional, thus reducing the Council of Ministers to five members. Oli could have easily read this in Article 77 (3) of the Constitution before making his decision. Presumably, however, he does not see himself as an interim prime minister at all.

Yet Oli should not even be an interim prime minister after the elected MPs of the people in the House of Representatives withdrew their confidence in him. Due to the disunity of his political opponents, no alternative prime minister could initially stand for election. Therefore, President Bidya Devi Bhandari appointed Oli to continue in office as interim Prime Minister. As such, according to Article 76, he would have had to seek another vote of confidence in the House of Representatives within 30 days. Had he lost this one too, his time as prime minister would have been history.

However, the situation changed within a few days with the nomination of a new candidate for prime minister through a list signed by 146 of 265 possible MPs. Realising that he no longer had a chance to maintain his power through legal means, Oli staged a coup with the active support of President Bhandari. Oli declared that he had even more MPs behind him than Sher Bahadur Deuba, the candidate of the opposition forces, of course without a list of signatures, because this was not possible at all in terms of numbers.

Bidya Devi Bhandari declared the situation as unclear, although she only had to ask the House of Representatives for a vote. In order to avoid any more opposition from the House, she, in consultation with KP Oli, dissolved the parliamentary chamber again, set new elections for November 2021 and reappointed Oli, who already had lost the confidence of the people's representatives, as interim prime minister until these elections. In explaining this action, Oli cited contradictory or unclear provisions of the Constitution and the Political Parties Act. Oli claimed that in a democracy, elected representatives are not allowed to vote according to their conscience, but must respect party discipline. In other words, according to Oli, democracy is not a rule of the people, but a rule of the parties. This is complicated by the fact that all of Nepal's political parties lack democratic structures and processes. They are all controlled by a very small group of mostly male Bahuns (recruited from six percent of the total population). These small party elites determine party policy and the voting behaviour of their MPs.

Even more serious is the fact that the respective party leaders are given an almost absolute power. All major parties are characterised by factionalism. As a rule, the party chairman is the top politician who has the most members behind him at the two highest party levels. The party chairman is then largely free to decide on personnel appointments as well as on the party's political stances. Resistance comes at most from the other factions within the party if he does not take them sufficiently into account in personnel policy.

In this sense, KP Oli sees himself as an almost absolutist ruler over his CPN-UML. His "world view" came into crisis when last year many MPs of his then still united party NCP opposed him and eventually even wanted to replace him as chairman and prime minister with another person from his party. This situation was aggravated when the Supreme Court annulled the merger of CPN-UML and CPN-MC. This meant that the CPN-UML was still the strongest party in parliament, but had lost its absolute majority. This majority was further reduced when the intra-party factions of MK Nepal and JN Khanal continued to oppose Oli and flirted with supporting a joint opposition prime ministerial candidate. Some of them then also signed the list submitted to the president.

Since then, Oli has been clamouring that it is undemocratic for MPs of his party to disregard his directives as chairman and support the opposition candidate. This aspect will also play a role when the Supreme Court has to decide in the next few days on the renewed dissolution of parliament and the machinations of Oli and Bhandari.

It is to be hoped that the Supreme Court will decide in favour of preserving democracy, the constitution and the rule of law. It will not be able to avoid better defining the understanding of democracy. It is also not acceptable for the Supreme Court to make the opposition candidate prime minister as is demanded by some lawyers on the plaintiff's side. This is not a task of the court, but of parliament. The Prime Minister must be elected solely by the elected representatives of the people by secret ballot and without party coercion. This alone is democracy! The Supreme Court should therefore order an immediate restoration of the House of Representatives..

This is a personal analysis of the legal situation. The bottom line, however, is that the question remains whether Nepal will find its way back to political rationality without new elections. Without a radical democratisation of the parties and the status of MPs, a weeding out of the failed old political guard and a much better social inclusion based on federalism and secularism, however, new elections will not change much .

(24 May 2021) Proposals for an immediate rescue attempt of the people, the constitution and democracy Step 1 : The Supreme Court has already made it clear to KP Oli and President Bidya Devi Bhandari that a prime minister has no right to dissolve the House of Representatives for the sole purpose of retaining power, but must adhere precisely to the provisions of Article 76 of the Constitution. It should therefore be easy for the SC to immediately confirm this to the two of them once again. The utter disregard for the pandemic suffering of the people on the part of the Oli government alone calls for utmost urgency. To seek elections in this situation borders on attempted manslaughter. Oli, but certainly also the leaders of the other parties, have already contributed greatly to the renewed escalation of the pandemic with their calls for mass meetings on the streets at the beginning of the year. Step 2 : After the SC has restored the House of Representatives as soon as possible, the opposition must immediately, and without further discussion and infighting in parliament, move a motion of no confidence against Oli and elect a new prime minister. Without the opposition taking action itself, Oli will not budge. He has proved that sufficiently. Sher Bahadur Deuba has exposed numerous flaws and mistakes in the past over the course of four terms in office, but he is the leader of the second strongest party in the House of Representatives and Oli must be removed from power immediately to prevent him from doing worse. Step 3 : As small a national government as possible should be formed under the leadership of Deuba, in which the portfolios should be filled according to competence and not according to party affiliation. The priority tasks of this national government should be thoughtful measures to contain and combat the pandemic. In addition, an annual budget must be prepared and passed by parliament without delay. Finally, all ordinances enforced by Oli in bypassing Parliament and signed by the President, must be immediately repealed and, where necessary, replaced by legislation passed by Parliament. Several ordinances enforced by Oli may have long since become invalid under Article 114 anyway, as Oli unconstitutionally prevented their discussion and decision by the House of Representatives during its first session after the reconstitution. Step 4 : If the majority situation in both Houses of Parliament appears sufficient, consideration should also be given to initiating impeachment proceedings against President Bidya Devi Bhandari for her repeated and increasing disregard for her outstanding obligation to respect and uphold the Constitution. Instead, she has blindly supported the man to whom she owes her presidency in the first place in his often unconstitutional and unlawful efforts to maintain personal power. Step 5 : KP Oli has disregarded many requirements of the constitution. These included, for example, the implementation of the federal state and the appointment of many constitutional bodies. In the few commissions that were actually created, he disregarded the Constitution's requirement for an inclusive composition and instead selected in a nepotistic manner. The federal state was actually created to decentralise and contribute to better social and regional inclusion. However, Oli's policy since he took office has meant more of a backward-looking centralisation. He virtually increased his efforts to keep all power under the control of the central government. Above all, there is still a lack of clear fiscal regulations and demarcations, which are an essential prerequisite for greater autonomy of the provinces and the local level in connection with the fulfilment of their intended tasks. With these steps, the national government and the reinstated House of Representatives should be fully busy until the next elections due in autumn 2022. Moreover, many laws are hanging in parliament because Oli has simply not allowed them to be discussed and passed. In parallel, however, the political parties should also make a serious effort by then to finally introduce democratic structures and equal opportunities in their own ranks. How would it be, for example, if at least the already existing, albeit still insufficient, laws in this regard were finally applied? It would also be necessary to make inclusion according to gender and ethnicity mandatory when nominating candidates for the next elections. This should come from the party base and not from the national party leadership. Only then would the people of Nepal finally have a real choice in the election.

(8 March 2021) Has the Supreme Court thought through its latest decision to the end? The SC's decision to judge the May 2018 form of merger of CPN-UML and CPN-MC into the NCP as illegitimate resolves some of the conflicts that have been simmering for weeks between the two factions of this ruling NCP, but at the same time it creates new problems and contradictions. The SC has to face the accusation that it has allowed the decision on the case filed by Rishi Ram Kattel's NCP, which was already officially registered and licensed under that name in 2018, to stew for more than two and a half years. At the same time, the Election Commission must be aware that it should never have registered the ruling NCP under that name at that time, according to the existing law. Already on 14 June 2018, there had been a first complaint against the new registration of the ruling party under the name NCP at the SC. However, that case was about the failure to meet the statutory requirement of at least 33 per cent women. Moreover, despite an appeal by the Kattel group, the EC had reaffirmed its decision on the party name on 26 October 2018. Following Kattel's complaint, the SC called on the EC and the ruling party for comments on 11 December 2018. It seems that the ruling party always had the bonus on its side, although the legal position was clearly in favour of Kattel's party. With its present judgement, the SC has finally done justice, but there are doubts whether the judges were aware of the consequences of their late judgement. The judgement implies that the ruling party is once again considered non-merged, that its original components CPN-UML and CPN-MC have been revived. This, however, has consequences that once again manoeuvre Nepal into an extremely precarious situation. One problem, for example, is that there is a party led by Gopal Kiranti which has since been registered and admitted to the EC under the name CPN-MC. A lawsuit by this party has already been announced. This is also likely to be a problem from a jurisdictional point of view. Does Kiranti's party now have to give itself a new name, although its current party name was unoccupied when it registered? Or must the original CPN-MC now adopt a new name, thereby losing any historical identification? There are also problems within the UML, as over the last year the internal split of the ruling NCP into an Oli faction and a Dahal and Nepal-led faction have caused the boundaries between the original UML and the CPN-MC to shift. There are no longer camps within the ruling party that could be so easily transformed back into a CPN-UML and a CPN-MC according to their early 2018 compositions. PM Oli once again sees himself as the big winner in the whole mess and is already mocking and ridiculing the defecting politicians of his original UML because he believes that they now automatically belong to the CPN-UML again, but that they no longer have a chance to split the party there because they need 40 percent of the party's MPs to do so. However, he fails to realise that his long overdue democratic removal as prime minister by parliament does not require a prior split of the UML. Members of his party may also vote against him in a vote of confidence or a vote of no confidence. This is perfectly normal in a democratic state. However, the SC's decision has solved one problem abruptly: the Election Commission no longer has to worry about the legality, names and symbols of the two factions of the ruling party. On the other hand, as already indicated, the EC will have to face new problems. The Election Commission itself has contributed decisively to this with its wrong decision in 2018. Meanwhile, the old, thoroughly failed top politicians of the parties represented in parliament are once again lacking any political culture and knowledge of democratic rules of the game. On the one hand, Prime Minister Oli, who is still in office, is trying by all means and flimsy moves to prevent the ordinances he has pushed through Parliament, with the active help of the President, from being discussed and then inevitably withdrawn in Parliament. The leaders of the opposition - and that means all parliamentarians except for the small remaining bunch of Oli - must once again be reproached for their continued inability, or rather unwillingness, to put aside their personal interests and ambitions for power and finally put a deserved end to the Oli-archy. What is the use of the completely justified re-establishment of parliament if it is not used for this purpose at its very first session? Nepal quo vadis with these politicians?

(2 March 2021) State and democracy still in danger despite SB decision!   On 23 February 2021, the Supreme Court finally delivered its long-awaited verdict on the constitutionality of Prime Minister Khadga Prasad Sharma Oli's dissolution of the House of Representatives on 20 December 2020 in cooperation with President Bidya Devi Bhandari. The Supreme Court's upholding of the unconstitutionality was a victory for democracy and confirmed for all time to come that Nepal's prime ministers have no right to dissolve parliament purely to satisfy their personal power needs. This breathed life back into the 2015 Constitution, which was thought to be dead after all. Oli's action can be considered a coup d'état.

A constitutionally and democratically oriented prime minister would have drawn the only possible moral conclusion from this verdict and would have resigned. Oli obviously does not belong to this category of politicians. He clings to his office and declares that he will never resign. After all, he is the best and most successful government Nepal has ever had; only he knows where he sees evidence for this. As he did before the court verdict, he ridicules the breakaway faction of his inner-party rivals Pushpa Kamal Dahal and Madhav Kumar Nepal with the greatest possible scorn because they would never manage to win the majority of votes in parliament necessary for his ouster. At the same time, he surrounds himself with the aura of a potential martyr whose life is endangered by his rivals.

Apart from the clear immorality of Oli's behaviour, the question arises how it is possible that a prime minister whose faction only has about a quarter of the members of the House of Representatives behind him is nevertheless not forced to resign by the remaining representatives of the people. The explanation lies in the equally lacking morality and democratic attitude of the opposition leaders. All top politicians are also primarily concerned with personal power, not with the people and the nation, be they called Dahal, Nepal, Deuba, Paudel or whatever. They are all unwilling to put aside their personal ambitions for power to get Nepal's democracy back on track.

A second factor mentioned in this context is the unclear situation within the NCP. Both factions insult each other with accusations that go beyond any framework of politeness and exclude each other from the party. Yet an official split of the NCP has never been carried out. Both factions are demanding that the Election Commission recognise them as the legitimate NCP under that very name and with the electoral symbol of the sun. Although early parliamentary elections are off the table for the time being thanks to the court ruling, at some point the Election Commission will have to make a decision and the two factions will have to make a clear separation.

However, they both clearly do not want the latter, as they are aware that the split is likely to make a parliamentary majority for the communists impossible in the long run, as was the case after the 2017 elections. Although the Nepali Congress (NC), as the main opposition party, has not been able to gain many points despite the Oli government's numerous advantageous proposals, the party is likely to win significantly more direct mandates again if the NCP splits. Oli's then CPN-UML was also just ahead of the NC in percentage vote share in 2017. Already within the NCP, the Oli group is the smaller faction today. Oli's failures on almost all fronts of governance, his authoritarian and in many cases human rights-suppressing policies, and most recently the utterly senseless waste of taxpayers' money through the unconstitutional dissolution of parliament and the forced preparation of early new elections are likely to cost the Oli faction further votes. In any case, if the NCP were to split, the votes in favour of that party in new elections would be split between two parties. This too would probably play into the hands of the NC.

These considerations have now also reached the top politicians of the Dahal Nepal faction. Since it has become clear that neither of the two opposition parties, the NC and the Rastriya Samajbadi Party Nepal (RSPN), is prepared to support a vote of no confidence against Oli in the reinstated parliament as long as the NCP's internal party relations have not been clarified, there have been tentative considerations to restore the NCP's unity after all. But that would mean accepting all of Oli's misconduct and continuing to accept him as prime minister and party leader. That would indeed be a change of mind that would be difficult to convince rationally and democratically minded people in Nepal of.

The very misery of Nepali democracy, which is particularly evident in the current crisis, has a lot to do with the lack of democratic structures in the parties. All parties are extremely centrist and oriented towards a few leaders, who in turn usually form factions within the party over time. Whoever makes it to the top level of the party is almost impossible to get out of it, no matter what he is guilty of and how miserably he fails in the fulfilment of his tasks; all prime ministers of the last few years can be cited as examples here. This is also due to the fact that the lower party levels have hardly any influence on the top party levels. The top politicians decide to a large extent on the composition of the two highest party bodies and are careful to ensure that the proportion of their clientele is maintained there. Even in the nomination of candidates for parliamentary and provincial elections, the decision-making power lies largely with the central party leadership. This is the same for all parties. It also contributes to the fact that at least the upper levels of the party are far from reflecting the composition of society: In extremely patriarchal Nepal, men dominate quite predominantly, especially those from the Bahun and Chhetri circles. Given the aforementioned party structures, it is not to be expected that this will change quickly.

Another significant aspect is the inability to realise justice in relation to past crimes or misconduct, or strictly speaking, the denial of such justice. Here, too, all parties are involved. If one takes the massive international call for justice for the victims of the Maoist insurgency alone, it is clear that many of today's top politicians had to bear responsibility at that time, whether as direct participants such as the former Maoist leaders or as state politicians who were responsible for the deployment and conduct of the security forces.

Only two examples should be mentioned here. Pushpa Kamal Dahal declared some time ago that he was responsible for the deaths of around 5,000 people as the then head of the Maoists. But that does not stop him from continuing to aspire to leading state and party offices. It does not even occur to him to take responsibility before a court.

A second example is Sher Bahadur Deuba, the chairman of the NC and four-time prime minister. He paved the way for the Maoist insurgency when, as prime minister in 1995, he militantly yet unsuccessfully tried to suppress the initial organisation of the Maoist party in mid-western Nepal. In early 1996, he refused to even discuss the 40 demands of the Maoists, although most of them were completely rational and many dealt with the state policy guidelines of the then constitution, which the government paid little attention to. In 2001, Deuba then pushed through the mobilisation of the army against the Maoists, which led to a complete escalation of the conflict. The fact that in 2002 he also called on King Gyanendra to dissolve parliament, thus dealing a death blow to the political system of 1990, is also worth mentioning in view of Oli's current misconduct.

Against this background, it is legitimate to ask whether the current party political leaderships are not mainly responsible for the permanent crisis and the constant setbacks of Nepal's democracy. If one answers this question with a yes, one should discuss how Nepal can move towards a better democratic path. However, it should not be enough to replace the old failed leaders with a new generation. This generational change must be accompanied by a complete renewal of the political parties, whereby in the multi-ethnic state of Nepal, adequate social inclusion is finally needed.

(23 February 2021) Democracy is still alive in Nepal! For a good two months, Prime Minister Oli could pretend that he was an absolute ruler, that he was above the Constitution and any legislation. Like Oli, his closest henchmen and his defenders proclaimed in the Supreme Court that the prime minister had every right on his side. Early elections in April and May would be completely out of the question. Now the Supreme Court has finally delivered its verdict. In the end, it was very quick and unequivocal: the dissolution of parliament and all of Oli's machinations in recent months were unconstitutional. Parliament must be reconstituted and convened within 13 days. This is the verdict that everyone convinced of democracy and the rule of law had expected from the Supreme Court. Thanks be to the court for putting all this in such a clear form. What is missing now is the accounting of Oli as a person. In relation to him, the ruling means that Oli's actions cannot be described as anything other than a coup. This must result in the harshest measures against him personally and also against all those who justified his actions with hair-raising justifications in court. The statements maliciously violated better knowledge. Let us hope that those responsible at the top of the other political parties finally come to their senses and are able to democratically elect a new government into office. It will be their task in the remaining one and a half years to complete the numerous shortcomings of the Oli government with regard to the implementation of the constitution and a socially inclusive and secular federal state.

(3 February 2021)   Even 45 days after the dissolution of parliament by Prime Minister KP Oli and President Bidya Devi Bhandari, the proceedings on the constitutionality of this action continue in the Supreme Court. Meanwhile, the submissions of the lawyers of the plaintiff sides have been completed. Since Monday, the lawyers of the government side have had the floor.

It is striking that the latter, in contrast to the lawyers of the plaintiff side, hardly refer to the constitution in their justification of Oli's and Bhandari's action. This is probably due to the fact that the Constitution does not really provide a justification. Thus, the defenders of the Oli government declare that such action is perfectly normal for a parliamentary democracy. Or they claim that Oli's action was necessary to preserve Nepal's sovereignty and nationalism.

One has to think several times about what lies behind these arguments. According to the constitution, Nepal's sovereignty lies with the people. The representatives legitimately and democratically elected by the people are the members of the House of Representatives. They therefore represent the sovereign people in Nepal's parliamentary system.

Dependent on this House of Representatives is the executive power. The representatives of the people elect a Prime Minister, who then forms a Council of Ministers to carry out and coordinate the official business of the country. To be elected, the prime minister needs the approval of a majority of the MPs within the House of Representatives. If a party has a clear majority in the House of Representatives, that party's top candidate is usually confirmed as prime minister, as provided by Article 76 (1) of the Constitution. If no party has an absolute majority, the candidate additionally needs the votes of one or more other parties, according to Article 76 (2).

When KP Oli was elected Prime Minister in February 2018, his CPN-UML did not have an absolute majority in the House of Representatives. Oli was therefore elected under Article 76 (2) as he was also still elected by CPN-MC MPs who had already formed an alliance with CPN-UML in the elections. Therefore, as required under Article 76 (4), Oli faced a vote of confidence in the House of Representatives within 30 days, in which he received almost 75 per cent of the votes. This whopping majority was further consolidated two months later when the two parties merged to form the NCP. Now, in a parliamentary democracy, it can happen that over time the approval a prime minister receives from parliament or even within his own party changes. This is a perfectly normal democratic process. The reason may be, for example, that the prime minister has pursued bad policies and has not fulfilled his duties in the necessary manner. It can also be that inner-party rivals have their own claims to power and therefore question the office of prime minister. These are all processes that occur in every democracy.

In such a case, it is the task of a prime minister to prove that he or she still has the confidence of the representatives of the sovereign people. In accordance with the basic principles of a democracy, this is done by the prime minister asking the House of Representatives for a vote of confidence. If he wins this, he automatically remains in office and his opponents have failed. If he loses the vote, he is automatically voted out and another candidate must seek the majority of MPs. In addition, his political opponents can also bring a vote of no confidence in parliament on their part. If a prime minister sees no chance of winning the vote of confidence in parliament from the outset, he can of course resign right away. These would have been the only options for the hard-pressed Prime Minister Oli in December 2020 at the latest. In fact, he should have faced these democratic options much earlier in order to avert greater damage to Nepal's state and society, especially in times of pandemic.

But Oli seems to understand and interpret the constitution and democracy differently. He probably sees parliament as representing the sovereign people only until they have elected the prime minister. After that, sovereignty passes to the latter. This is evidenced by Oli's dealings with parliament over the past three years. When parliament was active, important laws were often simply not passed. Time and again, Oli bypassed parliament by issuing ordinances in close cooperation with the president when parliament was not in session. This was easier for him, because then he was not bound by any votes and could push through what he liked.

The amendment to the Constitutional Council's decision-making procedure on 20 December was tantamount to a constitutional amendment by ordinance. The dissolution of the House of Representatives just five days later was a stab in the back for Nepal's fledgling democracy. It turned the constitution's provisions on sovereignty upside down. The Prime Minister, dependent on Parliament and accountable to it in every respect, dissolved the elected body of representatives of the sovereign people to preserve his personal power and impose policies that marginalised his political opponents. The argument of Oli's lawyers now before the Supreme Court that he had no other choice to preserve sovereignty, which is actually that of the people, is probably understood only by himself and his most adamant supporters. And the argument of preserving nationalism bodes ill. For months, Oli has presented himself as a Hindu fundamentalist. That would be the last thing Nepal needs now.

Oli and Bhandari undoubtedly bear the main responsibility for the escalation of the political and constitutional situation. But one should not absolve Oli's inner-party opponents, as well as the top politicians of opposition parties, from a more or less large share of the blame. In particular, in the context of the disputes on the streets and in the media, no real separation is discernible on all sides between the question of the legitimacy of Oli's steps and their own respective ambitions for power.

(10 January 2021)   The unresolved legal situation continues unchanged , while PM Khaga Prasad Sharma Oli continues to intensify his campaign for the new elections he has called for the House of Representatives.  He accuses the four former chief justices, who had clearly declared themselves on the unconstitutionality of the dissolution of parliament, of interfering in an ongoing court case and attempting to influence the Supreme Court. Meanwhile, he himself continues to claim every right to call his action constitutional; that the House of Representatives will not be reinstated under any circumstances and that the elections will be held as announced. But such words from the mouth of the Prime Minister, of course, have nothing to do with influencing the decision of the judiciary.

At the same time, Oli is trying to keep the state apparatus under his unrestricted control. Thus, in order to preserve the appearance of democracy, the winter session of the remaining parliamentary chamber, the National Assembly, was convened on 2 January, but on 10 January Oli had the session ended again after only four meetings. The fact that he spat on the floor of the National Assembly on this occasion makes it clear what he thinks of this democratic institution. Also, why does Oli need a legislature at all when Nepal has such an able and powerful PM? This way, Oli can pass laws, as he wants them, by ordinance and have them signed by his president. He has repeatedly used this as an ideal way in the past almost three years of his tenure.

Meanwhile, demonstrations against Oli's unconstitutional actions (here called so with no hidden agenda of influencing the court out of full conviction) are taking place in all corners of the country. Meanwhile, Oli also likes to have such demonstrators arrested by the police. At his own election rallies, the wearing of black masks is strictly forbidden, as this could be a symbol of protest. Even black breathing masks have to be removed. What does Oli care about protective measures against the spread of the pandemic? Any other kind of demonstration is also prevented at such events. In Dhangadhi, for example, a group of young people were arrested because they wore appropriate shirt inscriptions to remind people of the continuing lack of investigation into the rape and murder of Nirmala Pant and demanded justice. Since the crime, there have been accusations that the highest political circles are deliberately preventing the investigation.

Finally, the camp of the advocates of a return to monarchy and the Hindu state must unfortunately also be addressed. The anniversary of Prithvinarayan Shah's birth is a welcome occasion to remember the founder and military unifier of modern Nepal. While it is true that Nepal owes it to this Shah king that it still exists today as an independent state and has not been absorbed into the Indian Union, it must also be remembered that the policies of Prithvinarayan Shah and his successors are responsible for the system of patriarchy, inequality, exclusion and discrimination that makes it so difficult today to transform Nepal into a modern democratic state.

Significantly, ex-king Gyanendra once again spoke out today, pretending that his main concern was the preservation of the country. What is meant by this was made clear by Kamal Thapa, the chairman of the RPP, when he once again called for a return to monarchy and the Hindu state. Criticism of today's supposedly democratic politicians is made easy for the monarchists these days. Oli and the other so-called top politicians are well on their way to destroying the country. But they are only completing what the monarchy could not complete before. Only a younger charismatic generation of politicians from among Nepali citizens with a commitment to inclusion, democracy and secularism and an aversion to theocracy and overrated political ideologies can save the country!

(8 January 2021) How similar things are : When the US president incites his most diehard supporters to initiate a coup from above against the state and democracy for the purpose of retaining power, statesmen all over the world condemn his action.  Not so PM Khadga Prasad Sharma Oli and his government in Nepal. Why should they, Oli has behaved similarly to Trump after he could no longer hold on to power through democratic means. Trump has the American parliament stormed, which was about to confirm his ouster, Oli dissolves the Nepalese parliament so that the democratically elected representatives of the sovereign people there cannot deprive him of executive power.The latter, by the way, is a legitimate democratic right of parliament. Yet Trump in the US and Oli in Nepal have, in four respectively three years of failed politics, provided ample grounds for voting out or removing from executive power. What is missing in Nepal is a binding decision by the Supreme Court. Despite numerous shortcomings, the Nepali constitution speaks clearly about Oli's actions. Numerous constitutional experts and leading jurists have taken a clear stand. Objections and justifications have already been explained. Why does the Supreme Court not come to a judgement immediately? Every day seems valuable in this case. Democracy and the nascent federal state are in danger of collapsing if the constitutional issue is not resolved quickly. The political parties are already in an election mode, so to speak. Although they continue to protest pro forma against Oli's actions, this seems more like a means to an end. Ultimately, the leaders of the different party-political camps are concerned with personal power. They have always been willing to use any means to achieve this. Thus, Oli travels the country and declares to his remaining supporters at mass meetings (What does he care about the pandemic?) that everything he has done has been done on the basis of the constitution; the new elections are coming as he ordered; this cannot be reversed at all. Thus, Oli also decides on the rule of law of his actions. He does not need a Supreme Court for this. His current journey through the country is already pure election campaigning. Let us hope that he will at least pay for the costs of the trips and the events; they have nothing to do with his PM office.

The Dahal-Nepal faction of the NCP continues to pretend that its primary concern is the withdrawal of the dissolution of parliament. In keeping with the media, its leaders position themselves in a strictly hierarchical order at the forefront of the sit-ins on the streets. However, since it became clear that the other parties are not willing to join them in protest actions, the focus for Dahal and Nepal has also shifted more towards new elections. The visible sign at the moment is the effort to be recognised by the Election Commission as the legitimate NCP with a view to the future. Although the main opposition party NC continues to protest against the dissolution of parliament independently of the Dahal-Nepal group, its leader Sher Bahadur Deuba has already repeatedly expressed that he is hopeful of becoming prime minister for a fifth time through possible new elections, after all he has only failed miserably four times. Meanwhile, Oli as well as Dahal and Nepal are courting Deuba, as new majorities are needed to form a government in the event of a restoration of parliament. One party whose votes could also play a role in this is the Janata Samajbadi Party - Nepal (JSPN), as the third strongest faction in parliament so far. This party is also protesting against Oli's actions, but is also shying away from joint action with the other demonstrating parties.

Of the other parties, the RPP should be mentioned here, although this party seems completely insignificant in view of the election results of 2017. The problem is that this party of die-hards is trying to use the chaos caused by Oli and the NCP to promote a return to monarchy and the Hindu state through mass demonstrations.  Their leaders are proving that they have clearly not understood the history and society of Nepal. The demand for such a step backwards is unlikely to be successful, but it further exacerbates the current chaos. (Tsak Sherpa)

(6 January 2021) The political crisis continues . Today, the Supreme Court began hearing the 13 constitutional petitions that followed the dissolution of parliament by Prime Minister KP Sharma Oli and President Bidya Devi Bhandari. Of the 5 judges of the Constitutional Bench, Hari Krishna Karki has retired. He had been accused of bias as he had served as Attorney General during the first Oli government. The trial is scheduled to resume on 13 January 2021.

Meanwhile, both infighting between the two factions of the NCP at all levels of the federal system and protests by other parties continue unabated. Both NCP groups are showering accusations on each other and trying to damage the other group and push it out of power. For a long time now, this dispute has been endangering the very foundations of the entire state, especially since the leaders of the two factions seem to be mainly interested in their personal ambitions for power.

PM Oli is continually escalating into a defence of the legality of his actions. In the meantime, he is even claiming that this was a purely political measure on which the Supreme Court is not even entitled to judge.

One can only hope that the Supreme Court will reach a verdict on the constitutionality of the dissolution of parliament as soon as possible. In a democratic state, a prime minister has only two options if his government loses its majority: resignation or at least a vote of confidence in parliament. The elected representatives of the sovereign people sit in parliament. Oli owes his office only to the election by this Parliament, which alone has the right to deprive the PM of legitimacy. The dissolution of the House of Representatives, avowedly for Oli's personal retention of power, is therefore tantamount to a coup d'état.

But even if the Supreme Court reverses the dissolution of parliament, there remain legitimate doubts that this parliament will last much longer. The top politicians of the two factions have already destroyed Nepal's democratic system too much. There will be no stable governing majorities either at the central level or in the provinces after a possible restoration of parliament. In any case, the question of legitimacy remains. At the top of all the major parties are ageing leaders, some of whom have already failed several times or whose legitimacy to exercise power is at least questionable because of their political past. As a logical consequence, even if the House of Representatives is reinstated, there will probably be early elections sooner or later. However, with the current, largely over-aged party leaders, even these could be forgotten. Given the large parliamentary majority, the Oli government would have had a unique opportunity to stabilise Nepal politically and advance the country's development. Oli has miserably squandered this opportunity.

Meanwhile, the Corona pandemic continues to affect all aspects of life. But that does not seem to interest the politicians of all parties at all. The daily announced case numbers may seem low compared to western industrialised countries, but the value of the numbers mentioned is doubtful in view of the extremely low number of daily tests. While in most countries of the world the numbers of infections and deaths are steadily increasing or at least have remained at a high level for weeks, the numbers in Nepal continue to fall unabated. And this despite the fact that the Oli government continues to do absolutely nothing to control the spread of the pandemic.

Related Websites: Nepal Research Human Rights Forum Nepal (HURFON) Nepal Research Videos Nepal Research Languages Nepal Observer (ISSN 2626-2924) Hewa-Nepal Sherwa mi

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Assessing seismic gap in adjacent RC buildings post Gorkha earthquake in Nepal

  • Published: 27 June 2024

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research articles of nepal

  • Aviral Upadhayay 1 ,
  • Prem Nath Maskey 2 ,
  • Rajiv Manandhar 1 &
  • Binay Kumar Sah 3  

The purpose of this research is to safeguard neighbouring reinforced concrete (RC) buildings in developing settings from seismic pounding, which can cause damage to such closely spaced buildings. The results of this study help to mitigate the pounding impact that occurs during earthquakes between nearby structures with varying floor numbers and provide valuable insights for constructing closely separated buildings in rapidly growing urban environments. Floor-to-floor pounding is the subject of this research, and the easiest and most efficient way to mitigate the damage caused by this pounding effect is to allow adequate space between the buildings. The study’s objective is to determine the minimum seismic gap between adjacent RC buildings with floors at the same level using three distinct analysis techniques: Response Spectrum Analysis (RSA), Non-Linear Modal Time-History Analysis (NLMTHA), and Direct Integration Time-History Analysis (DITHA) and finally recommend a safe seismic gap value from those three methods of analysis. The effect of the number of bays and storeys on the seismic gap value is also covered in this study. In order to provide suitable gap values, the research models 18 buildings with varying floor numbers and varying bay numbers in X and Y directions in SAP 2000 v 20 and a total of 153 building combinations were generated from those 18 models.

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Aviral Upadhayay wrote the main manuscript.PremNath Maskey guided the research.Rajiv Manandhar prepared all the figures.Binay Kumar Sah helped with the writing format and paper submission.

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Upadhayay, A., Maskey, P.N., Manandhar, R. et al. Assessing seismic gap in adjacent RC buildings post Gorkha earthquake in Nepal. Asian J Civ Eng (2024). https://doi.org/10.1007/s42107-024-01098-6

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Reimagining India-Nepal ties: The decade that was and the road ahead

Author : Shivam Shekhawat

Originally Published The Annapurna Express Published on May 21, 2024

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As the current government in India completes its second stint in power, the timing is opportune to reflect on the trajectory that the bilateral relationship has taken up in the past decade

Reimagining India-Nepal ties: The decade that was and the road ahead

Oscillating between periods of cooperation and setbacks, the India-Nepal bilateral relationship is considered ‘special’ and ‘unique’ by all who observe their dynamics. Thus, the failure of the two sides to maximize their potential and fully capitalize on the factors that make this partnership different is often criticized. In the past decade, under India’s ‘Neighbourhood First’ policy, the focus of the Indian leadership has been on working on the convergences, while preventing the issues of contention from casting a shadow on progress. This approach has found a receptive audience in Nepal as well, with the two sides increasing cooperation. Even as China strives to solidify its presence in the country, Nepal, owing to its strategic location, has (in)voluntarily become a part of the geopolitical churning that is taking shape in South Asia. As the current government in India completes its second stint in power, the timing is opportune to briefly reflect on the trajectory that the bilateral relationship has taken up in the past decade and the course it will adopt in the coming years.

Unprecedented developments

For India, Nepal is an integral part of its ‘Neighbourhood First’ policy. New Delhi has consistently supported Nepal in its developmental endeavors and is the country’s top development partner. This year’s budget saw InRs 700bn earmarked as developmental assistance for Nepal, the second highest amount followed by Bhutan. Beginning with the Indian Prime Minister’s visit to the country in 2014, the two sides have seen a flurry of high-level visits throughout the decade. This is a testament to the consensus on both sides regarding the need to build the relationship further and also a response to the change in the geopolitical environment and the growing cleavages between India and China.

Beginning with the Indian Prime Minister’s visit to the country in 2014, the two sides have seen a flurry of high-level visits throughout the decade.

While the decade began on a positive note with the Prime Minister’s visit, a multitude of factors derailed the progress that was made at the time. The devastating earthquake in Nepal, followed by concerns regarding how Indian media portrayed the aid delivery, the adoption of a new constitution in 2015, the subsequent protests and the alleged economic blockade placed by India cumulatively dented the goodwill that was generated the previous year. At around the same time, China’s expanding presence in the country also complicated the dynamics between the two countries.

Fast forward 2024, while some endemic issues of contention have persisted between the two sides, the priorities have significantly altered for both countries. There is a subtle shift in how both Kathmandu and New Delhi want the relationship to move forward—a focus on pragmatic considerations and working together to enhance cooperation in connectivity and economic integration. Back in 2014, India committed to supporting Nepal with the ‘HIT’ model i.e. the construction of highways, information ways and transmission lines. In the last few years, India has refocused its attention on these aspects of the relationship.

For both India and Nepal, the complementarity that they share in terms of hydropower, i.e. Nepal’s willingness to export it and India’s need for energy has been one avenue in which the two sides have cooperated extensively. At present, as per some estimates, Indian companies have licenses for the generation of 4000 MW of hydropower. Starting in November 2021, India also began to buy Nepal’s hydropower with the latter selling Rs 11bn worth of hydropower to its neighbor between June and Dec 2022. On his maiden visit to India, Prime Minister Dahal oversaw the signing of memorandums of understanding (MoU) on the Arun Hydroelectric Project and the Upper Karnali project. A project development agreement was also signed for the 669 MW Lower Arun Hydroelectric Project. The two sides also inaugurated and laid the foundation stones for new integrated checkposts.

The signing of a power trade agreement during India’s EAM S. Jaishankar’s visit to the country in January this year, under which Nepal will export 10,000 MW of power to India over the next 10 years, is considered a major landmark in the growing partnership between the two countries. This was also discussed during Prime Minister Pushpa Kamal Dahal’s visit to the country along with the Nepal-Bangladesh power-sharing agreement, which will be facilitated by India. Another manifestation of connectivity has been in the sphere of digital connectivity with Indian nationals now able to make payments through the Unified Payments Interface (UPI) starting Feb 2024. This, as evidenced by some analysts, will smoothen the flow of remittances and also give a push for increased tourism in the country.

The signing of a power trade agreement during India’s EAM S. Jaishankar’s visit to the country in January this year, under which Nepal will export 10,000 MW of power to India over the next 10 years, is considered a major landmark in the growing partnership between the two countries.

In trade, India is Nepal’s biggest trading partner with the total volume of bilateral trade reaching Rs 1,134.53bn in the fiscal year 2022-23. It also has the highest FDI stock in the country, close to 33 percent of the overall volume. The transit trade agreement between the two sides was also renewed, revised and signed by the two last year. India’s High Impact Community Development Programs also completed 23 years last year, with New Delhi successfully finishing 475 of the 535 projects that it took up. India’s lines of credit were pegged at $1.65 as of Aug 2023 and 73 percent of the assistance offered by India goes into infrastructure development.

Observers see India’s relationship with Nepal on a strong footing, as the three important components of India’s relationship—security, economy and connectivity—have all seen progress in the past decade. But while there is optimism about the trajectory of the relationship, there is also some caution, with calls for ‘strategic reformulation’ and discarding the ‘roti-beti’ lens of looking at the country. This is because of how the world and the region around them is in a constant state of flux.

The impediments

Despite the progress made in enhancing economic integration and connectivity between the two countries, certain bilateral issues have persisted. The degree to which they can affect the positive momentum in the relationship depends on multiple factors. Recently, a cabinet meeting in Nepal decided to have a picture of the country’s map on the new Rs 100 notes. The map was the one that the then Prime Minister Oli released in 2020, showing the Kalapani, Lipulekh and Limpiyadhura regions as a part of the country. At that time the relations hit a new low. India deemed the decision as  ‘unilateral actions which don’t alter the reality on the ground.’ While there is no denying that the issue won’t have any immediate adverse impact on the positive momentum of ties between the two countries, the act itself and its timing indicate how long-standing issues can suddenly prop up with the potential to dampen the relationship. In a recent lecture, Nepal’s Foreign Minister articulated commitment to resolving bilateral issues through bilateral consultative mechanisms that have been set up for that purpose, based on historical facts. India’s External Affairs Ministry also highlighted that the issues are being discussed through established platforms. So, while the consensus is there on both sides to take this up mutually, the delay allows certain sections to use them for the perpetuation of their power or for making a political point, more often for a domestic audience.

The calls for the revision of the 1950 Treaty of Peace and Friendship, the boundary issue as mentioned above, the report of the Eminent Persons’ Group, and the opening of new air routes are all issues, which have propped up in the conversations between the two countries in the past decade. While for the time being it seems prudent to focus on the positives and create enough trust and goodwill that can then help in addressing the more contentious issues—as has been the sentiment in Nepal as well—a long-term approach will require active engagement on these issues.

The obstacles that delay the completion of projects like the Pancheshwar Multipurpose Project, other concerns related to delay in implementing projects on loans granted by the Exim bank, and assuaging Nepal’s concerns about the rising trade deficit are all issues that should be taken up with the other side.

With China’s growing presence in Nepal, there is a need for New Delhi to recalibrate its options and further push in areas where it has already achieved significant progress. The obstacles that delay the completion of projects like the Pancheshwar Multipurpose Project, other concerns related to delay in implementing projects on loans granted by the Exim bank, and assuaging Nepal’s concerns about the rising trade deficit are all issues that should be taken up with the other side. As Nepal’s then Prime Minister had articulated in 2016, remarking on the country’s ‘historic tilt’ toward India, security and development can’t progress in isolation.

As the growing cleavages between China and the US start playing in the neighborhood, for India and Nepal to strengthen their partnership, it is imperative to rejig the bilateral relationship. The two countries have the potential to build on the positives and adopt a pragmatic approach. However the rather quick changes in government in Nepal and the limits that it imposes on adopting a consistent foreign policy toward India does affect progress. With India on the cusp of concluding the voting for the general elections, one hopes that the two countries sustain the progress that they have made in the last decade and become more open in resolving the issues that plague the relationship.

This commentary originally appeared in  The Annapurna Express.

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  • connectivity
  • cooperation
  • economic integration
  • general elections
  • geopolitical
  • India-Nepal
  • Neighbourhood First policy
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Shivam Shekhawat

Shivam Shekhawat is a Junior Fellow with ORF’s Strategic Studies Programme. Her research focuses primarily on India’s neighbourhood- particularly tracking the security, political and economic ...

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Epidemiology of dengue virus infections in Nepal, 2006–2019

Komal raj rijal.

1 Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu Nepal

Bipin Adhikari

2 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

3 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand

Bindu Ghimire

Binod dhungel, uttam raj pyakurel.

4 Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal

Prakash Shah

Anup bastola.

5 Sukraraj Tropical and Infectious Disease Hospital Teku, Kathmandu, Nepal

Binod Lekhak

Megha raj banjara, basu dev pandey, daniel m. parker.

6 University of California, Irvine, CA USA

Prakash Ghimire

Associated data.

All data pertaining to this study are within the manuscript.

Dengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal.

This study is a retrospective analysis that covers the last 14 years (2006–2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal . Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression.

While endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval ( CI ) 1.5–15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8–438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01–0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time.

Conclusions

There is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.

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Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00837-0.

Nepal has seen the outbreak of several emerging and re-emerging diseases in recent years, including dengue fever, rickettsial fevers, and other vector borne diseases [ 1 ]. The emergence of these diseases has been attributed to ecological changes, climate change, dispersion of mosquito vectors [ 2 ] and human population dynamics [ 1 ]. Nepal has three major ecological zones: the tropical Terai region, a subtropical and temperate mid-hill region, and the subalpine to alpine Himalayan region [ 3 , 4 ].

Dengue fever, malaria, and Japanese encephalitis (JE) are among the most common vector borne diseases (VBDs) in low- and middle-income countries (LMICs) [ 5 ]. The endemicity and overall burden of VBDs in LMICs is strongly related to infrastructural weaknesses, including poor water systems, sanitation, and hygiene; and the health system to respond [ 6 ]. Studies suggest the co-circulation of similar VBDs like dengue and Japanese encephalitis (JE) for years in Nepal [ 7 ]. Recent outbreaks of dengue fever in Nepal in 2019 have alarmed public health authorities with unprecedented spread, morbidity and mortality.

Dengue is a viral infection transmitted by female Aedes aegypti and Aedes albopictus mosquitoes [ 8 ]. The causative agent, dengue virus (DENV), belongs to the genus Flavivirus of Flaviviridae family of single-stranded RNA virus [ 9 , 10 ]. DENV has four main serotypes: DENV-1, DENV-2, DENV-3 and DENV-4 [ 11 ]. Infection with any one of these serotypes likely confers lifelong immunity to that specific serotype [ 12 ]. Infection by a new serotype may result in severe disease [ 13 ]. Most dengue infections (up to 60%) are self-limiting [ 14 ], and are characterized by acute fever, frontal headache, vomiting, myalgia, joint pain, and macular skin rash [ 15 ]. However, some patients may develop life-threatening conditions such as acute dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and (multi-)organ failure [ 16 ]. In the absence of effective vaccines and antiviral drugs, symptomatic treatment and vector control programs are currently the only viable strategies for dealing with dengue infections [ 17 , 18 ]. Studies so far have suggested that timely diagnosis and clinical management with intravenous rehydration are critical to mitigate the severity of infection [ 19 ]. Transmission can be reduced through protection from blood feeding Aedes mosquitoes.

The laboratory diagnosis of dengue is supported by the clinical suspicion followed by diagnostics that include rapid diagnostic tests (RDT), enzyme linked immunosorbent assay (ELISA) and complete blood counts (CBC) [ 20 ]. A CBC profile demonstrating leucopenia, thrombocytopenia, increased hematocrit and liver enzymes are some of the parameters that aid in clinical suspicion [ 20 ]. More specific and sensitive diagnostic tools such as viral isolation and culture, and detection of viral genome by polymerase chain reaction (PCR), are not routinely performed in Nepal [ 20 ]. Moreover, serological tools are used even during epidemic outbreaks, which further limits the proper diagnosis of disease in Nepal, as such tests are not the gold standard and DENV virus may not be detected prior to the development of antibodies, severely limiting diagnosis during outbreaks [ 21 ].

Previous studies from Nepal have explored the seroprevalence in various regions since the first potential outbreak of dengue in Nepal in 2006. Overall seroprevalence of 10.4% (anti-DENV-IgG) was found among suspected cases of dengue fever (DF) and DHF in south-west region of Nepal 2006 [ 21 ]. Seroprevalence studies targeting smaller geographic locations have found 7.7% in Kathmandu in 2007 [ 22 ], 29.3% in south-western Terai between 2007 and 2008 [ 23 ], 9.8% in 2009 in the same region [ 24 ], 12.2% in Kanchanpur [ 25 ], 11.8% Bharatpur and Rapti Zonal Hospital in 2011 [ 26 , 27 ], and 19.3% in Chitwan and Dang in 2013[ 28 ]. ELISA was the choice of technique in all these studies. Rapid diagnostic tests and particle agglutination tests were used for primary screening. In few studies, molecular techniques such as reverse transcriptase PCR were also used [ 20 , 23 ]. Despite of these various methods, seroprevalence in the range of 10 to 30% in Nepal.

Although the Government of Nepal has developed an Early Warning and Reporting Systems (EWRS) to issue warning on potential outbreaks, the response to dengue outbreaks have not been sufficient to prevent outbreaks. In 2019 there was a large dengue epidemic in Nepal [ 29 ], coinciding with outbreaks of dengue and other Aedes -spread diseases throughout much of the tropical world. There are several challenges for prevention and control of dengue infection in Nepal, among which robust mechanism to respond to the outbreak has been constrained by lack of updated epidemiological data. In addition, Nepal has recently entered into a federal system with three tiers of government: federal, provincial and local which lack effective coordination that has adversely impacted the management of human resources, logistic chain management and surveillance [ 30 ]. To mitigate these challenges, the federal system has devised an integrated vector control strategy (that includes diseases such as malaria, and kalaazar), that is currently under preparation. Nonetheless, variation in characteristics of vectors, mechanism of disease transmission and epidemiology may remain as major challenges.

Countering these challenges is critical for designing an effective dengue control and prevention program which largely relies on effective detection of the cases, diagnosis and prevention based on the surveillance data. There are no previous studies systematically exploring the epidemiological trends and distribution of the dengue cases at a nationwide scale. The main objective of this study was to explore the epidemiological patterns of dengue fever since its first outbreak (2006) through 2019 in Nepal so that future public health efforts can be appropriately targeted.

Study design

This study is a retrospective analysis of reported dengue case data available from the Epidemiological Disease Control Division (EDCD), under the Ministry of Health and Population, Government of Nepal. Dengue data were extracted from EDCD record. The data presented in this study represents serological diagnosis using rapid test kit [SD Bioline dengue IgG/IgM antibody up to 2015; and after 2015, SD Bioline dengue duo (dengue NS1 Ag + IgG/IgM), ( SD , Bio line , Korea), IgM ELISA was used] of dengue cases. The data in this study covers a period of 14 years (2006–2019) .

Nepal is a landlocked nation bordering India on the South, East and West; and China on the North. Since the declaration of a new constitution in 2015, Nepal has been divided into seven provinces [Province-1, Province-2, Bagmati Province (Province 3), Gandaki Province (Province 4), Province-5, Karnali Province (Province 6) and Sudurpaschim Province (Province 7)] and 77 districts with area of 147,516 km 2 . It occupies 0.3% of the land region in Asia and 0.03% in the world. Nepal is located between 26° 22′ N to 30° 27′ N and longitude 80° 4′ E to 88° 12′ E. The general landscape of Nepal includes the lowland swamp Terai region at 70 m from ocean level to the highest elevation in the world: Mount Everest (8848 m). Land divisions incorporate Terai, Hills and Mountains. The most recent statistics in 2011 estimated a population of 26.5 million with a development pace of 1.35 individual per annum [ 31 ]. Over half of the population lives in the Terai district of Nepal, where vector borne diseases such as malaria, dengue, Japanese encephalitis, visceral leishmaniasis (kala-azar) fever are endemic.

Data collection

Data on dengue surveillance is collected by the health system infrastructure that includes Health Posts, Primary Health Centers (PHC), District Hospitals, Provincial Hospitals and Central Hospitals. Dengue cases recorded in the health center are collected monthly and are reported to the District Health Office (DHO)/District Public Health Office (DPHO). The information is subsequently reported to the Epidemiology and Diseases Control Division (EDCD) from DHO/DPHO on a monthly basis through the Health Management Information System (HMIS)-reporting mechanism. Besides HMIS, an Early Warning Reporting System (EWARS) is also utilized to record hospital admitted dengue cases and dengue deaths. Population density at the district level was calculated as people per km 2 . District level population counts were derived from the 2011 Nepal Census. We calculated mean elevation for each district using elevation data from the GTOPO30 global digital elevation model (DEM).

Data analysis

Data were first entered in Microsoft Excel 2010 (Microsoft, Seattle, WA, USA) for analysis. Trends in incidence of reported dengue cases and proportions of dengue cases in different province/districts in Nepal (2006–2019) were analyzed. Districts level of dengue cases were available for 2016 through 2019. A map of dengue cases was created for 2016 through 2019. A mixed effects negative binomial regression was used to test for associations between reported case incidence and calendar year, mean elevation at the district level, and district population density. A random intercept was used for district to account for repeated observations within each district across the calendar years. The outcome variable was reported case incidence per 100 000 per year, rounded to the nearest whole number. We hypothesized that incidence was increasing at higher elevations over time and included an interaction term between calendar year and mean elevation to test our hypothesis. Both population density and mean elevation were centered on their mean values and standardized using their respective standard deviations so that a one-unit change in both values corresponds to one standard deviation change.

All maps and map layers were created using QGIS version 3.4 ( https://qgis.org/en/site/ ). The negative binomial regressions were done using R statistical software version 3.5.2.

Annual trend of dengue incidence in Nepal (2006–2019)

The trend of dengue (confirmed by serological test either IgM ELISA or rapid test kit) incidence over the period of 2006–2016 was analyzed (Fig.  1 ). The trends of dengue incidence are presented below in different intervals, ranging from 1 to 4 years.

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Prevalence of dengue in Nepal: 2006–2019

Dengue in 2006

Nepal reported its first dengue case in a Japanese foreigner, imported from India in 2004. Two years later there was an endogenous outbreak in lowland Chitwan district in 2006; with a total of 32 reported dengue cases throughout the country.

Period between 2007 and 2010

From 2007 to 2009, the total number of reported dengue cases was slightly less in comparison to the 2006 outbreak. In 2007, 27 dengue cases were reported from four districts of Terai region. However, there was slight decrease in number of dengue cases; reported 10 from three districts. In 2010 Nepal faced a major outbreak of dengue, with 917 reported cases and 5 reported deaths (2 from Chitwan district, 1 from Nawalparasi and 2 from Rupandehi district) from six districts of Nepal (Fig.  1 ).

Period between 2011 and 2013

In 2011, the number of dengue cases (79 cases) were very low in comparison to 2010. However, there was an expansion in its distribution: cases were reported from 15 districts of Nepal (only 6 districts in 2010 epidemic). There was another dengue epidemic in 2013 and a total of 686 cases were reported from 25 districts of Nepal. There were no reports of DENV-related deaths between 2011 and 2013.

Period between 2014 and 2016

In 2014, a total of 356 dengue cases were reported from 21 districts of Nepal. Out of the 356 cases, 50.8% (181/356) were from Bagmati Province, 35.9% (128/356) from Province-2, 7.3% (26/356) from Sudurpaschim Province, 3.6% (13/356) from Province-5 and 2.2% (8/356) from Province-1. There were no dengue cases reported from Karnali Province and Gandaki Province in 2014 (Fig.  2 ). In 2015, there were only 135 reported dengue cases throughout the country, most from Bagmati Province (76 cases out of 135 cases) and 1 death from Dang District. In 2016, there was another dengue epidemic in Nepal and a total of 1527 dengue cases were reported from 30 districts; comprising all seven Provinces. Only one dengue death was reported from Chitwan District in 2016 epidemic. Province-wise dengue cases from 2016 showed 51.2% (781/1527) from Bagmati Province, 27.4% (418/1527) from Province -1, 15.8% (242/1527) from Province-5, 2.8% (43/1527) from Province-2, 1.5% (23/1527) from Karnali Province, 1.1% (17/1527) from Sudurpaschim Province; and only three dengue cases were reported from Gandaki Province (Fig.  2 ). Among 1527 cases, 44.8% (687/1527) were from Chitwan district (Bagmati Province) and 26.5% (405/1527) were from Jhapa District (Province 1) in 2016 (Additional file 1 : Table S1).

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Province wise dengue cases in Nepal, 2014–2019

Period between 2017 and 2019

In 2017, a total of 2111 dengue cases were reported from 28 districts of Nepal. The number of cases rose by 38% (1527 in 2016 versus 2111 in 2017) in comparison to 2016. Out of 2111 cases, 40.4% (853/2111) were from Province-5, 28.8% (609/2111) from Province-2, 25.7% (543/2111) from Province-1, and 4.5% (95/2111) from Bagmati Province. There were three dengue deaths reported each from Palpa, Chitwan and Makawanpur districts in 2017. In 2018, there were only 811 reported cases throughout the country, most from Gandaki Province (568 cases out of 811 cases). There was a geographic expansion in reported cases, now from 43 districts of Nepal. There were three deaths reported in Rupandehi (two cases) and Makawanpur district (1 case).

In 2019, there was a large dengue epidemic in Nepal, with a total of 17 992 reported dengue cases from 68 districts; comprising all seven Provinces. There were six dengue deaths reported from five districts of Nepal (2 deaths in Chitwan, and one each death in Sunsari, Sindhupalanchock, Kathmandu and Doti) in the 2019 epidemic. Province-wise dengue cases distribution in 2019, 40.5% (7276/17 992) were from Bagmati Province, 24.4% (4379/17 992) from Province-1, 19% (3421/17 992) from Gandaki Province, 13.4% (2414/17 992) from Province-5, 1.5% (276/17 992) from Province-2, 0.8% (152/17 992) from Sudurpaschim Province and very low (0.4%; 74/17 992) from Karnali Province (Fig.  2 ). On district wise distribution, Sunsari District comprised 19% (3431/17 992) followed by Chitwan (18.9%; 3402/17 992), Kaski (15.7%; 2824/17 992), Kathmandu (8.8%; 1589/17 992), Lalitpur (3.3%; 596/17 992) and Jhapa (2.9%; 525/17 992) (Additional file 1 : Table S1).

Spatial distribution and ecological analysis of reported dengue fever case incidence at the district level (2016–2019)

Choropleth maps of reported dengue fever case incidence at the district level (2016–2019) were generated, with case incidence presented as the number of cases per 100 000 people for each year (Fig.  3 ).

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Choropleth maps of reported dengue fever case incidence at the district level (2016–2019). Case incidence is presented as number of cases per 100 000 people for each year

Reported case incidence was much higher in 2018 and 2019, using 2016 as a comparison (Additional file 2 : Table S2). The incidence was approximately five times higher in 2018 (incidence rate ratio (IRR): 4.8; 95% confidence interval ( CI ) 1.5–15.3) and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8–438.4). Population density was not a statistically significant predictor of case incidence. Mean elevation had a negative association with case incidence (Table ​ (Table1). 1 ). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01–0.20). However, the association with mean elevation varied across the years, as is evident from the interaction effect in our model. In comparison to 2016, incidence was greater at higher elevations in 2018 (IRR: 22.7; 95% CI 6.0–86.1) and 2019 (IRR: 9.6; 95% CI 2.6–36.1).

Results from the mixed effects negative binomial regression for predictors of reported dengue fever case incidence at the district level

CovariateIRR (95% s)
Year
 2016Comparator
 20173.1 (0.9–10.8)
 20184.8 (1.5–15.3)
 2019141.6 (45.8–438.4)
 Mean elevation0.1 (0.01–0.2)
 Population density (people per km )1.3 (0.9–1.8)
Year and elevation interaction
 2016 × mean elevationComparator
 2017 × mean elevation1.8 (0.4–7.6)
 2018 × mean elevation22.7 (6.0–86.1)
 2019 × mean elevation9.6 (2.6–36.1)

IRR  Incidence rate ratio,  CI  Confidence interval

Since the first report of dengue fever in 2004 [ 32 ], Nepal has steadily experienced a rise and expansion of cases, with 17 992 cases in 2018/2019 from most districts (68 out of 77 districts). The choropleth maps (2016–2019) of reported dengue fever case incidence at the district level showed dengue incidence was five times higher in 2018 and over 140 times higher in 2019. Such a steady rise and nationwide distribution of dengue makes the disease a national priority with urgent implications for control and prevention.

Trends of dengue cases in Nepal

The overall trend of dengue incidence and its distribution show a rising trend with outbreaks in 2010, 2013, 2016 and 2019 in Nepal. In just last 6 years since the first imported case of dengue in 2004, Nepal has become an endemic country for dengue. Following the outbreak of DF/DHF in India in 2006, a minor outbreak was confirmed in the same year in Nepal [ 21 , 23 ] with 32 cases but no fatalities. All four serotypes of DENV were isolated in the 2006 outbreak from nine districts of lowland tropical Terai whereas the populous hilly districts including Kathmandu and Pokhara were spared from the outbreak [ 20 ]. The primary vector of dengue transmission, Ae. aegypti, was reported from only five districts bordering India implying a possibility of high importation of cases [ 20 ]. A previous study also showed clustering of dengue cases in border districts with India and were attributed to favorable climatic conditions, high population density, and high population movement across the border [ 33 ].

Dengue remained almost latent during the period of 2007 and 2009, until the massive outbreak of 2010 with 917 cases and distribution into six districts. One study conducted in southern Terai during this period showed a high prevalence (29.3%) of anti-DENV IgM [ 23 ]. Subsequent studies suggested lower seroprevalence, one showing a seroprevalence of 9.8% in 2009 [ 24 ] and an extensive cross-sectional study covering southern Terai showing an overall seroprevalence of 12.1% with a high proportion in Kanchanpur bordering India [ 25 ]. These studies showed the high vulnerability and impending epidemic outbreak in the Terai region [ 25 ]. Around 80% of the total confirmed cases were reported from Terai region that showed all serotypes with entomological evidence of both vectors: Ae. aegypti and Ae. albopictus [ 21 ].

The outbreak of 2016 was the result of re-emergence of DENV-1 that recorded 1527 cases, with distribution in 30 districts of Nepal. Two terai districts: Chitwan and Jhapa accounted almost 72% (1092/1527) of all reported cases. Both of these districts have a tropical climate, and border with India which can explain in part the high incidence of dengue cases [ 34 ]. Following the first report of dengue in the highland region in 2010, 3.1% of the total cases, with 0.4% from Kathmandu alone were reported by the end of 2016. The National Public Health Laboratory (NPHL) Kathmandu reported 16.9% (45 out of 266) of patients showing anti dengue IgM antibodies in serum [ 35 ].

Triennial peaks and the expansion in distribution of dengue epidemics in 2010, 2013, 2016 and 2019 are in line with the previous reports from Brazil [ 36 ] and Cuba [ 37 ]. In the subsequent outbreaks, serious complications associated with the dengue infection were not observed as expected and could be due to prevalence of a newer serotype (DENV-2) in the 2013 outbreak [ 38 ]. This could be due to the low virulence of newer strain, or cross-immunity developed due to endogenous infection. Also, the higher mortality and morbidity are associated with secondary infection with another serotype. Antibody dependent enhancement has been shown to be causing severe form of dengue, also known as secondary explosion as is observed in India, Bangladesh [ 39 ]; Vietnam, Singapore and Senegal [ 40 ]. The same mechanism may have a role in the outbreak that occurred in 2016 and 2019 in Nepal; and poses risk for future outbreaks.

Geospatial distribution of dengue cases

In 2010, DENV-1 was the prominent serotype for the epidemic. However, the outbreak of 2013 was solely caused by the DENV-2 [ 38 , 41 ]. This indicated the prevalence of all serotypes with endemicity of DENV as silent threat all over the country. Three lowland Terai districts–Chitwan, Jhapa, and Parsa were again worst hit districts, together constituting 85% of all reported cases in the country. Over the years, the rising incidence of dengue in Kathmandu has countered the presumption that Kathmandu was climatically unsuitable for dengue vectors. Increased urbanization, industrialization together with the climate change may have contributed a conducive ambient environment for Aedes vector mosquitoes [ 42 – 44 ].

The outbreak of 2016 showed both an increase in the number of cases and the distribution of disease to newer temperate zones within Nepal. For instance, temperate hilly zones of Gandaki province began to report cases in 2015 while the outbreak in subsequent year affected Karnali province located in upper hilly region. Also, the outbreak of 2016 marked the geographic expansion of dengue infections in all seven provinces. The emergence and re-emergence of DENV serotypes intermittently in varying manifestations implies the possible burst of severe forms of dengue-related illnesses. Similar mechanism and patterns of DENV infection with multiple virus clades were observed in Indonesia [ 45 ] and Brazil [ 46 ] while circulation of DENV-1 in the same period (2014–2016) was also observed in China [ 47 ] and other South Asian countries: India [ 48 ], Bangladesh [ 49 ], Pakistan [ 50 ] and Sri Lanka [ 51 ]. In our study, dengue case incidence showed five times higher incidence in 2018 and over 140 times in 2019 in comparison to 2016 (Table ​ (Table1). 1 ). The findings of our study are in line with studies reported from Thailand [ 52 ] and Bangladesh [ 53 ].

Dengue poses a serious public health threat and economic challenge globally and in Nepal. Multipronged vector control strategies that are cost effective, sustainable and environmentally friendly are gaining increasing priority. Currently, newer vector control methods such as sterile insect technique, production of genetically modified vectors and paratransgenesis are being studied in various parts of the world. Also, innovative vaccine candidates have been used for the prevention of dengue infections. The use of tetravalent dengue vaccine (CY-D-TDV) has been found to be effective for the treatment of dengue infections [ 54 ]. Nonetheless, there are various constraints and urges the need for a multi-pronged approach including vaccine development [ 44 , 55 ].

Impact of climate change and ecology

There was a steady rise in number of cases and its distribution between the period of 2017 and 2019. The outbreak is remarkable for its spatial and temporal shift in addition to the role of two serotypes (DENV-1 and DENV-2) [ 1 ]. Kathmandu saw the repeated outbreak of dengue and since then experts fear the imminent outbreak of dengue in future. Although the vectors are thought to normally only fly 500 m in their lifetime [ 56 , 57 ], a number of underlying factors such as urbanization, trade and transit from dengue-infested regions and climate change are favoring their spread and potency. Specifically, changes in temperature and rainfall in upland hilly regions and relative humidity in lowland plains are established as contributing factors for rise and distribution of vectors [ 58 ].

The primary vectors: Aedes aegypti and Aedes albopictus— depend upon temperature and precipitation for their growth, survival and feeding behavior [ 59 ] and also affects the vector-human transmission cycle [ 60 ]. Increasing temperature in the region can provide a favorable environment for dengue vectors and its transmission. The latest dengue outbreak of 2019 may have been flared up by unexpected early rains which may have accelerated the outbreak as early as on May 13, 2019 from Sunsari district [ 29 ]. Similarly, annual monsoon season of each year in the country makes ambient room for mosquitoes by its high humidity while the post-monsoon period favors their breeding and transmission by high rainfall and heavy flooding [ 1 ]. Some prevailing findings have suggested the existence of dengue vectors ( Aedes aegypti and Aedes albopictus ) from the tropical lowland to the highland Dhunche, Rasuwa (2100 m elevation) district in Nepal [ 61 ]. This geographical expansion of dengue fever is likely the result of vector habitat expansion, which may be a result of global warming [ 58 ].

Implications for national dengue control program

The government of Nepal has released the national guidelines for the prevention, control, and management of dengue in the country which has focused on vector-control strategies as the best policy to curb epidemics. Despite the guideline, the rising trend of dengue cases and expansion in geographic distribution in almost all the districts of Nepal poses significant challenges. Of the challenges, Nepal can plan through the historical account of dengue epidemiology, rising trend and its spread in the districts. Specifically, the visualization of dengue cases among the districts can also help in categorizing and prioritizing the districts based on the epidemiological burden identified in this study. Also, the dengue control and prevention program can incorporate spatially focused strategies to ensure the preventive measures such as distributing mosquito repellants, clearing of puddles (or water collection around the households), bushy areas, and fumigation. Targeted programs with allocation of resources for treatment and prevention can be planned based on the spatio-temporal distribution of the cases visualized in this study. In addition, integrated vector control programs may benefit from the comprehensive data of dengue cases and its distribution for resource allocation.

Strengths and limitations

This study has consolidated the national dengue data since the first report of dengue in Nepal up to the present. In addition to integrating all the data through epidemiological analysis, this study reveals trends in space and time which can inform the dengue control and prevention program of Nepal. This study has several limitations. Due to resemblance with other symptoms of tropical diseases, dengue cases may have been undetected and overlooked, posing a challenge on reporting [ 53 ]. In our study, the majority of dengue cases were diagnosed by ELISA (IgM/IgG antibody detection) which may have failed to detect dengue virial infection in the early stages and can give false positive result in a patient who had past dengue infections or any other infections by flaviviruses. The study relied on the retrospective data from government’s EDCD which may have missed private sector data and thus may not reflect the true extent of the dengue burden in Nepal. During the outbreaks due to logistic shortages, reporting of the cases were not uniformly confirmed by RDTs, sometimes were based on the clinical diagnosis.

Nepal is experiencing a major increase the burden of dengue fever . While cases were once limited to the tropical lowland Terai region, they now occur at higher elevations and with increasing case loads. Chikungunya and Zika viral infections are both spread by the same vectors, Aedes aegypti and Aedes albopictus . Therefore, there will be chance of spread of these infections since dengue has become endemic. Urgent measures are required to increase the diagnostics and resources to mitigate the epidemic burden of dengue in Terai and peripheral regions. Findings from this study can inform the national dengue control and prevention program in resource allocation and priority setting with implications for future epidemics.

Acknowledgements

The authors would like thank Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu.

Abbreviations

EDCDEpidemiology Diseases Control Division
IRRIncidence rate ratio
VBDsVector borne diseases
LMICsLow- and middle-income countries
JEJapanese encephalitis
DENVDengue virus
DFDengue fever
DHFDengue hemorrhagic fever
DSSDengue shock syndrome
RDTRapid diagnostic tests
ELISAEnzyme linked immunosorbent assay
CBCComplete blood counts
PCRPolymerase chain reaction
EWRSEarly Warning and Reporting Systems
DHODistrict Health Office
DPHODistrict Public Health Office
DEMDigital elevation model
NPHLNational Public Health Laboratory
Confidence interval

Authors’ contributions

KRR, BA, MRB, BDP and PG developed the concept of research work. BG, BD and KRR conceived and designed the study, collected the retro specific data, carried out research works. KRR, BA, MRB, DMP analyzed the data. URP, PS, AB, MRB, BDP and PG provided oversight for the project. KRR, BD, BA prepared the initial draft of the manuscript. KRR, BA, DMP and PG revised the subsequent versions of the manuscript. All authors read and approved the final manuscript.

To conduct this research, no fund was received from any sources.

Availability of supporting data

Declarations.

This study obtained ethical approval from Ethical Review Board of Nepal Health Research Council (Reg No. 496/2020 P).

Not applicable.

The authors declare that they have no competing interests.

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