Submit your Article

Seven of the 10 leading causes of deaths in Nepal are non-communicable diseases, states a 2019 report, indicating that most of the untimely deaths that occur every year can be prevented through healthier ways of living. According to Nepal Burden of Disease 2019, a study report by the Nepal Health Research Council (NHRC) and the Ministry of Health and Population, non-communicable diseases have caused most deaths in Nepal. Of the 193,331 estimated deaths in 2019, 71.1 per cent were attributed to non-communicable diseases, 21.1 percent to communicable, maternal, neonatal and nutritional diseases and the remaining 7.8 percent were due to injuries, the NHRC report has revealed. Cardiovascular diseases Cardiovascular diseases ranked on top as the cause of death of people in Nepal with a 24 percent contribution to the total number of deaths. Deaths attributable to cardiovascular diseases were 26.8 per cent in males and 20.7 percent in females. Chronic respiratory diseases Chronic respiratory diseases come second among the top causes of deaths in Nepal with 21.1 percent of total deaths attributable to them, per the NHRC report. The proportion of deaths attributable to chronic respiratory diseases was 18.9 percent in males and 23.8 percent in females. Neoplasms Neoplasm is an abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should. Neoplasms may be benign (non-cancerous) or malignant (cancerous). Deaths from neoplasms rank third among the causes of deaths in Nepal. Malignant neoplasm (cancer) was responsible for 11.2 percent of total deaths in both sexes, 10.8 per cent of total deaths in males and 11.6 of total deaths in females, per the report. Respiratory infections and TB A communicable disease caused by a type of bacteria called Mycobacterium tuberculosis, tuberculosis (TB) most commonly affects the lungs (pulmonary tuberculosis), but it can also involve any other organ in which case it is called extra-pulmonary tuberculosis. TB was responsible for 3.9 per cent of total deaths in both sexes, 4.8 per cent of total deaths in males and 2.8 percent of total deaths in females in the reporting period, goes the report. Digestive diseases Ranked fifth among the killer diseases, digestive diseases are another leading cause of deaths of Nepali people, As per the report, digestive diseases are responsible for 5.9 per cent of total deaths in both sexes. Genderwise, they account for 6.4 per cent of total deaths in males and 5.2 per cent in females. Diarrhea is one of the common digestive diseases in Nepal, the most common of illnesses among children. It continues to be a major cause of childhood morbidity and mortality in Nepal. Maternal and neonatal disorders According to Nepal Demographic Health Survey 2016, maternal deaths are a subset of all female deaths; they are defined as deaths that occur during pregnancy or childbirth, or within 42 days after the birth or termination of a pregnancy, but are not due to accidents or violence. The most common underlying causes of neonatal death are respiratory and cardiovascular disorders of the perinatal period (the timeframe from one year before to 18 to 24 months after the birth of the child) and complications of pregnancy, labor, and delivery. Maternal and neonatal diseases were responsible for 5.2 per cent of total deaths in both sexes, 4.5 per cent of total deaths in male and 6.1 per cent of total deaths in females, the NHRC report says. Diabetes and kidney diseases Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Diabetes and kidney diseases were responsible for 4.4 per cent of total deaths in both sexes, 4 percent of total deaths in males and 4.9 per cent of total deaths in females during the reporting period, the report noted. Unintentional injuries Deaths due to injuries such as falling from trees or cliffs are more common in young adults. Injuries leading to lives lost in 2019 included self-harm, falls, drowning, pedestrian road injuries and motorcyclist road injuries. Unintentional injuries were responsible for 4.2 percent of total deaths in both sexes, 4.5 per cent of the total deaths in males and 4.2 per cent of total deaths in females, the report noted. Enteric infections Enteric diseases are caused by microorganisms such as viruses, bacteria and parasites that cause intestinal illnesses. Enteric infections are a major cause of morbidity and mortality in low-income and middle-income countries, particularly among children younger than five years, the World Health Organization states. As per the report, enteric infections accounted for 3.6 per cent of total deaths in both sexes—2.5 in male and 4.9 in female.  Neurological disorders Neurological disorders range from epilepsy to Alzheimer’s disease, from stroke to headache. They also include brain injuries, neuroinfections, multiple sclerosis and Parkinson’s disease. Neurological disorders accounted for 2.3 percent of total deaths in both sexes—1.9 in male and 2.8 in female.   Proportion of deaths due to different causes Rank                        Disease                                        Both    Male    Female 1                              Cardiovascular disease               24    26.8 20.7 2                              Chronic respiratory disease           21.1 18.9 23.8 3                              Neoplasms                                   11.2 10.8 11.6 4                              Respiratory Infections and TB       8.4   8.7   8.1 5                              Digestive diseases                  5.9   6.4   5.2 6                              Maternal and neonatal disorders   5.2   4.5   6.1 7                              Diabetes and kidney diseases       4.4   4      4.9 8                              Unintentional injuries                 4.2   4.5   4.2 9                              Enteric infections                       3.6   2.5   4.9 10                            Neurological disorders                   2.3   1.9   2.8

An economic slowdown automatically leads to a decline in revenues. This results in a budget deficit, which has not only made it difficult to maintain public expenditures, but also resulted in excessive increment in socio-economic inequalities. There has been uncertainty about expenditures used for providing health services and food for saving lives, and the budget allocation for investment in physical infrastructure and education. The devaluation of Nepali currency against the US dollar has increased loan obligations, and financial space has shrunk, with foreign aid decreasing due to a global crisis. Unemployment and poverty have soared. Allocating budget for social security in the context of shrinking economic sources is easier said than done, compounding policy complexities. It is challenging to propose the annual budget for the fiscal year, 2023/24 amid challenges posed by the macroeconomic indices and the economy advancing toward a crisis. The onus is on the government to fulfill the immediate needs and keep the dream of future prosperity intact despite adversities. The present situation calls for making plans with caution and taking decisive policy initiatives. To fight the recession, the government should increase expenditure under the financial incentives in physical infrastructure, health, education and social security. Providing financial incentives is not a recommendation that takes credits at a time when there is insufficient money, but such investment help create jobs, boost economic activities and provide assistance to affected groups. So, it is crucial for the Ministry of Finance and the central bank to reach an understanding for saving the economy by forgetting ideological differences. Budget should prioritize tax reforms at a time when there is a delay in economic rehabilitation and a long recession ahead. Such reforms may be able to collect required revenues while taxes becoming progressive and efficient do not affect economic activities. Strengthening the private sector is limited to rhetoric only. We lack even a single exemplary project that is based on the public-private partnership. There is a need for introducing the program directed by the budget for groups affected by recession for their livelihood by reducing administrative hurdles, and carrying out and implementing required reforms mentioned in the budget. These groups are such that they cannot speak up for themselves, and there is no one to speak up for them. The thing that we pretend not to understand even after understanding it is that we hesitate to invest in human capital in the name of the unavailability of resources. Factors like education, health service and social service not only bring qualitative reforms in the lives of people; they also increase productivity of human resources. It means investing in such sectors will help in economic development in the long run. Our economy is based on limited areas, and the credibility of these areas cannot be estimated. For instance, there is a lack diversification in our foreign trade. It means the main reasons for recession in Nepal are its structural shortcomings and incapability for work execution apart from other global challenges and complications. It can encourage regulatory reforms and budget directed investments by including mentioning these issues in the budget. In the past few years, climate change has been a serious problem in Nepal. Factors like flash floods, rising temperatures, soil erosion and glacial lake outburst floods have increased food insecurity and poverty. The budget this time should manage resources for the climate change adaptation strategy to reduce the losses taking place due to the climate change. For this, things like renewable energy, sustainable agriculture development and the reduction of disaster risks should be prioritized.  Budget is always brought with hard work and amid blame-games in the parliament. Despite this, 60 percent of capital expenditures remains unused. The budget this time should focus on some theoretical principles in order to address this problem. While allocating budget, there is a need to identify sectors with higher potential. The areas for which the budget is allocated should be such that they can help in the economic development, create job opportunities and have long-term impacts on national development. There is a need to conduct a study on the ways of merits and demerits of the proposed sector to calculate returns on investments. This policy will ease the prioritization of projects. Besides, it is equally necessary to introduce a risk management plan. Each investment involves some risks like political protests, economic changes and project failure. There is a need to prepare a plan to reduce problems by estimating such possible challenges in the process of preparing a budget. As our experiences have shown, it requires creating a timeline for implementation if we actually want to increase capital expenditures. It will be easier to work out and implement alternative solutions if possible political, economic and other challenges of the project are properly assessed. Trust of service-seekers in a project increases only when there are manageable and proper consultations among government employees, business leaders and concerned communities. There should be conceptual clarity and transparency on rationale for increasing capital expenditures, plans to utilize income sources, substantial benefits of investment and ways to manage required capital even by adding an index in the budget. There is a need to mention in the index the methodology elaborating how effectively and with what efficiency the sectoral budget allocation can be spent. It will be easier to get required help from international organizations, which have been providing technical and monetary assistance, by winning their confidence by maintaining close relations with them. Our main aim is to increase people’s trust in the budget, and make people feel the results of its implementation. Special focus should be on creating a technical and legal mechanism to control corruption in projects. For collaboration with the private sector, encouraging efforts like offering tax discounts and providing subsidies for certain projects should not be off the table. It is necessary to remove the bureaucratic red tape for creating a more conducive environment for investment. Finally, the Ministry of Finance, through the budget for the next fiscal year, should seek to strike a balance between the revival of the national economy and financial stability. The author is an economist and a former Nepali ambassador

I’m a 21-year-old woman and I’m confused about my sexual orientation. I think I like both men and women. But accepting that is difficult, especially because our society isn’t open about these things. I’m afraid of exploring my sexual orientation and how I feel about it. I push people away because I’m afraid that my feelings won’t be validated or that people will judge me. I haven’t even been able to share this with my family and friends. I just need some helpful advice on how I can overcome this fear and live a life where I’m not hiding who I truly am. Please help!—A confused soul  Answered by Kapil Sharma, counseling psychologist, Nepal Institute of Mental Health I understand that discussing your sexual orientation can be difficult. It’s not something our society openly talks about either. It’s natural to feel anxious and afraid of judgment. This is something many people frequently go through because of the social taboos and stereotypes in our society. But at the same time, you must realize that your happiness and sanity matter the most.  One of the things that’s bothering you is the uncertainty you have when it comes to your sexual orientation. You might sometimes wonder why you’re acting a certain way and might not have any answers. But then you are unable to share how you feel with anyone. So before anything else, I think it’s important to clear out those confusions.  But the thing is, the confusion won’t go away unless you talk about it. Maybe you aren’t comfortable talking about it with your friends or family. But if there is anyone who you think will understand what you’re going through, and will acknowledge your feelings, talk to them. If not, you can start by attending psychoeducation sessions with a mental health professional. There, you can learn facts about gender identities and sexual orientation that will help you understand what you’re going through.  Uncertainties will not only affect your mental health but also take a toll on your relationships with others. For instance, not being clear about what you want in a romantic relationship might compel you to push away everyone around you, especially to avoid having feelings towards them. But that will only make you lonely and your mental health will get worse. So doing everything you can do to get rid of that uncertainty is important. And that includes accepting yourself for who you are. Our society has forced us to internalize shame and guilt when we don’t fit into their standards. And there are going to be instances where your emotions get triggered despite you accepting yourself. So, it’s important to know what those triggering factors are and how you can deal with them. For that, you will need a supportive environment as well as people around you.  If it helps, I think you should attend talk sessions or events where people going through the same as you share their experiences. You’ll know that you aren’t alone in this. When you’re comfortable, you can share your experiences too. But if it gets too difficult, I think it’s best to seek help from a professional. Getting the right kind of therapy can assist you in navigating and overcoming all your difficulties.

The monsoon season is just three weeks away, and the government is yet to take the measures to prevent and respond to potential disasters. According to the Department of Hydrology and Meteorology (DHM), the pre-monsoon period rains will begin in approximately two weeks. Typically, the monsoon season begins in the second week of June and lasts until September. The Terai region, which includes 22 districts, is highly susceptible to floods, while the hilly districts are vulnerable to landslides. However, the government lacks specific records regarding the presence of children and elderly individuals in the flood-prone areas of the country. The National Disaster Risk Reduction Management Authority (NDRRMA), the designated agency responsible for addressing natural disasters, has not yet formulated concrete plans to effectively handle the monsoon-induced disasters. “We are busy holding meetings to prepare for disaster management,” says Dhruba Bahadur Khadka, the spokesperson for NDRRMA. Had the authority been more foresighted, such meetings should have been held months ago. Data compiled by the NDRRMA shows that over the course of the past 12 years, floods have claimed the lives of 876 people, with an additional 563 reported missing and 209 injured. Similarly, landslides have resulted in the loss of 1,483 lives, with 347 people still missing and 1,224 others injured. Additionally, heavy rainfall has caused the death of 126 individuals, while two people remain unaccounted for, and 336 have been injured. The monetary damage caused by the monsoon disasters over the past 12 years is estimated to be Rs 20bn. Officials at the Ministry of Home Affairs acknowledge that despite witnessing significant loss of lives and properties, their preparations for monsoon disasters have remained poor. “We have been unable to effectively mitigate the impact of these disasters due to inadequate resources and management,” says an official at the ministry. Jitendra Basnet, joint secretary and spokesperson for the ministry, says the ministry has recently conducted coordination meetings with stakeholders to prepare for the upcoming monsoon season. “We are in the process of formulating plans,” he says. “We have directed the Nepal Police and the Armed Police Force to deploy personnel across all districts during emergencies. However, we face limitations in terms of budget, resources, and equipment.” According to Basnet, the NDRRMA will undertake all necessary tasks in this regard. Khadka, the spokesperson for NDRRMA, says they are currently gathering information regarding the availability of equipment such as tents, ambulances, ropes, and other necessary resources in districts and local bodies. “We have recently acquired eight mass-casualty ambulances. We have allocated one to each province and one to the federal government,” he says. “We have also trained 25 divers to conduct search and rescue.” The government has yet to initiate a hazard mapping survey to gather data on land elevation, geological structure, house construction, and the number of children and elderly individuals residing in vulnerable areas. “Although we had planned to conduct the survey at 134 local units, we have only managed to do so in about a dozen local units so far,” adds Khadka. Meanwhile, the NDRRMA has implemented an audio-visual notification warning system for floods in six districts: Banke, Bardiya, Kailali, Kanchanpur, Rautahat, and Saptari. “This siren system, equipped with audio-visual flood warnings, has been installed at 34 locations across 13 local units in these six districts,” says Rajendra Sharma, coordinator of technical team at the NDRRMA. The NDRRMA officials acknowledge that the current preparations are not sufficiently robust to effectively address the risks posed by monsoon disasters. They say that local bodies would provide support by utilizing public buildings as temporary shelters during emergencies. Furthermore, a new regulation has been introduced in the current fiscal year, requiring districts to maintain a minimum balance in their disaster management fund. According to the regulation, a mountainous district should have a minimum of Rs 1.5m in its disaster management fund, a hilly district should have Rs 2m, and a Terai district should have Rs 2.5m. However, the NDRRMA has not been monitoring whether the districts have been maintaining the disaster funds. The impact of rain-related disasters extends to agriculture, livestock, and public infrastructure. The NDRRMA suggests that the federal government should contribute 50-60 percent to the disaster management budget, while provinces can provide 30 percent and  local units can chip in 10-20 percent. Currently, the government provides compensation of Rs 10,000-20,000 per affected household in flood-affected areas and Rs 200,000 per deceased individual. However, in cases of multiple deaths within the same family, only Rs 100,000 is provided for the second or subsequent deaths. The Ministry of Home Affairs categorizes disaster management into four main areas: risk reduction, rescue operations, relief distribution, and reconstruction. Multiple ministries, organizations, and development partners are involved in these efforts. The clusters responsible for disaster management include ministries such as Agriculture and Land Development, Health and Population, Water Supply, Education, Science and Technology, Women, Children and Senior Citizens, Urban Development, Home Affairs, Federal Affairs and General Administration, and Communication and Information Technology. Moreover, development partners and organizations, such as FAO, WFP, WHO, UNICEF, UNFPA, NRCS/IFRC, IOM, UNDP, and RCO, play co-leading roles in coordinating and assisting with disaster management initiatives. The NDRRMA has a fund of Rs 1bn disbursed from the Prime Minister’s Fund for Natural Disaster Rescue and Relief. However, the NDRRMA did not provide the details of expenses on reconstruction, risk reduction and relief distribution. The development partners had pledged to provide Rs 1.51bn in grants last year, but only Rs 960m was actually released. “The government had provided us with Rs 95m. Of the amount, Rs 40m was spent on salaries while Rs 50m was disbursed as grants for reconstruction,” says Khadka. The government has proposed a budget ceiling of Rs 194.04m for the NDRRMA in the upcoming fiscal year. However, officials express concerns that the proposed ceiling is inadequate to effectively address the plans for disaster mitigation and development. The NDRRMA has formulated the Disaster Risk Reduction National Strategic Workplan for the period 2018-2030. Despite having comprehensive plans, the lack of sufficient funding hinders the authority’s ability to tackle natural disasters effectively. Anil Pokharel, the CEO of NDRRMA, says there is a significant shortfall in funds for disaster risk reduction measures, which are crucial in mitigating disasters. “We have just begun planning for disaster risk reduction due to the prevailing financial crisis. An estimated $600m is required for the development of pre-information systems, and an additional $200m is needed for preparedness measures by the year 2030,” he says.