For an administrative unit to be a municipality, it has to have a hospital with at least 25 beds, according to the Local Government Operation Act 2017. Only seven municipalities in Province 5 meet this criteria. The remaining 25 municipalities do not have a hospital with 25 beds; 10 of them have a 15-bed hospital each. There is no new initiative to add beds. 

Universal Medical College in Siddharthanagar municipality in the district of Rupandehi has 50 beds. So do Crimson Hospital in Tilottama municipality and Devdaha Medical College in Devdaha municipality. These are private medical colleges. 

Prithvi Chandra hospital in Ramgram municipality in the district of Nawalparasi also has 50 beds. But Lumbini Sanskritik municipality and Sainamaina municipality (both in Rupandehi) are without hospitals, compelling locals to travel elsewhere for medical treatment. 

The plan to make Pyuthan Hospital in Bijuwar a 50-bed hospital has been gathering dust for over a decade. Patients from Pyuthan as well as from the neighboring districts of Gulmi, Rolpa and Arghakhanchi visit this hospital, and many of them struggle to get beds. Those from areas bordering India also have to travel across the frontier for treatment. 

The Ministry of Health and Population has recently started the process of increasing the number of beds at a primary health center in Swargadwari municipality, Pyuthan, to 15 from the existing three. Two years after it was declared a municipality, there is no sign of a 25-bed hospital. Local representatives are in fact glad to get a 15-bed medical center. 

Likewise, two years after Sitganga in Arghakhanchi district was declared a municipality, residents cannot get specialized medical services locally and have to travel to Kathmandu, Butwal or Bhairahawa; the primary health center and health post there provide only general medical services. The municipality has recently started the process of converting the health center into a 15-bed hospital. Municipality Chief Surya Prasad Adhikari says there is no space to build a bigger hospital. 

District Hospital Rolpa has only 15 beds. Rolpa Municipality Chief Purna KC says the hospital, built with an investment of Rs 310 million, has the approval to upgrade to 50 beds—and yet nothing is happening. 

Similarly, District Hospital Gulmi is in the process of getting 50 beds; the ministry has already signed off on an upgrade. “But the approval notwithstanding, the hospital has neither the required number of doctors nor proper physical infrastructure,” laments municipality chief Dilli Raj Bhusal. 

Netra Raj Adhikari, chief of Shivaraj Municipality in Kapilvastu, bemoans that locals have to depend on private clinics and health centers for medical services. Of the 11 wards in the municipality, only eight have health centers. 

Bishal Subedi, head of the Pyuthan Medical Center, says the federal ministries’ strategies are not in lockstep with the requirements set by the Local Government Operation Act 2017. “Municipalities must have a 25-bed hospital; a 15-bed hospital is not enough,” he emphasizes.

Diplomatic license 
A confident Nepal confronts India

The Indian political establishment and bureaucracy hate to admit it. But India’s Nepal policy has undergone a forced and dramatic change thanks to China. Former Indian ambassador to Nepal, Ranjit Rae, may be wrong on some things but he is bang on in his assertion that after the 2015-16 blockade, the Indian establishment has been occupied with keeping Kathmandu in good humor, lest Nepal slides farther into the Chinese orbit. The over-promising and under-delivering India has been shaken awake. A cross-border oil pipeline quickly came up, and there is fresh impetus on all kinds of Indo-Nepal connectivity projects. 

According to the Indians, Narendra Modi would have come to Nepal if not for President Xi’s Kathmandu trip. Perhaps Modi did not want to be overshadowed by Xi. But this cannot be the whole story. If the Indians were irked by the zealous welcome Xi was accorded in Nepal, they have not let it show. What we see instead is India’s greater readiness to make all kinds of concessions to Nepal: from offering it new transit facilities to keeping mum when Nepal erupted over Kalapani. 

The Madhesis have been conveniently forgotten post-blockade. India now insists it is not competing against China in Nepal. When India tried to punish Nepal for daring to promulgate a national charter without its say-so, Nepal got closer to China. This rang alarm bells in New Delhi, even though the likes of Rae continued to maintain that China can never replace India in Nepal. Hence the rather acerbic Rae, who was also a firm supporter of the Madhesi cause, was replaced by Manjeev Singh Puri, an affable businessman with no ardent ideological moorings. If China wanted to be business-like in Nepal, so would India. 

The Indian policy on Nepal is now geared toward accommodating Kathmandu after futile attempts to punish it for straying. We see something similar happening in Sri Lanka, as India tries to accommodate the newly-elected Rajapakshas, long known for their sympathies to China. In the Indian eyes, they were the ones who handed Hambantota to the Chinese on a silver platter. Yet the Lankans have elected them back to power and India has now accepted it as a fait accompli.   

India is finding its options shrinking in this multipolar world, as it struggles to get even Bhutan, whose security it oversees, to toe its line vis-à-vis China. The recent by-elections in Nepal have showed the ruling NCP’s hold on Nepali politics is as strong as ever, and it will be sometime before the Nepali Congress or any other party can break the communist grip. India has no option but to deal with the communist leadership. 

It would not be an exaggeration to say that under PM Oli, Nepal gets more respect from India than it ever did after the 1990 change. Try convincing Oli or the NCP that the outreach to China is counterproductive. Or that their efforts to revive SAARC is futile. An increasingly confident Nepal is opening up to the outside world. The days when Nepal was under India’s exclusive sphere of influence are gone. To their credit, the Indian political leadership and intellectuals seem to realize this.   

Ganga Devi Gautam from Tatopani in the north-western district of Jumla gave birth to four children, hoping one of them would be a son. Her family was unhappy that Gautam had not had a son—until she finally gave birth to one in her fifth attempt. When that happened, her family and neighbors, accompanied by a band, reached the hospital to celebrate the occasion. They also organized an abir jatra (a colorful procession) and a communal meal. Gautam’s family members started treating her better. 

When word spread that Laxmi Raut from Thantikandh, a rural municipality in Dailekh, gave birth to a son, her family and relatives also went to the health center with a band. They also celebrated the occasion by doing an abir jatra, to the surprise of the health center’s staff. 

These two are representative examples of gender discrimination. In Karnali Province (where both Jumla and Dailekh fall), girls are discriminated against right from the womb. Family and relatives do not celebrate the birth of a girl because of the entrenched belief that while a son takes care of the parents in old age, a daughter leaves home after marriage. 

As a result, most couples face societal pressure to have a son, and women keep producing babies hoping they would finally give birth to a male child. Meanwhile, having so many babies wrecks women’s health. 

Pushe Nepali, 65, from Tila rural municipality in Jumla got married when he was just 14. His wife gave birth to 11 daughters in the hope of having a son. Because of the dire financial situation of the household, it was difficult to raise 11 daughters, three of whom died. Says Pushe, “I wanted a son but ended up with many daughters. I regret it now.”

Because she did not give birth to a son, Jhan Maya Rokaya from Kanakasundari rural municipality in Jumla was thrown out of her house by her husband, who faced family pressure to do so. The Rokayas have six daughters together. Jhan Maya’s case is not atypical; most women in Karnali have to endure domestic violence if they do not give birth to a son. 

Also on the rise in recent years are cases of female feticide, which is common even among educated folks. Latest statistics show that female birth rates have gone down in the provincial capital of Birendranagar. Local and provincial governments have introduced various schemes to check the trend. To encourage couples to have daughters, the provincial government has started opening a bank account in the name of all girls born in Karnali Province and depositing Rs 500 every month in their account for 20 years.

Khandachakra municipality in Kalikot, another district in the province, has started handing over a cash gift to couples who give birth to a daughter. Says municipality chief, Jasi Prasad Pandey, “We are facing the problem of a skewed sex ratio, so we have had to provide incentives for couples to have daughters. Any couple in the municipality giving birth to two daughters at most and undergoing sterilization will be given Rs one lakh in cash.” 

The Chinese train may or may not be coming to Nepal soon. China has only just agreed to a feasibility study of the Keyrung-Kathmandu railway. But is the train the best way to ensure better cross-border connectivity? What about improving the condition of our roads leading to China, at far less cost and time? The locals of Rasuwagadhi on the border with China don’t understand the federal government’s push for a train when improving the state of border roads could immediately work wonders to boost Nepal’s trade with China. 

They have a point. The Chinese have been keen on developing Rasuwagadhi into a major trading point between the two countries after the closure of the border point at Tatopani, over security concerns, following the 2015 earthquake. On the Chinese side of the border, high-tech immigration and custom facilities are ready. On the Nepali side, work has barely begun. Without a customs office, Nepali traders face many hassles. Says Choten Sherpa, a Rasuwagadhi resident, “Chinese officials and tourists come here frequently, and they always request us to press our government to speed up the upgrade of the roads.” 

But seldom do the visiting Chinese talk of a rail line, he says. The Chinese have let their Nepali counterparts know that building a rail line via Rasuwagadhi will be mighty difficult, and yet Nepal keeps insisting on it. The Chinese see no option but to go along with the Nepali request, perhaps hoping that Nepalis will see sense once the feasibility study is completed and the real costs become clear. 

Back in Rasuwagadhi, “the Chinese are asking us to hurry, but the Department of Roads is delaying the process citing budgetary constraints,” says Dawa Dorjee Tamang, Chairman of Ward 2 of the Gosaikunda rural municipality near the border. He says the work could be further delayed as the government needs to follow a public tender process.

The road versus rail debate continues to make news in Kathmandu. Meanwhile, the residents of Rasuwagadhi are confident that despite all the delays, it is only a matter of time before the roads to China are repaired and their lives, and the lives of their compatriots, become progressively easier.

Rasuwagadhi folks want roads now than railways later

The impatient Rasuagadhi locals, though dejected with the slow work of their government, have their fingers 
crossed. Most are optimistic that even though it may take some time, better roads to China are an inevitability

“Chinese officials and tourists come here frequently, and they always request us to press our government to speed up the upgrade of the roads between the two countries,” says Choten Sherpa, a resident of Rasuwagadhi, an area in Rasuwa district bordering China. “Seldom do they mention the railway.”

Interestingly, many locals have no clue about the possible routes of the much-hyped cross-border railway and the progress on it so far. They are instead worried about the roads. The Chinese side had officially opened the Gyirong Port on the Rasuwagadhi border in 2014 as an alternative to the Tatopani border point. Locals say there has since been little progress on Nepal’s part in improving road conditions.

“In the name of railways, we may continue to ignore these vital roads for another 20 years,” laments Dawa Dorjee Tamang, Chairman of Ward 2 of the Gosaikunda rural municipality near the border. “The government collects billions in revenue from this border point. Why not spend some of it in maintaining and repairing our roads?”

He also advises the federal government to focus more on roads rather than railways. The pre-feasibility study of the Keyrung-Kathmandu railway line has already identified the big hurdles on its way—hard rocks, snowfalls and greater chances of earthquakes. China has informed Nepal that a railway line may be possible, but only after considerable homework. During Chinese President Xi Jinping’s Nepal visit in October, the two sides agreed to a feasibility study for a cross-border railway. The visit also emphasized road and tunnel connectivity.

“The Chinese side conveyed its readiness in initiating the repair of Syaphrubesi-Rasuwagadhi Highway,” states the joint statement issued after Xi's visit. “Realizing the importance of enhanced level of connectivity between the two countries, the two sides agreed to proactively cooperate on the feasibility study for the construction of tunnels along the road from Jilong/Keyrung to Kathmandu.”

Roads not easy too

Yet even the operation of roads year-round in this area presents formidable challenges because of the difficult terrain and snowfall. There are three main road linkages between Kathmandu and Rasuwadadhi.

The first one, between Kathmandu and Betrawati, are connected by three different roads: a) Kathmandu-Galchi-Betrawati, b) Kathmandu-Kakani-Betrawaiti, and c) Kathmandu-Tokha-Betrawati. Expansion of all three is underway. In parts of the Kathmandu-Galchi-Betrawati highway, a four-lane-road has already been built.

The second section comprises the route between Betrawati and Syabrubesi, an old, 41-km-long road via Dhunche (see the map alongside). A new road, which is 24 kilometers shorter than Betrawati-Dhunche-Sybrubesi, is under construction, connecting Betrawati with Sybrubesi via Mailung.

Although there is regular bus service between Betrawati, Dhunche and Syabrubesi, it is frequently obstructed—sometimes for two to three months—because of snowfall and landslides. The under-construction Mailung-Syabrubesi road is being built over hard rock, and it will take time to make it work. But this section via Mailung offers two benefits: it is shorter and sees less snowfall than the road via Dhunche.

The Betrawati-Dhunche-Syabrubesi road section is now under operation and buses and trucks plying between Kathmandu and Syabrubesi are routed this way. But the road is in a pathetic state and the government has paid scant attention to its maintenance, compelling people to make a risky journey.

The third section between Syabrubesi and Rasuwaghadi is also in a bad shape. The Chinese side has already agreed to financial assistance to upgrade this 16-km stretch. The agreement states that the section will be upgraded to two-lanes and blacktopped. Although the inauguration of the upgrade works took place in September, work is yet to start because of the delay in removing electric pylons and shifting human settlements on the Nepali side.

Betting on the hare

“The Chinese are asking us to hurry, but the Department of Roads is delaying the process citing budgetary constraints,” says ward chair Dawa Dorjee Tamang. He says the work could be further delayed as the government needs to follow a public tender process. “Even though the local sentiment is in favor of improving roads, five years since this border-point officially came into operation, there has not been much progress except for the opening of the Mailung-Syabrubesi track,” adds Tamang.

Not only roads, Nepal is yet to build other infrastructures needed to operate the border point. For instance, the foundation stone of the Integrated Customs Office was laid in 2014, but construction has not moved beyond the initial stage. The absence of such an office has made life difficult for Nepali traders and security officials, who face countless immigration-related hassles at the border. Proper lodging facilities for border forces and other staff deployed there are also lacking. China, on the other hand, has already built high-tech immigration and custom facilities on its side of the border.

The Chinese have been keen on turning Rasuwagadhi into a major trading point between the two countries after the closure of the border point at Tatopani following the 2015 earthquake.

But on Nepal’s part, despite frequent and loud talk about connectivity with the northern neighbor in the past few years, mainly after the Indian blockade of 2015-16, there has been no substantial progress.

In the absence of proper roads and other infrastructures, traders and locals alike face a plethora of problems. But the impatient Rasuagadhi locals, though dejected with the slow work of their own government, have their fingers crossed. Most of them are optimistic that even though it may take some time better roads to China are an inevitability.