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Over the past two decades, the world has made remarkable progress in the fight against tuberculosis (TB). However, TB is still a serious challenge from a global health and development perspective.  According to WHO, more than 10m people continue to fall ill with TB every year. More importantly, a heavy burden of TB is on poor, vulnerable and socially marginalized populations.

In this context, the strategic interventions primarily focus on a unified response to end all the sufferings by addressing social determinants of TB. However, in many low-income countries, there are still inadequate policies and strategies to support implementation of universal health coverage, social protection, and regulatory frameworks to prevent and end TB.

Nepal has set the goal to end TB by 2035. The first-ever prevalence survey in 2018-19 shows that TB incidence and prevalence in Nepal are 245 and 416 per 100,000 people, respectively with a majority of TB patients from productive age groups. Interestingly, the prevalence among men is more than in women. Considering this reality, Nepal’s strategic plan to end TB (2020/21-2025/26) offers fresh hopes to many TB patients in terms of an easy access to timely diagnosis, treatment, prevention and care.  

An ambitious plan

By 2025, the ambitious strategy aims to significantly increase treatment coverage, success rate, uptake of new diagnostics and new drugs, and reduce catastrophic costs. The strategic priorities primarily include integrated patient-centered care, treatment and prevention, multi-sector engagement, and research for creating synergies for a unified response. Putting patients at the heart of the delivery, the strategy calls for consistent actions to ensure early detection, treatment and prevention for all TB patients.

A recent review of the strategic plan to end TB suggests that there are significant gaps in strengthening prevention and treatment services, community engagement, multi-sectoral coordination and accountability in the federal context. While social protection services for improved service delivery are critically needed, the rollout of new tools and innovative digital technologies are crucial for an effective TB response. This will help ensure treatment for all people with TB, including the drug-resistant strain.

A priority agenda

Engaging the private sector is a priority agenda in TB response. However, there are limited interventions to strengthen implementation of the public-private partnership strategies at all levels. Experiences from Bangladesh, India and Myanmar suggest that non-governmental organizations can play a critical role in providing essential TB services at the community level.

Effective implementation of the strategic plan is crucial at the local level. Because of inadequately-trained human resources for TB services, it is a challenging task for local governments to provide quality TB services. Therefore, concerted efforts are needed to ensure supportive supervision, periodic review, monitoring and evaluation, and timely feedback mechanism for actions at the local level.   

Despite persistent challenges of ensuring human and financial resources, Nepal has implemented a TB-free initiative at the local level for enhancing political leadership and ownership in TB response. The scaling up of the TB-free initiative is critical to strengthen local health policies and harness the power of multi-sectoral engagement for timely notification, diagnosis, prevention, treatment and care.

Inadequate efforts

However, existing efforts are inadequate to enhance the capacity of local governments in participatory and inclusive planning of a TB-free initiative. More focus is needed in the area of ensuring meaningful engagement of TB patients so that their representation, voiced experiences, and choices of prevention, treatment and care are realistically addressed at all levels. While TB is heavily influenced by socio-cultural, economic and health risk-related factors such as undernutrition, diabetes, HIV infection, and smoking, multi-sector actions are needed to combat the epidemic.   

More importantly, there are high-level global and regional events that have significantly reaffirmed commitments toward ending TB. In Sept 2023, the political declarations adopted at the UN High-level Meeting on TB include commitments toward universal access to TB services in both high and low-burden countries, with time-bound targets of reaching, with health services, at least 90 percent of people with or at risk of TB between 2023 and 2027. Moreover, there is a critical need to increase investments, and fast-track the development and availability of new tools to prevent, diagnose and provide treatment for TB.  

Undoubtedly, TB is largely a social disease that poses significant development challenges. There are growing needs to reduce human suffering and the socio-economic burden of TB by providing mental health and social protection services at the community level. Toward this end, anthropology of infectious diseases is instrumental in understanding interaction among socio-cultural, economic, political and biological variables in prevention and treatment of TB.

In this context, it is evident that TB is disproportionately common among disadvantaged populations. From an anthropological perspective, the relationship between poor health and poverty is a consequence of biosocial and biocultural factors. Still, stigma and discrimination associated with TB is another challenge to provide necessary care and support in the families. Therefore, apart from TB prevalence surveys, it is equally important to better understand people’s indigenous knowledge, attitude and health–seeking behavior to prevent and provide treatment for TB in the communities.

Urgent action necessary

To sum up, urgent actions are necessary to ensure universal access to TB prevention, treatment and care at all levels. The strategic priorities must focus on multisectoral actions to address wider determinants of the TB epidemic and effective management of the co-morbidities. In addition, there is an emerging need to strengthen health systems for ensuring essential TB services during disasters and pandemics such as Covid-19. 

The author is a health policy analyst

Every year, in the run up to the International Women’s Day (March 8), local bodies organize various programs centered around women empowerment, inclusion, and representation. There are several women groups, such as Aama Samuha, Tole Vikas Sanstha, Mahila Samiti, and Women Vikas Sanjal, that take up women’s issues. Meanwhile, local governments do their part by allocating a certain amount of funds for the upliftment of targeted groups, including women, children, marginalized communities, and senior citizens. Lal Subba Gurung, Vice-chairperson of Rupa Rural Municipality, says while the conditions of rights and representation of women have improved over the years, there are still many challenges—from budget allocation to policy making to better representation—that need to be overcomed. Smita Adhikari of ApEx spoke with Gurung on the challenges faced by women and the works being done by Rupa Rural Municipality to address them.

Tell us what your rural municipality is doing for the local women?

We have been carrying out several programs to empower targeted women groups by providing them training, orientations, and resources, as well as providing them with social and legal consultations. For this, we have been reaching out in the community to ask local women about their needs, especially in regard to implementing the programs designed for targeted groups. We have also been increasing the size of our budget for women.  

What changes have you observed regarding the condition of women in your area over the years?

In the initial days, women here faced immense challenges because of traditional perception held by men towards women. Gathering women in one place for an event or a program was very difficult. It turned out that many women weren’t allowed by their family members to attend the program. We also found that some women choose not to attend the program because they were too caught up with their household chores. As a result, we were unable to teach them about their rights and responsibilities. The situation has improved a lot over the years, but we are yet to make the desired progress.

What are the consequences of women staying passive and not seeking their role in local development?

First of all, when women are passive about their rights and roles in local development,  there is a risk of the budget allocated to the target women groups getting frozen. We have experienced this in our municipality, which has led to limited allocation in the women development sector. In such a case, the local government will be powerless when it comes to coming up with better programs and policies for women. The women’s population in most parts of the country is higher than that of men, so logically it is the women who should be given the first priority in terms of developing ownership. But that is not happening. To increase women’s participation and engagement in development works, we have enhanced community outreach to pull the attention of local women. Conventional perception of society towards women and financial dependency are the major problems as to why women in rural areas are not able to make their voices heard. So we are trying to address these problems through various programs, such as skill development and social counseling.  

What is the current status of women in villages?

If you compare the situation of women now and a couple of years back, you can see that today there are many committees focused on women development. Most of these committees are registered with the municipal offices as Aama Samuha, Mahila Sanjal, Mahila Adhikar Dabab Samuha, and so on. Similarly, Many Tole Vikash Sanstha (Neighborhood Development Organization) actively work in local areas, and they have seen increased participation of women over the years. Obviously, it indicates a silver lining of hope for women’s development in rural Nepal. But again, there are lots of improvements left to be desired. 

What do you expect from local women groups? 

Only forming groups and carrying out minor programs is not enough to meet the goal of inclusion and equity. Local women should actively seek their role in development works and governance. We want to empower women groups and enable them to participate actively in planning and execution of development programs.

The CPN-UML has concluded the seventh meeting of its central committee with 22-point declarations and programs of action on a host of intra-party and national political issues. 

The meeting has decided to focus on party building rather than making efforts to change the government. The party has recognized several intra-party issues that need to be addressed to keep the party united. 

Soon after the 2022 general elections, the UML launched ‘Mission Grassroots’ and ‘Sankalpa Yatra’ (Resolution March) aimed at enhancing the party’s strength. But according to party leaders, the two programs did not bring the desired results. 

The conclusions, drawn by nine groups of the UML central committee, were presented at the meeting. Kashi Nath Adhikari presented the suggestions on behalf of the party’s standing committee, Ghanashyam Khatiwada from Koshi, Chandreshwar Mandal from Madhes, Kailash Dhungel from Bagmati, Navaraj Sharma from Gandaki, Radhakrishna Kandel from Lumbini, Gulanjung Shah from Karnali, Krishna Prasad Jaisi from Sudurpashchim, and Pema Lama from the department, valley, liaison, and diaspora group.

In their suggestions, the groups said that the general public is disaffected with the current government for its governance deficiencies, economic failures, corruption, insecurity, and inflation. On the party front, they emphasized the need to promote discipline, financial transparency, and moral conduct.

Addressing the concluding ceremony of the meeting, UML Chairman KP Sharma Oli urged the central committee members to put in all efforts to ensure a UML-led majority government after the 2027 general elections.

General Secretary Shankar Pokharel responded to the questions raised by party leaders. He said that the UML was executing the annual action plan, renewing party membership, ensuring the systematic operation of the party school, and collaborating with the party’s people’s representatives for their effective performance.

The UML central committee has concluded that due to unsuited individuals governing the state, the republic system was facing various challenges, with national interests taking a back seat and foreign relations becoming immature and imbalanced.

The party has resolved to utilize all its strength to bolster the democratic republic system, foster the idea of prosperous Nepal, fulfill the national aspirations of contented Nepalis, safeguard national interests and dignity, and ensure a bright future for the country.

Stating that the government has failed to expedite capital spending and that tax revenue is falling short of covering government expenses, and delays in releasing payments to contractors for completed projects have hampered the implementation of development initiatives, the UML has pledged to take meaningful action to address these issues. 

The central committee has also called for the resignation implicated in various scandals, including the deaths of two youths in the Balkumari area of Lalitpur on 29 Dec 2023.  

Highlighting the plight of loan shark victims marched all the way to Kathmandu to demand for justice, the UML has demanded that the government take strong action against greedy usurers and deliver justice to the victims. The party has also expressed sympathy towards the protests of the victims of cooperatives and microcredit institutions, and called on the government to safeguard the deposits of ordinary people. 

Stating that dairy farmers, who faced significant losses due to a lumpy skin outbreak, have been unable to receive payments totaling more than Rs 6bn from dairy producers, the UML has urged the government to demonstrate a serious commitment to supporting farmers. According to the party, the government has reduced subsidies based on production and ceased subsidizing farm insurance premiums, promoting the import of powdered milk, instead of boosting domestic production. The party has called on the government to address long-term land issues, implement a system for distributing identification cards after identifying and categorizing farmers, and allocate grants and subsidies to incentivize farming. 

The UML has urged the government to take needful measures to ensure a stable market for farm products, eradicate middlemen, and safeguard citizens from the impacts of climate change. It has also urged the government to control inflation and ensure the smooth supply of daily necessities.

The UML central committee has demanded that the government promptly release the grant funds for quake-affected families to construct temporary homes, and immediately bring plans for their reconstruction and rehabilitation without delay. Thirty-eight survivors of the Jajarkot earthquake have died due to the cold winter because of government indifference, the party said.

The UML has urged the government to devise concrete strategies to stop political meddling in the higher education sector. The party has also demanded action against the perpetrators who attacked 16 members of its student wing at Lamjung Agriculture and Livestock Campus.

The UML has criticized the diplomatic failure on the part of the government to secure the release of Bipin Joshi, who has been held hostage by Hamas since the attack on Israel by Hamas in October last year. The party has called for a lasting peace in the Middle East and advocated for the establishment of an independent Palestinian state as proposed by the United Nations. 

The party has also called out the government’s ineffectiveness to bring back the Nepali youths working for the Russian army. 

Regarding the power trade agreement with India, the UML has expressed concerns that certain provisions go against the national interest. Instead of resolving issues related to long-pending projects like Pancheshwar and Upper Karnali, the UML said that the government awarded key projects such as West Seti, Seti-6, and Phukot Karnali to Indian developers without the competitive bidding process. The UML has demanded that the government make public all agreements, understandings, and arrangements made for energy production and trade to safeguard Nepal’s national interests in natural resources and to ensure competitive arrangements in energy production and distribution.

The party has also expressed its concerns regarding the activities of some groups to disrupt social harmony by stoking social and religious tensions. The UML has claimed that some individuals within the government are involved in such activities. Thep party has called upon people of all languages, castes, religions, and cultures to remain vigilant against any actions that undermine social harmony, to identify those responsible for such acts, and to contribute to strengthening social harmony and national unity.

The UML has also raised objections to the release of individuals involved in the death of its activist Chetan Aidy, who was killed by Nepali Congress workers during the 2022 general elections, under the political pressure and influence. Such incidents undermine the rule of law, erode public confidence in the judiciary, and perpetuate impunity, the party has said.

Black-bellied tern (Sterna acuticauda) is a globally endangered bird species that belongs to the family Laridae and is locally known as “Utkroshi Phyalphyale” in Nepal. The species, once abundant throughout its distribution range, is vanishing silently. This calls for a heightened conservation attention from stakeholders.

Native to countries like Nepal, India, Bangladesh, Pakistan, Thailand, China and other Southeast Asian countries, this species is found near water bodies like rivers, ponds, lakes and marshes. Once found abundantly on the lowlands of Nepal at the elevation range of 75-730 meters, the species seems to have vanished, literally, these days.

Characterized by a distinctive black belly, deeply forked and long tail and slender orange bill, black-bellied tern is a small waterbird measuring 32-35 cm in length. Its diet includes fishes and insects. The bird is quick when diving for fish and skims over the surface of water and land to catch its prey. Nesting and breeding take place from February to April.

This bird is solitary during nesting, nests on sand and gravel islands in water bodies. It shares its habitat with other bird species, so conservation of one species helps other bird species as well. 

In the Bengali region, this bird is considered sacred and is associated with wealth and prosperity. The species is known for its unique appearance and a major ecological role, mainly as a predator to small fishes and insects. The conservation of this species is important to maintain a healthy ecosystem and biodiversity.

Globally, the population of this geographically-restricted species, like several other waterbird species, is declining, with an estimated population of less than 10,000 individuals at present, including merely 10-20 individuals in Nepal. 

Habitat loss and degradation, invasive species, overexploitation of resources and climate change are some of the threats facing the species. Anthropogenic activities such as hunting of the species for meat and foraging for eggs, and use of catapults have impacted the species directly. Invasive plant species in lakes and rivers, overfishing, sand and stone mining and extraction, dam and other water regulatory bodies, recreational activities (picnics near their habitats, boating, etc), agriculture and aquaculture have impacted the species indirectly.  

The threats to the species native to the Tarai region are multiplying, thanks to a number of factors like massive migration of people after the eradication of malaria from the region in 1950s’ and 60s’ in search of fertile farmlands and better infrastructure. Industrial development, rampant extraction of construction materials like sand, stones and boulders from riverbeds, ‘transformation’ of many wetlands turned into settlements and agricultural land, this species and several other flora and fauna are facing an increased threat. Combined, these threats can lead to local extinction of the species. 

What next?

As we have a limited understanding of the ecology of the species in Nepal, including information on its distribution, our first priority should be on addressing the knowledge void. 

What is shocking in this regard is a recent study that recorded just two individuals at the Koshi Tappu Region, considered a prime habitat for the species, pointing toward serious threats facing the species.

Deploying bird watching groups as citizen scientists can be fruitful in this matter. Conservation measures should be carried out side by side as we cannot wait till the ample evidence is collected for devising conservation measures. Raising awareness in local communities particularly those whose livelihood is directly dependent on the rivers and wetland is must.  Sensitization of other stakeholders, including local people, schoolchildren and government representatives are also essential.

Monitoring of the nesting sites to avoid egg collection, prohibition on collection of river bed materials during the breeding season and regulation of the use of heavy machinery in potential habitats are also equally necessary. Also important is the livelihood diversification of fishing communities to reduce their dependence on wetlands. Dams have drawn criticism for their negative impact on many species, but for this species, dams are a habitat. So, we might think of constructing dams in some areas as they provide a perfect habitat for this species and also protect its food habitat.

Conclusion

Black-bellied terns, whose population has suffered a drastic decline in Nepal, need serious conservation intervention. As we lack information on the ecology of the species, there’s a need to carry out research and conservation works side by side. Working together, we can create a better future for black-bellied terns and other waterbirds.

The author is a conservation associate at Environment Protection and Study Center (ENPROSC)