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Forget stock markets and GDP trends; there’s another annual report that genuinely reveals the health of a nation: Transparency International’s Corruption Perception Index (CPI). This year, the news for South Asia isn’t pretty. While the numbers don't directly measure coughs or broken bones, they paint a chilling picture of a region struggling with a disease that eats away at its very well-being—corruption.

Across the board, South Asia scores below the global average, like a student consistently failing basic integrity tests. Only Bhutan and the Maldives show signs of improvement, but what about the rest? Stagnant or slipping backwards. Afghanistan languishes at the bottom, Sri Lanka takes a worrying dip, and even giants like India and Pakistan fail to impress.

But why should we care about greased palms and shady deals when discussing health? Because corruption is a silent killer. It diverts lifesaving funds from hospitals, fuels the spread of counterfeit drugs, and silences voices that could expose public health failures. The lower the CPI score, the harder it becomes to guarantee equal access to quality healthcare, a fundamental human right that shouldn’t be a luxury. The CPI is a wake-up call that the fight for a healthier South Asia starts with tackling the rot at its core. 

Consider how public health budgets for lifesaving medications and equipment are diverted to enrich corrupt individuals, a harsh reality in many South Asian countries. In 2022, Pakistan’s Anti-Corruption Establishment (ACE) registered a Rs 800m embezzlement case against seven doctors and four other officials of the Mayo Hospital for a nefarious scheme, purchasing substandard items at inflated prices, effectively playing with people's lives.

Meanwhile, a few days ago, in India, the Central Bureau of Investigation (CBI) arrested two of its own officers investigating alleged irregularities in Madhya Pradesh nursing colleges. These officers face charges of setting up a cartel that would collect bribes from college officials in exchange for overlooking issues and granting clean chits. The fake nursing college scandal undermines public health by potentially graduating unqualified nurses, who could put patients at risk, raising concerns about the broader prevalence of such institutions nationwide.

When Covid-19 first made inroads into Bangladesh, doctors worried about the inadequate quality of personal protective equipment. There have also been instances of healthcare establishments providing fraudulent Covid-19 test results at a hefty cost. They went even further, charging a premium for Covid-19 treatment, which the hospital should have provided for free and reimbursed by the government. Instead, it did both.

Transparency International’s 2020 report on Pakistan paints a grim picture, highlighting the widespread practice of bribery for essential services like prenatal care and surgery. In this environment, the poor and marginalized, who are already struggling to make ends meet, are often left with no choice but to forego treatment, perpetuating a vicious cycle of illness and despair.

The Criminal Investigations Department (CID) arrested Sri Lanka’s former health minister and current environment minister in Feb 2024 for spending $465,00 on lifesaving medications that failed quality tests. Sri Lanka's National Medicines Regulatory Authority (NMRA) claimed that falsified paperwork was utilized to get this batch of low-quality human immunoglobulin, a lifesaving treatment for severe antibody deficiency. In the middle of last year, hospitals complained about patients’ drug reactions.

The ‘Pradhan Mantri Jan Arogya Yojana’ health insurance scheme, a source of hope for India’s low-income families, was rocked by allegations in 2021. Private hospitals entrusted with critical care have been accused of inflating bills, performing unnecessary surgeries and even refusing to treat those who are eligible. This breach of trust may have diverted significant funds to provide a lifeline for the underprivileged. While investigations continue, the possibility of large-scale corruption casts a cloud of suspicion over this critical program.

Nepal’s Omni scandal during Covid-19 starkly illustrates the insidious reach of corruption in South Asian healthcare. Amidst the pandemic’s urgency, a dubious contract inflated prices and awarded medical supply procurement to a politically-connected company (OBCI) lacking relevant experience. This case exposes the nexus between politics, business and bureaucrats, where public health takes a backseat to self-interest, jeopardizing lives during a crisis.

Looking beyond our immediate borders, the Maldives, despite its idyllic image, is not immune to healthcare corruption. A 2019 Transparency Maldives report found evidence of bribery in procuring medical equipment and pharmaceuticals, raising concerns about the quality and accessibility of care. Myanmar also faces significant challenges. A United Nations report in 2021 highlighted inadequate healthcare infrastructure and a shortage of qualified personnel, exacerbated by potential systemic corruption.

In Ghana, over 80 children tragically lost their lives after consuming cough syrup imported from India, a grim result of systemic regulatory failures and corruption. This incident underscores the severe consequences of compromised safety standards in pharmaceutical exports, driven by the prioritization of profit over human lives. The Ghana scandal highlights global ramifications of health sector corruption, demonstrating that lapses in regulatory oversight can have deadly international repercussions.

This discussion paints a bleak picture of how deeply corruption pervades South Asia’s health systems, with disastrous consequences for public health. This begs the question: Can we remain silent in the face of such widespread suffering? Given the lackluster and haphazard efforts of governments in this region to address corruption in meaningful ways, two key actors have a moral obligation to raise their voices and help tackle this issue head-on: WHO and other UN agencies.

As the world’s leading authority on public health, the World Health Organization (WHO) cannot ignore the insidious link between corruption and poor health outcomes. Its regional and country offices must become vocal supporters of clean and transparent healthcare systems. Issuing strong statements is a powerful way to effect change. The WHO director-general and regional directors should publicly condemn corruption in health, emphasizing its negative impact on populations. They can set the tone for prioritizing integrity and accountability in healthcare systems by stating their position clearly. Since WHO leadership now makes statements on ongoing wars and conflicts, corruption should no longer be taboo. 

WHO’s ambivalence on corruption and reluctance to highlight how privatization of health services harms public health outcomes has not helped either. The evidence for this correlation has long been available, but there has been no effective advocacy by the global custodian of health. Many of South Asia’s lawmakers and their families own private hospitals, medical colleges, nursing homes and schools. It is clear where they would stand in the privatization of health debate. WHO should advocate, in particular, with those international finance institutions constantly pushing for lower public-sector health spending and see privatization as the first line of treatment for failing healthcare systems. WHO enters into three to five-year country cooperation agreements with host governments to outline the agreed-upon work plan. Corruption in the healthcare sector should be a vital component of this agreement with allocated funds. Without this, the WHO becomes an accomplice to local politicians, who steal donated money.

Thorough country-focused research and reports showing the quantifiable effects of corruption on health outcomes are another essential strategy for fighting health corruption. Data encourages decision-makers to act, especially when it comes to citizen health. Rather than adding to its already overburdened issue list, the WHO should work closely with organizations like Transparency International and the Boston University School of Public Health, which have specialized expertise and credibility in this field. In such partnerships, the WHO can help develop clear policies, implement effective oversight mechanisms, and promote transparency in health procurement and resource allocation.

Supporting whistleblower protection within WHO, specifically its regional and country offices worldwide, is a critical aspect of combating corruption in health. WHO employees and collaborators who witness corruption firsthand should have safe and confidential channels to report it without fear of retaliation. The WHO can help expose corruption, hold wrongdoers accountable and improve healthcare delivery by creating an environment where whistleblowers feel empowered and protected. 

Development agencies, the United Nations and international donors are critical players because they provide the financial and technical support required to drive country-level development efforts. 

However, due to the pervasive influence of corruption, these organizations frequently face obstacles in their efforts. To effectively address this issue, they must take proactive measures and make more intentional decisions. First, they should include corruption assessments in their country reports. This allows them to better understand the scope and nature of corruption in each country, which is critical when developing effective anti-corruption strategies. Recent UN country reports rarely mention the words ‘corruption’ and ‘misgovernance’. Second, donors should tie aid to demonstrable anti-corruption efforts. Third, they should help civil society organizations (CSOs) combat corruption. CSOs play an essential role in holding governments and other institutions accountable, and they require financial and technical resources to do so effectively.

Corruption is a human invention; it can be dealt with, even in South Asia!

The Buddha Purnima is over but peace and bliss is very much in the air in the studios of Nepal Art Gallery (the venue of the exhibition titled Deities of Nepal-II, which started on May 21 and will remain open till June 10) drowned in a stream of mellifluous music in the midst of a cacophonous concrete jungle.

 Two lion-like, friendly-looking creatures (Sharduls?) welcome you as you enter the modern building that, frankly speaking, does not have much to offer in terms of traditional architecture of Nepal. But then it will be wrong to judge the council by its building as it has done quite a lot since its establishment in 1962 to promote Nepal’s art and craft.

 As you enter the building and turn right, a spacious gallery draws you. There, next to a beautiful idol of Ganesh, the divine remover of obstacles, Tsering Phonjo Gurung`s monastery (medium: Canvas), adorned with colorful windows and prayer flags, appears to rise with the clouds, unlike the modern-day centers of faith that rise on the lap of Mother Nature, obscuring Nature herself, particularly one of her finest creations, the lush-green woods. 

 Close by, gently rises Priyanka Karn´s Patan Krishna Mandir in Mithila style (medium: canvas), with ‘Hare Krishna’ in a yellow background, bringing a generous touch of Mithilanchal. Karn appears to bring Mithila finesse and fertility to the ruggedness of the mountains that the Shikhar (mountain-like) style seems to represent. 

 In a large canvas titled Snapshot(s) of Lalitpur`s Heritage(s) (acrylic & oil color), Raju Chitrakar offers glimpses of the archaeological heritages of Lalitpur, the city of fine arts. 

In a background of Ashtamangal (eight auspicious symbols), he presents in broad strokes shrines and the presiding deities of those shrines. 

 Among other heritages, the canvas sports the Kumari Chhen and the living goddess, Matsyendranath and his abode in Patan,  Shakyamuni Buddha in his lotus posture and his stupas at Lagankhel and Pulchowk. 

Gushing with water, traditional stone spouts of the Kathmandu valley come to life in Rabita Kisi`s artwork, which is part of her Dhungedhara series VII. While a plastic vessel is quenching thirst, another eagerly awaits, symbolizing, perhaps, a parched urban jungle`s eternal quest and thirst for water. 

 Bishal Maharjan`s Makara (acrylic on canvas) presides over a corner with its coiled snout, leaving a powerful impression that a finely executed piece of artwork never fails to do. 

 Close by, Naresh Sundar Sainju`s piece of art titled Bramhayani Shakti Pith-Treasures of Ancient Panauti (medium: acrylic on canvas) perhaps offers a glimpse of our ancient heritages slipping into oblivion because of our collective neglect. 

Mixed perhaps with the artist´s sad mood at a poor state of affairs vis-a-vis the preservation of our history, it seeks to send a powerful message to the rich and the powerful, who would do well to wake up before it’s a little too late. 

 Jyoti Prakash`s 108 Ganesha (mix media) stands out, both in terms of size and price. The remover of obstacles, by the way, has a formidable presence also in the form of Sushma Rajbhandari´s Ashok Vinayak (acrylic color), one of Kathmandu Valley’s four principal Vinayaks. 

 Other vignettes of the valley’s socio-religious-spiritual-cultural milieu are all there, in the form of royal palace squares, Lokeshwars, Lakhe dance, shrines in the midst of busy thoroughfares  and ancient temples bathed in modern street lights. 

At the center of all this stands Chandra Shyam Dangol’s Bauddhanath stupa carved in stone, with Buddha’s all-seeing eyes looking in every imaginable direction in the form of universal consciousness. Indeed, there’s no escaping his all-seeing eyes. 

While trying to read into the artworks on display, this scribbler had almost forgotten to notice the gallery wall displaying what appeared like a complex web of nerves. He was already quite tired and chances of him getting lost into the web were pretty high. 

 A marathon tour

Then and there came Amish Joshi, an amicable guide and a BFA (first year) student. Showing the way through wide and narrow roads and alleyways of the valley, Joshiji explained that the web of nerves was, in fact, the interwoven network of roads connecting the valley and the idea behind this exhibition was to offer people glimpses of the valley’s architectural heritages, including the major shrines located along the arteries. 

Only then did this scribbler come to know the reason behind his exhaustion: An hour-long, marathon visit of major heritages in the valley had taken its toll, leaving him with no energy to move further. After catching a breath, as this scribbler hit the road again, the sweet music from the art studio drowned and cacophony prevailed, making him wonder how on Earth artists find the peace of mind to create works of art in the midst of chaos. 

 Safety of artworks

Summing up, a piece of art is simply invaluable and Nepal is home to art lovers, who have high regard for artists and their works of art. Still, there are elements around the world, who even seek to desecrate works of art. Nepal’s art fraternity, including artists, art studios and relevant government authorities, should leave no stone unturned to ensure the safety and security of artworks.

The Nepal Bar Association (NBA) is an important force in advancing justice and reshaping the country’s legal system. Founded in 1956, this umbrella organization for all bar units across the country plays a critical role in maintaining judicial independence, strengthening ties between the bar and the bench, and promoting human rights. ​Creating fora for legal professionals to debate and confront urgent legal system challenges is one of NBA’s most important responsibilities. Events like the yearly All-Nepal Lawyers National Conference give attorneys a forum to discuss and suggest changes. The 2024 conference, for example, had themes like ‘Competent Lawyers, Dignified Bar’ and ‘Restructuring of the Judiciary’, demonstrating NBA’s dedication to boosting public trust in the legal profession and promoting judicial independence.​ With the ability to navigate many important areas of influence and responsibility, NBA is well-positioned to play a significant role in Nepal's legal and judicial environment.

Judicial freedom

The NBA has been a vocal supporter of an independent judiciary. To make sure that political influence and corruption do not make inroads into the judicial system, the group frequently participates in discussions and agreements about judicial appointments and reorganization of the judiciary. This involves raising concerns about the Judicial Council’s makeup and the hierarchy of judges, especially in view of the process governing judges’ nominations that has sparked controversies. 

Helping future attorneys

Supporting new generations of attorneys is one of the NBA’s major responsibilities. Many young attorneys struggle to start their practices and feel cut off from more experienced members of the bar. To ease the transition from academic studies to professional practice, NBA is aiming to promote mentoring programs and create a more inclusive atmosphere. This involves offering forums for experienced attorneys and novices to collaborate and share expertise.​

Reforms and public trust

In an effort to boost public trust in the legal system, NBA is actively engaged in more extensive legal changes. This entails promoting legislation that improves judicial efficiency and transparency as well as pressing for constitutional modifications. The association plays a key role in making laws by helping with the formulation of the Integrated Legal Aid Policy, which attempts to increase underprivileged populations’ access to the legal system.​

Political influence and law

Although political affiliations are inevitable for lawyers, NBA works to strike a balance where legal practice takes precedence over political activity. While recognizing that politics has an impact on the legal community, it stresses that legal advocacy, professional competency and judicial accountability should continue to be its key priorities.​

Access to justice

Working together with global partners like the UNDP and the Norwegian government, NBA has been developing initiatives to improve access to justice. The initiatives include the provision of free legal services, with a focus on women and vulnerable groups, and the assistance of local judicial committees in strengthening their ability to administer justice. NBA’s participation in these initiatives demonstrates its dedication to making justice available to all segments of the society.

Prospective courses

Looking ahead, NBA intends to keep up its efforts to preserve the independence and integrity of the judiciary, create opportunities for professional development of its members and implement legal changes. By tackling both internal obstacles within the legal fraternity and more general systemic problems, NBA hopes to fortify Nepal’s legal system and advance equity for everyone.​

A key player in Nepal’s legal system, NBA takes on a variety of roles, including promoting judicial independence, mentoring aspiring attorneys and expanding access to justice via international partnerships and legislative changes. It plays a variety of roles, including advocating for judicial changes, making sure attorneys are represented in judge nominations and offering vital legal services to marginalized groups. The integrity and accessibility of Nepal’s judicial system depend heavily on their ongoing efforts. NBA is a major contributor to maintaining Nepal’s independent, equitable, and open legal system in addition to standing out for the rights and interests of attorneys.​ The integrity and advancement of the legal profession in Nepal are greatly dependent on NBA as it keeps working to enhance the legal profession, the legal education system and the judicial system as a whole. The NBA’s work is essential to guaranteeing that Nepal’s judicial system is impartial, autonomous and competent to preserve democracy and justice. NBA remains a pillar in the fight for a strong and effective legal system in Nepal by attending to the interests of its members and pushing for structural changes.

This article is based on my sole observation of clinical examination of patients of one month till 16 years over the period of one month across both government and private hospitals. The underlying reason to draft this article without further waiting for more data is to substantiate the urgency to bring upon the alarming health situation facing Nepal. For the western world, the industrial revolution was a great success in terms of technological development, but let it not be forgotten that the so-called golden era negatively impacted the environment by polluting the water we drink, the air we breathe and the soil where plants grow. These adverse effects have also spilled into Nepal, thus challenging the pronounced concept of an untainted Shangri-La. 

Clearly, urbanization and industrialization are reaching unprecedented and upsetting proportions worldwide and our country is also in this race. 

Rising air pollution resulting from a slew of factors like wildfires and emissions are exacting a heavy toll on the entire population, including children.  

According to UNICEF, air pollution poses one of the most serious threats to children’s health, and more so an alarming percentage of children live in places where air quality is literally toxic to breathe, consequently risking their chances to grow into healthy adults. Being a pediatrician, who genuinely wants to see improvements in children’s health, it saddens me to observe that the children, the future of this nation, are growing by breathing in unhealthy air. The cost of toxic air is bound to be enormous and long-lasting. 

Data from a study conducted by the Ministry of Health and Populations in 2023 show that air pollution leads to 42,100 deaths every year in Nepal—with under-fives accounting for 19 percent of deaths and those above 70 years of age accounting for about 27 percent of deaths. 

Per the findings, air pollution is responsible for reducing the life expectancy of an average Nepali by 4.1 years. Data on the major causes of deaths in Nepal also show that air pollution is a major contributor to the top five causes of death, namely chronic obstructive pulmonary disease or COPD (66 percent), ischemic heart disease (34 percent), stroke (37 percent), lower respiratory infection
(47 percent) and neonatal deaths (22 percent). 

In the last few months, I have witnessed across the government and private hospitals a soaring number of cases related to air pollution such as respiratory conditions like pneumonia, bronchitis and asthma.  Out of 10, I see seven cases related to diseases associated with air pollution. So, the question is why are children vulnerable? Children have developing lungs and brains, which make them especially susceptible to air pollution. It is an obvious fact that children have weaker immune systems than adults, exposing them to viral, bacterial and other infections. 

Due to other metabolic factors and physiological structuring of lungs, young children breathe faster than adults and take in more air relative to their body weight, often through the mouth, which takes in more pollutants. Habitually, children spend more time closer to the ground, where some pollutants reach peak concentrations. Worst of all, their knowledge on wearing protective devices is limited.

All these factors can exacerbate underlying health conditions and go further in impairing children’s physical and cognitive development. Consequently, air pollution leads to a chain of health effects, thereby affecting the children’s ability to attend and meet educational standards and social functions. 

The effect of air pollution is so far-entrenching that it takes a lay person quite some time to even comprehend the situation. I have clinically examined newborns whose parents complain of the latter experiencing exertion while breathing, coughing, or wheezing, slow development and perinatal disorder, leading me to raise questions about the parents’ past or present occupation and surroundings.

My findings show that almost all of the parents in question started working in hazardous environments. A few of the surveyed parents indicated that they had been experiencing miscarriages and early deliveries, apart from under-weight newborns.  

Medical journals and research have indicated that this is a classic case of air pollution. Fine and ultrafine particulate matter can make it through airways and reach the bloodstream, causing serious illnesses. Through breastfeeding, mothers are likely to pass these pollutants into children. Making lay persons understand all this requires an engaging conversation since many perceive that the effect is short-lived and won’t persist for generations to come. 

These findings are based on the observations I made while operating in a confined space of 100 sq ft for four hours daily for a limited period of time. My write up does not justify the appreciative work of other senior and junior pediatricians. According to the Medical Council of Nepal 2020, there are 690 registered pediatricians in Nepal and presumptions can be made on the volume of outpatients suffering from diseases linked to air pollution. If I am overwhelmed with the cases, then let’s put simple math into work and do the calculation and workload of each pediatrician. 

Add to this grim scenario decades-old data that we still rely on to measure the population’s access to healthcare. Back then, the population’s access to medical intervention within a 30-min walk was 61 percent, which has not improved due to the state’s low funding on healthcare. The data are vague on the percentage/number of the children affected. It will be safe to surmise that the children are not taken into account as they cannot coherently express their illnesses, thus they are likely to be at a disadvantage.