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Nepal’s Quest for a Digitized Healthcare System: The Importance of Electrification

SAHESHA Upadhyay


The WHO recommends a minimum of 2.5 health workers per 1,000 population as a general benchmark to ensure adequate access to essential health services. This ratio appears as an unconvincing goal for Nepal given its current ratio of  8.52 per 10,000 (or 0.85 per 1,000 population). This presents a major challenge in terms of healthcare access, particularly in rural areas where mountainous terrain has impeded infrastructure development. The emergence of digital healthcare technology, including telemedicine, tele-visits, remote monitoring, IoT equipment, wearables, and digital healthcare database management, offers a promising solution to bridge this gap. The successful integration of a digital healthcare system requires efficient and dependable energy infrastructure as a foundation. Nepal, therefore, needs to align its healthcare and energy goals if it is to fully realize the potential of digital healthcare technology. 

Medical Doctors per 10,000 population

Snapshot of Digital Healthcare in Nepal  

In recognition of the potential impact of digital health on healthcare accessibility and quality, Nepal’s Digital Framework 2019 has identified health as one of its eight priority sectors and established seven initiatives aimed at leveraging digital tools and technologies that include:

  1. National Digital Healthcare Platform
  2. Next-Generation Digital Healthcare Facilities
  3. Electronic Health Records 2.0
  4. Mobile Health Units 
  5. e-Maternal Care
  6. Drones for delivery of emergency medical supplies
  7. Centralized Telemedicine Center

Several online platforms, including Jeeve, Hamro Patro, TeleCareNepal, Tele Upchar, and Hello Health, have successfully been delivering digital healthcare services in Nepal. Their services range from e-consultation and drug prescription to drug delivery to electronic management of healthcare records. Post-COVID-19, Nepal’s telehealth and digital health technology sector has witnessed a significant growth. Despite Nepal’s healthcare system being on the brink of collapse during the pandemic, the need for innovative solutions that could deliver healthcare services to people remotely was amplified. As a result, the utilization of Internet and telephone technologies for consultations skyrocketed in both hospitals and clinics, with numerous new and cutting-edge applications emerging. Furthermore, the country experienced a remarkable transformation in digital payment technologies and services, contributing to the widespread adoption of digital health channels.

Electrification and Healthcare

Despite all the possibilities that digital technologies offer, the challenge is to equip these technologies with the best resources that will keep them running smoothly. Electrical power remains the backbone of hospital operations; we need it not only for powering specific healthcare devices and technologies but also for basic office operations works including lighting, communication, and refrigeration. We cannot emphasize the term “reliability” enough when discussing the availability of electricity in regard to healthcare access. Interruptions in electricity, even for just a few minutes, can have dire consequences, such as life-saving devices failing during medical procedures, or critical medicines becoming spoiled due to loss of refrigeration. Likewise, tele-visits and remote-diagnoses are out of the question, when electricity is simply not dependable. Electricity must be ubiquitous in Nepal for healthcare access to be universal.

We cannot overemphasize the term “reliability” when discussing the availability of electricity in regard to healthcare access. The Energy Progress Report 2020  indicates that 90 percent of Nepal’s population has access to electricity, yet despite this achievement, frequent power cuts in rural areas continue to pose difficulties for the proper functioning of healthcare facilities. According to the Nepal Electricity Authority, several districts, including Ilam, Panchthar, Taplejung, Okhaldhunga, Khotang, Solukhumbu, Bhojpur, Sankhuwasabha, Udayapur, Kavre, Makwanpur, Dhading, Nawalpur, Darchula, and Dolpa have very low electrification;  Dolpa, Mugu, and Humla of Karnali Province have no connection to the national grid at all. The World Health Organization (WHO) also reports that only 65 percent of hospitals and 56 percent of non-hospital healthcare facilities in Nepal have a steady supply of electricity. Likewise, four percent of healthcare facilities in the country do not have access to any electricity supply. The issue of limited access to reliable electricity in healthcare facilities affects nearly one billion people globally, as reported by the United Nations.

For telemedicine and remote-diagnostic technologies to be successful, it is not only crucial for hospitals but also for individual households to have access to reliable electricity. Despite the widespread availability of affordable mobile devices and the expansion of 3G and 4G networks, which have led to a 90 percent coverage of wireless networks in Nepal, there are still significant gaps in coverage, particularly in rural areas. These limitations hinder effective telemedicine visits and remote diagnostics. As such, ensuring access to reliable electricity is essential for both powering devices and providing reliable broadband internet access.

Way Forward

The integration of alternative energy sources such as solar panels holds great promise as a transformative solution that can revolutionize healthcare services in Nepal. In many rural areas, solar power initiatives have already been successful, with 15 percent of the population gaining access to electricity through solar grids as reported by Nepal News news portal. Moreover, the cost of solar panels has decreased significantly in recent years, making it a more viable option for expanding healthcare services. By expanding these programs to rural healthcare facilities, Nepal can significantly improve the digitization of its healthcare technology and make healthcare facilities more reliable.

One way to achieve this is by implementing projects aimed at decentralizing electricity by providing every remote healthcare facility with its own solar panel grid. This not only has the potential to enhance service delivery but also make electricity access more resilient. Catastrophic climate events or any other national emergency will not interrupt the operation of specific healthcare facilities. A great example of this is St. Luke’s Hospital in Ethiopia, where a private renewable energy company provided assistance in implementing a groundbreaking solar hybrid system that delivers 320 KWh of electricity. This resulted in significant cost savings and improved service delivery.

In addition to its impact on healthcare delivery, the electrification of healthcare facilities can also have a profound effect on the distribution of healthcare professionals. A study has shown that access to reliable electricity and digital healthcare technology can serve as a powerful incentive for healthcare professionals, particularly in rural and remote areas. By making healthcare facilities more appealing and attractive, electrification can help attract and retain healthcare professionals in these areas, thereby increasing the availability of healthcare services for communities in need.

To ensure the longevity and effectiveness of these projects, regular maintenance of power plants and medical equipment, as well as personnel training, must be prioritized in the healthcare project design and budgeting process. Effective collaboration between stakeholders from both the healthcare and energy sectors, including public and private entities, can guarantee that healthcare needs are taken into consideration during the design and implementation of electrification projects. Finally, it is also important to draw attention to the fact that the adoption of digital healthcare, particularly telehealth, has far-reaching benefits that go beyond just improving individual health outcomes in rural areas. In addition to providing convenient access to medical services, by eliminating the need for frequent doctor-patient commutes, telehealth significantly reduces the carbon footprint associated with transportation

OP-EDs and Columns

Renewable energy and Nepal

– NISCHAL Dhungel* and SISIR Bhandari

Dhungel is a non-resident fellow at NIPoRe. The opinion piece originally appeared in The Kathmandu Post on 30 October 2022. Please read the original article here.

In the current context of climate change, where global movements towards renewable energy are gaining momentum, the world’s attention is shifting to doubling renewable energy resources. The world has witnessed a significant rise in the production of renewable resources from 941 terawatt hours in 1965 to 7,931 terawatt hours in 2021. In this context, Nepal, with more than 6,000 rivers and rivulets, can become a bedrock of energy security for South Asia. The country’s untapped hydropower can play a significant role in future energy supply as it is an affordable and renewable source of electricity with few environmental effects. It can significantly reduce the carbon footprints of neighbouring giants and one of the most populous countries, Bangladesh.

Nepal has declared Energy and Water Resources Decade (2018-28) to implement the Roadmap for Energy Development. Nepal has now become self-sufficient in electricity production, producing 11,064 GWh in 2022, a significant jump from 4,258 GWh in 2013. The roadmap promotes generating and using electricity, intending to increase production, consumption and national income by selling energy. With the rise in electricity output, today, 93 percent of the population has direct access to electricity. The government has aimed for 100 percent energy access by the fiscal year 2022-23.

Arun 4 (capacity 490.2 megawatts), West Seti (750 megawatts), Arun III (900 megawatts) and Lower Arun (769 megawatts) are major hydropower projects which will start distribution between 2030 and 2035. There has been increased production and export of energy and a reduction in energy imports. Where should we use this surplus energy? The ideal answer would be using it to replace traditional or non-renewable energy. Nepal has also become the first country in South Asia to participate in the Indian Energy Exchange from which it aims to expand trading in South Asia. Today, 14.1 percent of the country’s total imports consist of petroleum products which can be easily substituted by electricity. Nepal’s hydropower can convert one-third of South Asia from non-renewable to renewable energy consumption, thus reducing approximately 3.5 percent of total greenhouse gas emissions worldwide by 2040.

Nepal should focus on making the best use of hydroelectricity and possibly hydrogen energy, which has a promising comparative advantage in the energy trade. This presents an opportunity for Nepal to decarbonise the region’s major energy end-use sectors such as households (use of electric cooking stoves) and transport (battery-powered vehicles).

Climate financing

Climate change priorities and strategies are mainstreamed into government planning and budgeting procedures; however, direct government investment is significantly low. Legal and practical obstacles limit foreign direct investment, private sector investment and bilateral and multilateral support. Energy-related industries had received 59.7 percent of the investment pledges as of March of fiscal 2020-21, but actual investment came to only 35 percent. There is a need to create a favourable environment by relaxing legal obstacles to attract more foreign investment in the vibrant energy sector.

The financial requirement for meeting climate objectives is huge and needs to be better defined. Currently, the primary climate funding comes from the government, multilateral funding agencies and small private sector contributions. The climate budget has increased from $3.75 billion in 2017-18 to $4.66 billion in 2021-22. Since 2010, Nepal has received more than $300 million in international climate funds from the United Nations Framework Convention on Climate Change (UNFCC) alone. According to the most recent data, between 2015 and 2020, Nepal received over $2.59 billion in climate finance from international development banks, with $1.2 billion coming in 2020 (excluding mitigation and adaptation funds). Most domestic banks finance hydropower projects with local currency debt, but their capacity for large-scale lending is limited. Between 2017 and 2021, private independent power producers invested $400 million per year in hydropower production.

The energy sector in Nepal received investments totalling, on average, $527 million annually from 2010 to 2017. The power generation sector received most of the funds (more than 70 percent), nearly all of which went to hydropower projects. Local independent power producers and the Nepal Electricity Authority came second and third, respectively, in terms of investment in hydroelectricity generation. A total of $29-$46 billion in investments is expected to be required in the electricity sector over the period 2018-2040. Although a large sum, it is insufficient to cover the annual needs.

Energy investments

Moreover, export-focused hydropower projects would require yearly incremental investments of $0.5-$1.0 billion. Even under the most optimistic assumptions, the financial sector’s capabilities are limited and require further investment. The underlying economics of export-oriented projects and the creation of a solid institutional and regulatory environment for energy commerce will determine their success in contributing to the national economy. Development partners are already on board, note World Bank support for Nepal’s Green, Resilient and Inclusive Development approach, climate financing and the Millennium Challenge Cooperation compact (United States-Nepal partnership), and Indian and Chinese energy investments.

The government should build on the momentum and gain more support from the international community. Also, the international community should understand Nepal’s untapped energy potential that can contribute to long-term climate goals in the region. In the coming years, domestic consumption (industrial and household) alone will not be sufficient to consume the ever-increasing electricity generation. India and Bangladesh particularly seem interested in Nepal’s enormous energy potential to lift the region out of energy poverty and point it towards environmental salvation by bringing regional energy connectivity to the centre of discussion, commitments and collaborations. Energy trade can be fruitfully fostered.

Research Commentaries

NRC0002 – Nepal’s Leverage as a Founding Member of AIIB

Nepal’s Leverage as a Founding Member of AIIB

Nirnaya Bhatta


Following the decision in May 2019 to co-finance $90 million in the Upper Trisuli I Hydropower Project, the Asian Infrastructure Investment Bank (AIIB) started its official engagements with Nepal. The country has found yet another avenue to seek loans to fund its infrastructural financing needs. Despite much excitement about Nepal being a founding member of AIIB, how effectively it will be able to leverage the new China-led Multilateral Development Bank (MDB) to finance its massive infrastructure needs is up for discussion. This depends on concerted efforts put in to understand the newly-formed MDB by the recipient countries such as Nepal that hold minuscule voting rights in the institution. To that end, this commentary will identify Nepal’s place in AIIB, its governance structure, other approved projects, shareholder and voting powers, its collaboration with other major MDBs, Nepal’s shares and voting rights, and the recently approved project for Nepal.


Nepal enjoys the status of being one of the founding members of the Asian Infrastructure Investment Bank (AIIB), which it does not with any other Multilateral Development Banks (MDBs) that have engaged with the country for many decades. Although, by the virtue of merely being a founding member of the newly-formed MDB hardly amounts to anything substantial unless Nepali policymakers closely acquaint themselves with it – especially on operational and administrative issues. It is laudable that over the years Nepali policymakers and political leaders have intensified efforts in wooing donors and investors, but it is also equally critical to understand them- their motivations, development philosophies, and the nature of engagement with other recipient nations.

The AIIB’s Board of Directors approved a loan of up to $90 million for the 216-megawatt Upper Trisuli 1 Hydropower Project. The project is expected to cost $647.4 million, and the rest of it will be co-financed by Asian Development Bank (ADB), International Finance Corporation (IFC) and a Korean Consortium. Given that AIIB has made multiple lending in its member countries (see Annex III), it is reasonable to believe that there is more scope in terms of future financing beyond the Upper Trisuli 1 Hydropower Project. Plus, investments in Nepal’s hydropower project is almost always desirable, given that the poor performance of the energy sector is widely recognized as a major constraint to economic growth.

The Asian Infrastructure Investment Bank

The AIIB was launched in October 2014 and boasted 97 approved members in April 2019. The AIIB owes its origins to the demand emanating from Asia’s massive infrastructure gap on the one hand, and the steady economic and political clout wielded by the People’s Republic of China (PRC). As a China-initiated MDB, the AIIB symbolises China’s increased ambition and role in the global affairs – especially those pertaining to the infrastructure development. To the surprise of many, European countries including the UK, Germany, France and Italy became members of the institution. Their decision may have been informed as they foresaw the inevitable influence that a China-led MDB would command in the close future in the global development arena.


AIIB comprises of regional and non-regional members. The following contributor generated map identifies AIIB’s regional and non-regional members:

Figure 1: AIIB’s Regional and Non-Regional Members (Data Source: AIIB)

Shareholders and voting rights

The AIIB’s authorized capital stock is US$100 billion, which is divided into shares valued at USD100, 000 each (Articles of Agreement). Meaning, each share is equivalent to USD100, 000. Regional members will hold 75% of total subscribed capital stock, while non-regional members will hold the rest. Nepal’s two neighboring countries China and India are the largest shareholders with 30.34% and 8.54% respectively of the total shares issued, while holding 26.06% and 7.51% voting rights (Articles of Agreement). Nepal holds a share of 0.08 percent (809 share units) and 0.33% voting rights. For a comparative perspective, take these numbers: China, India, and Russia hold 300,398, 86,267, 67,956 votes respectively (AIIB).

Selected AIIB Members’ Voting Rights in Percentage (Data Source: AIIB)

Nepal in AIIB

Nepal became one of the 57 prospective founding members of the AIIB by signing the Article of Agreement on 29 June 2015.

Although, what does it really mean for Nepal in terms of decision making in AIIB? Does it mean it is now in a better position to leverage more loans? It should be noted that a meager 600 votes are allotted to each founding member. In total, Nepal has been allocated 3839 votes- of 809 votes are based on the share purchases (worth USD80.9 million), basic votes of 2430 provided to each member, and 600 for being a founding member.

An American politician Michael Enzi remarked, “If you are not at the table, you are on the menu.” Despite the status that comes with being a founding member, it is unlikely that countries like Nepal (with negligible voting rights) will have an influence on major decisions at the institution. Hence, how Nepal fares in this institution may depend on the country’s concerted effort at understanding how the institution functions. While the Board of Governors consist a member from Nepal, they will at least be cognizant of the major decisions taken at the annual meetings. The following are the reasons why Government of Nepal needs to be ‘on top of things’ when it comes to any issue pertaining to AIIB:

  • To be legally on the safe side: To clearly understand the legal implications of being a member and a borrower. There may be conditions attached to specific projects that Nepal would rather be better off avoiding.
  • To avoid unnecessary politicization of infrastructure projects in Nepal: Once the Government of Nepal is well versed with the nitty-gritties associated with the MDB, it will be able to run more accurate and effective public discourses on the projects financed by AIIB. This will help avoid politicization of projects by opposing political parties. There has been disappointing wrangling among succeeding governments in Nepal recently with regard to awarding hydropower projects to its two mighty neighbors. Engaging in such public discourses will also encourage transparency and invite lesser political interventions.
  • Financial opportunities beyond Upper Trisuli I Hydropower Project: It may be useful to study the publicly available data on the 40 or so approved projects costing USD 8.03 billion by AIIB and identify the type of projects that possibly matches with Nepal’s infrastructural needs. Projects that are often financed are related with water resource management, energy, transport, telecom, landslide and disaster mitigation projects etc. Plus, it is also useful to be on the lookout for possible co-financiers because AIIB has not undertaken projects that require too big a financing. Detailed information is available on proposed and profiled projects (find link here). It is useful to note that AIIB has financed projects in the same country multiple times (Refer to Annex III). Indicating, that there may be a possibility of getting multiple projects financed in the country.
AIIB in Nepal

As it is typical of AIIB-financed projects, they are co-lending in Nepal too. As a new agency, it is understandable that they would seek to avoid major risks that come with lending considerable sums of money to nations like Nepal.

The total project cost of the Upper Trisuli I Hydropower Project is USD647.4 million, of which USD90 million will be loaned by AIIB. Not limited to just co-financing with other MDBs such as the ADB, IFC and a Korean Consortium in Nepal, AIIB will also adhere to the IFC’s Policy on Environmental and Social Sustainability (IFC Policy) and Performance Standards on Environmental and Social Sustainability (IFC PSs) (2012). Designated as Category A by AIIB, “The project is likely to have significant adverse environmental and social impacts that are irreversible, cumulative, diverse or unprecedented” (AIIB 2019).

  1. Smoother operations for an MBD in Nepal. The two largest shareholders in AIIB are China and India. This will likely deter adventurism by either party in the development sector in Nepal, as it happened recently with Budhi Gandaki Hydropower Project.
  2. Scope for growth: Recently, AIIB raised USD2.5 billion through its debut global stock in a matter of just a week time. This exhibits its immense capacity to raise finances and consequently potential for growth. Today, its authorized capital stock is less than that of the World Bank and Asian Development Bank and is not at par with such MDBs that have an institutional experience- in terms of research, network, and reputation- of more than 50 years. Nonetheless, AIIB will continue growing in terms of its financing capacity, and as mentioned earlier Nepal should be on the lookout for more funding shortly.
  3. With further diversification of MDBs in Nepal, it would foster competitiveness among them, especially with the entry of an institution led by emerging countries. While it is premature to exactly understand the implication of AIIB’s entry into Nepal, the Bank’s infrastructure-driven-economic-development model will indeed propel Nepal’s infrastructure forward on the whole.
  1. ADB. (2019, March 21 ). ADB and AIIB Presidents Discuss Strategic and Operational Issues. Retrieved from ADB : https://www.adb.org/news/adb-and-aiib-presidents-discuss-strategic-and-operational-issues
  2. AIIB. (2015, June 29). 50 Countries Sign the Articles of Agreement for the Asian Infrastructure Investment Bank. Retrieved from AIIB: https://www.aiib.org/en/news-events/news/2015/20150629_001.html
  3. AIIB. (2016, January 16). AIIB Turns 3, Reflects on Startup Growth. Retrieved from AIIB : https://www.aiib.org/en/news-events/news/2019/20190116_001.html
  4. AIIB. (2018). The green imperative: developing interconnected low-carbon power networks in AsiaThe EIU. Retrieved from AIIB: https://www.aiib.org/en/news-events/asian-infrastructure-finance/articles/a03-green-imperative.html
  5. AIIB. (2019, June 10). AIIB Approves First Investment in Nepal. Retrieved from AIIB : https://www.aiib.org/en/news-events/news/2019/20190610_001.html
  6. AIIB. (2019). Introduction . Retrieved from https://www.aiib.org/en/about-aiib/index.html
  7. Reuters, Agence France-Presse. (2015). China to hold 30 per cent stake in AIIB and 26 per cent voting rights. Retrieved from South China Morning Post: https://www.scmp.com/news/china/policies-politics/article/1829095/founding-nations-attend-signing-ceremony-china-led

Governance Structure

In an excellent comparative study of governance structures of major MDBs, Johns Hopins Professor Natalie Lichtenstein concludes, AIIB follows multilateral development banks (MDBs) such as the World Bank, Asian Development Bank, European Bank for Reconstruction and Development and Inter-American Development Bank in its governance structure (Board of Governors, Board of Directors and President)”.

For the extended organogram, visit AIIB

Important note: The Board of Directors consists of 12 Directors, and under each Director’s purview exists a constituency comprising a number of member countries. For instance, under the Director represented by the Philippines, the countries Bangladesh, Malaysia, Maldives, Nepal, and Thailand have been clustered (Article of Agreement).

Annex II

AIIB on social, labor and environmental guidelines

For parties who are skeptical of a China-led MDB complying with international social, labour and environmental standards, it should be consoling that AIIB has explicitly laid down legally binding guidelines to observe international standards (see AIIB Environmental and Social Framework). Furthermore, most of the approved projects AIIB is financing are co-financed by other MDBs such the World Bank, ADB, JICA, and the governments of recipient countries. There are very few stand-alone projects that the AIIB has undertaken (look at figure 03). Take for instance, as of now, AIIB and ADB have co-financed 5 projects: Bangladesh, Georgia, India, and Pakistan, and Myanmar. Further, in March 2019, AIIB and ADB also signed a Cofinancing Framework Agreement, ‘that will guide overall co-financing arrangements between the two institutions going forward, including regular meetings to discuss co-financing matters’ (ADB, 2019). Meaning, it can be expected that there will be collaboration between the AIIB and ADB wherever there is a convergence of strategic interests.

Hence, it is unlikely that AIIB financed projects will flout international standards on labor, environmental and social concerns given the multi-institutional collaboration they usually undertake. AIIB is also committed to a green imperative that aims at ‘Developing interconnected low-carbon power networks in Asia’, which demonstrates their commitment to environment and the climate (AIIB, 2018).

Annex III
AIIB Approved Projects in 2018 and 2019


Country Approval Date Sector Project Loans


Nepal May 21, 2019 Energy Upper Trisuli I Hydropower Project 90.0 ADB, IFC, Korea Consortium
Sri Lanka April 04, 2019 Urban housing Colombo Urban Regeneration Project 200.0 Government of Sri Lanka and Private Partner
Sri Lanka April 04, 2019 energy Other Reduction of Landslide Vulnerability by Mitigation Measures (RLVMM) Project 80.0 Government of Sri Lanka
Lao PDR April 04, 2019 Transport National Road 13 Improvement and Maintenance Project 40.0 Government of Laos, NDF and IDA
Bangladesh Mar 26, 2019 Energy Power System Upgrade and Expansion Project 120.0 Government of Bangladesh and Power Grid Corporation of Bangladesh


India Dec 07, 2018 Water Andhra Pradesh Urban Water Supply and Septage Management Improvement Project 400.00 Government of Andhra Pradesh, Andhra Pradesh Urban Finance Infrastructure and Development Corporation
Indonesia Dec 07, 2018 Multi-sector Mandalika Urban and Tourism Infrastructure Project 248.39 Government of Indonesia
Turkey Sep 28, 2018 Finance TSKB Sustainable Energy and Infrastructure On-lending Facility 200.0 Sole finance by AIIB
Egypt Sep 28, 2018 Water Sustainable Rural Sanitation Services Program 300.0 World Bank
India Sep 28, 2018 Transport Andhra Pradesh Rural Roads Project 455.0 Government of Andhra Pradesh
Indonesia June 24, 2018 Water Strategic Irrigation Modernization and Urgent Rehabilitation Project 250.0 World Bank
Turkey June 24, 2018 Energy Tuz Golu Gar Storage Expansion Project 600.0 World Bank, Islamic Development Bank, BOTAS and commercial loans


India June 24, 2018 Finance National Investment and Infrastructure Fund 100.0 World Bank, Islamic Development Bank, BOTAS and commercial loans


India April 11, 2018 Transport Madhya Pradesh Rural Connectivity Project 140.0 World Bank
Bangladesh Feb 09, 2018 Energy Bangladesh Bhola IPP 60.0 Sole finance by AIIB

Table 1: AIIB Approved Projects in 2018 and 2019 (Source: AIIB)