Shilajit - A Brief Introduction to Himalayan Treasure

Clinical research and medicine have long been intertwined with traditional practices, particularly in regions rich with historical and cultural heritage. A detailed description of it's property, collection, purity and medicinal uses of Shilajit was written in traditional medicinal textbooks of Ayurveda. Approximately 80% of the world’s population relies on Traditional Medicine for their health needs. In Nepal, traditional medicine has been integral since the dawn of civilization. Among the various substances used in Nepali traditional medicine, Shilajit stands out as a natural mineral revered for its potent medicinal properties. This article delves into the clinical research and medicinal benefits of Shilajit, aiming to provide a comprehensive understanding for research students and professionals.

What is Shilajit ?

Shilajit, often referred to as the "Destroyer of Weakness" and the "Conqueror of Mountains," is a powerful substance with a rich history in traditional medicine. Found in the high altitudes of the Himalayas, particularly in Nepal, Shilajit is a sticky, tar-like substance that oozes from rocks in high mountain ranges. It is harvested and purified before being consumed as a supplement. Shilajit is rich in fulvic acid and more than 84 minerals, formed over centuries by the gradual decomposition of certain plants by microorganisms. This composition has been utilized in Ayurvedic medicine for centuries to enhance physical and mental health.

Availability and Harvesting of Shilajit in Nepal

Nepal's unique geographical features, with its rugged terrain and high altitudes, provide the perfect environment for the formation of Shilajit. Regions such as Dolpo, Mustang, and Karnali are particularly known for high-quality Shilajit deposits. Harvesters often trek to altitudes of 16,000 to 18,000 feet to find and extract the resin from rock crevices. With growing demand, modern techniques have been introduced to enhance the efficiency and sustainability of Shilajit extraction, ensuring that the natural environment is preserved while meeting increasing market needs.

Health Benefits of Shilajit

Shilajit offers numerous health benefits, making it a valuable supplement in ayurveda medicinal textbooks. It leads to multi system benefits in human health. 

1. Anti-Inflammatory and Antioxidant Properties: Fulvic acid in Shilajit has significant anti-inflammatory properties, helping to reduce the risk of chronic conditions like arthritis, diabetes, and neurological diseases. Its antioxidant properties prevent cellular damage and aging symptoms.

2. Bone Health : Shilajit supplementation has been linked to improved bone health, notably increasing bone mineral density in postmenopausal women.

3. Cognitive Function : Research suggests that Shilajit may alleviate Alzheimer's symptoms by preventing tau protein buildup and reducing brain inflammation.

4. Altitude Sickness and Chronic Fatigue : Shilajit is believed to relieve altitude sickness and chronic fatigue syndrome, enhancing energy levels and overall vitality.

5. Reproductive Health : It supports men's reproductive health by increasing sperm count and testosterone levels.

6. Heart Health: Shilajit may improve heart health by lowering cholesterol and triglyceride levels.

7. Muscle Repair: It has shown potential in boosting muscle repair and adaptation to exercise, especially in people with obesity.

Cultural Significance of Shilajit in Nepal

In Nepal, Shilajit is not only valued for its health benefits but also holds cultural significance. It is used in various traditional rituals and is considered a holy substance among ethnic groups such as the Sherpas and Tamangs. Shilajit is believed to detoxify the body, cleanse impurities, and enhance vitality.

Economic Impact of Shilajit

The Shilajit industry plays a vital role in the local economy, providing livelihoods for many communities in remote Himalayan regions. Local communities engage in the labor-intensive collection of Shilajit during the summer, providing a vital source of income. The trade of Shilajit, driven by domestic and international demand, generates revenue and creates employment opportunities, helping to reduce poverty and improve living standards. The industry also supports local businesses involved in processing and logistics, fostering entrepreneurial activities. Sustainable harvesting initiatives and ecotourism further enhance economic benefits by promoting responsible practices and attracting visitors interested in traditional methods and the natural environment. Additionally, Shilajit contributes to Nepal's export market, being a sought-after product globally.

Challenges and Future Prospects

The increasing demand for Shilajit has led to concerns about overharvesting, threatening the sustainability of this precious resource. Ensuring the purity and quality of Shilajit is crucial, as adulteration and counterfeit products have become common issues. Implementing stringent quality control measures and certifications can help maintain standards. Initiatives to educate local communities about sustainable harvesting practices and the importance of environmental conservation are essential to preserve Shilajit for future generations.

Conclusion

Shilajit is a potent natural supplement with a wide range of health benefits. From boosting energy and cognitive function to promoting heart health and reducing inflammation, its effects are far-reaching. However, as with any supplement, it’s crucial to use it responsibly and ensure you’re getting a high-quality product. Shilajit, with its myriad health benefits and deep-rooted cultural significance, remains a treasured natural resource in Nepal. As interest in traditional and alternative medicine continues to grow globally, ensuring the sustainable harvesting and fair trade of Shilajit is vital. By valuing and protecting this Himalayan elixir, we can continue to benefit from its remarkable properties while supporting the communities that rely on it.

                                                                                                        Thank You !!! 

This Article was written by Mr. Chetan Karki Pyakurel (B. Pharm)  and Dr. Suman Paudel (BAMS, MSc. Clinical Research)

References:

1. Exploring Shilajit: Its Rich History and Cultural Significance
2. Historical Uses and Cultural Significance of Himalayan Shilajit
3. Chemical Studies on a Nepalese Panacea – Shilajit
4. Review on Shilajit Used in Traditional Indian Medicine

The Impact of Ultra-Processed Foods on Public Health in Nepal: A Growing Concern

Introduction

Food processing involves any method that changes food from its natural form, such as drying, freezing, milling, canning, or adding ingredients like salt, sugar, fat, or other additives for flavor or preservation. Nearly all foods and beverages undergo some form of processing before they are bought or consumed. The term "processed foods" includes a wide range of items, from frozen vegetables and canned beans to candies, chips, and sodas. To classify these foods based on the degree and purpose of processing, researchers developed the NOVA classification system. It has classified food into four groups: unprocessed/minimally processed, processed culinary ingredients, processed foods, and ultra-processed foods (UPFs).

UPFs are industrially produced edible items derived from natural or synthetic sources, designed for high profitability and convenience, often enhanced with additives like preservatives, colorings, and flavorings. They are commonly processed through methods such as molding, extruding, hydrogenation, or frying. These products include sugary beverages, snacks, ready-to-eat meals, and reconstituted meat products. The rapid dietary transition in lower and middle-income countries (LMICs) is marked by an increasing demand for UPFs.

The Rise of Ultra-Processed Foods in Nepal

The proliferation of UPFs is driven by socioeconomic factors including urbanization, economic growth, and lifestyle changes. Marketing strategies target all age groups, with children and adolescents being particularly vulnerable. Cultural shifts towards convenience and fast-paced lifestyles have made UPFs a dietary mainstay. Economic disparities also play a role, as lower-income populations often rely on cheaper energy-dense UPFs due to financial constraints.

Over the past 60 years, advancements in food science and grocery retailing have led to a significant increase in the production and consumption of ultra-processed foods. Initially prevalent in high-income countries, this trend has now spread globally across all income levels. The increasing consumption of UPFs is a significant public health issue with profound implications for nutrition and health outcomes. Their consumption has surged globally, correlating with rising rates of obesity, diabetes, cardiovascular diseases, and other non-communicable diseases (NCDs).

Nutrient Composition of Ultra-Processed Foods

Ultra-processed foods are characterized by their high energy content and excessive levels of added sugars, sodium, unhealthy fats like trans fats and saturated fats, and refined carbohydrates. They also tend to lack essential nutrients found in less-processed and whole foods, such as dietary fiber, vitamins (particularly vitamin C and B vitamins), and minerals like potassium and magnesium. UPFs undergo extensive processing that often removes natural nutrients and fiber, replacing them with synthetic additives to improve flavor, texture, and shelf-life. This nutrient profile contributes to their calorie-dense nature and raises concerns about their potential negative impact on health when consumed regularly as a significant part of the diet. They promote overeating due to their convenience, hyper-palatable formulations, disruption of satiety signals, and pervasive marketing, often aimed at children.

Additionally, UPFs frequently contain harmful chemicals such as contaminants from high-temperature cooking, industrial additives that cause inflammation and gut microbiota imbalances, and hormone-disrupting compounds from plastics used in food manufacturing and packaging.

Health Implications of UPF Consumption

Ultra-processed foods present significant health risks that extend well beyond their nutritional content and calorie density. Unlike natural whole foods, where components are digested slowly within their original matrix, UPFs are typically dense in calories and rich in free sugars, refined starches, unhealthy fats, and sodium. These factors contribute to their association with rising global rates of obesity and non-communicable diseases. Beyond their poor nutritional quality, UPFs are hyper-palatable and may contain potentially addictive additives that our digestive systems struggle to break down, altering the gut microbiome and potentially promoting disease in susceptible individuals.

Intensive processing methods can further disrupt the food's structure, affecting digestion and nutrient absorption, while additives like non-sugar sweeteners and emulsifiers have been linked to adverse health effects such as gut inflammation and cancer. Industrial processes used in UPFs also produce harmful substances like acrylamide and advanced glycation end products, which are implicated in chronic inflammatory conditions. Similarly, contaminants from packaging materials used in UPFs pose additional health risks, such as leukemia and other systemic cancers. These diverse factors collectively underscore the complex mechanisms through which UPFs contribute to adverse health outcomes, highlighting the importance of minimizing their consumption in favor of whole, minimally processed foods for overall health and well-being.

Obesity and Metabolic Syndrome

Research consistently links high UPF consumption to an increased risk of obesity and metabolic syndrome. A study conducted in Brazil found a 7% increase in the risk of developing Metabolic Syndrome (MetS) for every additional 150 grams of ultra-processed food consumed per day. Furthermore, individuals in the highest quartile of UPF consumption had a 33% higher risk compared to those in the lowest quartile. Studies show that individuals consuming high amounts of UPFs have higher body mass indices (BMIs) and greater waist circumferences.

Cardiovascular Diseases

The high levels of trans fats, sodium, and added sugars in UPFs contribute to hypertension, dyslipidemia, and other cardiovascular risk factors. UPF consumption has been associated with higher rates of heart disease and stroke, attributed to poor diet quality and the promotion of atherogenic and inflammatory pathways. In the Framingham Offspring Study, an 18-year follow-up revealed that each additional daily serving of ultra-processed foods increased the risk of developing cardiovascular disease (CVD) by 7%. Similarly, the French NutriNet-Santé cohort study found a 12% higher risk of CVD with increased consumption of ultra-processed foods. Meta-analyses provide strong evidence that certain ultra-processed products, such as processed meats and sugar-sweetened beverages, along with nutrients commonly found in these foods, like trans fats and sodium, elevate the risk of CVD. Additionally, epidemiological studies have connected ultra-processed foods to various CVD risk factors.

Diabetes

Diets rich in ultra-processed foods have been implicated in the development of type 2 diabetes. The high glycemic index of many UPFs causes rapid spikes in blood glucose levels, which increases the risk of insulin resistance. Furthermore, the lack of fiber and essential nutrients in these foods exacerbates this risk. Observational studies consistently link ultra-processed food intake with an increased risk of diabetes, with particular emphasis on certain food groups like sugar-sweetened beverages and processed meats. However, there is a notable gap in meta-analyses evaluating the overall risk of diabetes across all ultra-processed food groups. A meta-analysis found that 72% of included studies showed a positive association between ultra-processed foods and diabetes risk. The meta-analysis revealed that moderate intake of ultra-processed foods increased the risk of diabetes by 12%, while high intake increased the risk by 31%.

Cancer

Emerging evidence suggests a link between UPF consumption and certain cancers. Additives, packaging chemicals, and the high calorie content of UPFs may contribute to carcinogenesis. Studies have reported associations between high UPF intake and increased risks of breast, colorectal, and other cancers. The systematic analysis over different time periods reveals a significant positive association between ultra-processed food intake and increased risk of various cancers, excluding prostate cancer, after adjusting for confounding factors. Specifically, higher UPF consumption is linked to increased risks of overall cancer, breast cancer, colorectal cancer, and pancreatic cancer. Additionally, more modest associations were observed for chronic lymphocytic leukemia and central nervous system tumors.

Other Chronic Diseases

Ultra-processed foods have been increasingly linked to various chronic diseases, including hypertension and depression. Studies indicate that diets high in UPFs often contribute to elevated blood pressure due to their high sodium content and poor nutrient profile. Research has shown that individuals consuming more UPFs are at a higher risk of developing hypertension compared to those with lower UPF intake. For example, the Australian Longitudinal Study on Women’s Health investigated the impact of ultra-processed foods on incident cardiovascular disease and hypertension among middle-aged women. The study revealed that those with the highest intake of UPFs (more than 34.2% of total dietary intake) had a 39% increased likelihood of developing hypertension.

Moreover, UPFs have also been implicated in mental health issues such as depression. A study published in the British Journal of Psychiatry highlighted that higher consumption of processed foods, including UPFs, was associated with an increased likelihood of developing depression. The mechanisms behind this association involve nutrient deficiencies and the inflammatory effects of UPFs, which may adversely affect brain function and mood regulation over time. The study underscored that diets rich in fruits, vegetables, and whole grains, which are typically low in UPFs, were inversely associated with depression risk.

Similarly, a study conducted among non-Hispanic White females found that compared to individuals with the lowest quintile of ultra-processed food consumption, those in the highest quintile showed an increased risk of depression as indicated by both strict (HR 1.49; 95% CI 1.26-1.76; P < 0.001) and broad definitions (HR 1.34; 95% CI 1.20-1.50; P < 0.001). Also, comparing the highest and lowest quintiles, the study found that only artificially sweetened beverages (HR 1.37; 95% CI 1.19-1.57; P < 0.001) and artificial sweeteners (HR 1.26; 95% CI 1.10-1.43; P < 0.001) were significantly associated with an increased risk of depression.

Public Health Measures in Nepal

To reduce the consumption of ultra-processed foods, it is essential to combine education, policy, and community initiatives. Launching public campaigns and incorporating nutrition education in schools can raise awareness about the health risks of ultra-processed foods. Implementing clear labeling on food packaging, restricting advertising, and introducing taxes on these foods can further discourage their consumption. Promoting healthy alternatives through subsidies for fresh foods and supporting farmers' markets can make nutritious options more accessible. Community initiatives like establishing community gardens and offering cooking classes can encourage healthier eating habits.

Additionally, encouraging workplaces, schools, and hospitals to provide healthy food options and replacing ultra-processed snacks in vending machines can create supportive environments. Promoting home cooking through meal planning and sharing nutritious recipes, along with working with retailers to prioritize healthier foods and designing urban areas that support access to fresh food markets, can collectively help shift dietary habits towards healthier choices.

Conclusion

Ultra-processed foods pose significant health risks across various chronic diseases, including obesity, metabolic disorders, diabetes, heart diseases, hypertension, cancer, and depression. Studies consistently demonstrate that higher consumption of UPFs correlates with elevated odds of developing different chronic diseases. These findings underscore the detrimental impact of UPFs on both physical and mental health outcomes. To address these challenges, effective public health measures are crucial, including educational campaigns, nutritional interventions in schools, clear food labeling, restrictions on advertising, and taxation of UPFs. Promoting access to fresh foods, supporting community-based initiatives, and fostering environments conducive to healthier dietary choices are essential steps towards mitigating the adverse health effects of UPFs on a population level in Nepal.

Article was jointly Authored by Dr. Suman Paudel and Ms. Rojina Basnet !!!

Rare Diseases are Not Rare in Nepal - A Global Perspective

Rare diseases, despite their name, impact millions of lives globally. The complexity and uniqueness of these diseases demand focused attention and specialized care. This blog post explores the landscape of rare diseases, with a particular focus on initiatives in the United States and the prevalence of certain diseases in Nepal.

Rare Diseases: An Overview

Genetic and Rare Diseases (GARD) Program in the USA

The National Institute of Health (NIH) in the United States runs the Genetic and Rare Diseases (GARD) program, which plays a crucial role in providing comprehensive information about rare diseases. This initiative focuses on:

• Diagnosis and Clinical Information: Simplified and accessible information on various rare diseases.
• Support Systems: Technical, emotional, and social support for individuals and families affected by rare diseases.
• Guidance on Management: Resources and guidance for managing and handling rare diseases.

A disease is classified as rare in the USA if it affects fewer than 200,000 people. There are an estimated 7,000 different rare diseases affecting approximately 30 million Americans. These diseases are not only rare due to the number of people affected but also because of their genetic and pathological intricacies. Many rare diseases stem from unexplained genetic or chromosomal changes. Interestingly, some infectious diseases, particularly those of tropical origin, are also classified as rare in the USA due to their limited prevalence, despite having well-understood mechanisms and management protocols.

Prevalence of Tropical Diseases in Nepal

Many tropical diseases of significant public health concern in Nepal are listed as rare diseases in international registries in Europe and the USA. Marginalized communities in Nepal continue to struggle with diseases that have been eradicated in many other countries. Examples of such diseases include leprosy, lymphatic filariasis, kala-azar, dengue, rabies, and snakebite envenoming.

Nepal has recently faced a significant surge in dengue fever cases, particularly during the rainy season. Despite widespread awareness and treatment facilities, the disease has spread extensively from the Terai region to the hilly and mountainous parts of the country.

In 2018/19, Nepal conducted its first National TB Prevalence Survey, revealing alarming data:

• Prevalence: 416 per 100,000 people, with about 117,000 individuals living with TB.
• Incidence: 245 per 100,000 people, with an estimated 69,000 new cases.
• Mortality: 3.1 times higher than previous estimates.

The high infectivity of TB, combined with increased public movement, poses a significant challenge to eliminating TB in Nepal. Besides TB, diseases like malaria, dengue, rabies, and snakebites are significant public health concerns in Nepal. These are classified as neglected tropical diseases and are often registered under rare diseases.

Solutions and Way Forward

Tackling Infective Rare Diseases

• New Medicines and Active Surveillance: The availability of new medications and active case surveillance are critical in controlling infectious diseases.
• Technology and Education: Utilizing technology and spreading awareness to reduce disease spread are essential strategies.
• Involving Communities: Adopting an integrated approach involving multiple stakeholders and engaging various communities is crucial. For example, sickle cell disease affects multiple generations of specific ethnic groups in the Terai region of Nepal. To combat this disease, the Ministry of Health and central government should implement a national surveillance and prevention program, while local governments should run awareness campaigns. Communities should also promote genetic testing for sickle cell disease before marriage and childbearing.

Addressing Genetic Rare Diseases

• Advanced Genetic Research: High-end genetic research labs and molecular research are crucial for understanding and managing genetic rare diseases.
• Institutional Collaboration: Given Nepal's limited resources, collaboration at the institutional level is necessary to tackle these challenges.

Importance of Disease Registry

• Rapid Development of Disease Registry: Tracking and reporting cases to the national registry is vital for early diagnosis and management.
• Implementation of Treatment Options: Immediate application of the best available treatment options is crucial.
• National Policies: Specific national policies need to be formulated and implemented swiftly. For instance, a malaria control program should start by identifying high numbers of malaria cases, followed by targeted interventions. Similarly, rabies control can be managed through vaccination campaigns and zoonotic spread awareness.

Conclusion

Addressing rare diseases requires a multifaceted approach, combining advanced research, public health initiatives, and international collaboration. By developing robust disease registries and implementing effective national policies, we can make significant strides in managing and potentially eradicating these conditions.

References

1. National Institute of Health - GARD Program
2. National Cancer Institute - Definition of Rare Disease
3. The Increasing Problem of Tuberculosis in Nepal
4. World Health Organization - Nepal Commemorates World Neglected Tropical Diseases and World Leprosy Day 2024

The Evolution of Food and Nutrition: From Ancient Practices to Modern Trends

Food and nutrition have been vital components of human existence since the dawn of civilization. Our ancestors' relationship with food has undergone significant transformations, from hunting and gathering to the development of agriculture, and further into the complexities of modern dietary practices. This blog post explores the historical perspectives on food and nutrition, tracing the journey from ancient times to the 21st century.

Ancient Practices: Hunter-Gatherers to Early Agriculture

Hunter-Gatherer Societies

For thousands of years, human survival depended on hunting wild animals and gathering edible plants. This hunter-gatherer lifestyle required vast knowledge of the natural environment, as people had to identify safe and nutritious food sources. Their diets were diverse, encompassing fruits, nuts, seeds, meat, and fish, providing a variety of nutrients essential for their physical demands.

The Neolithic Revolution

The transition from hunting and gathering to agriculture marked a significant turning point in human history. Known as the Neolithic Revolution, this period saw the domestication of plants and animals. Agriculture allowed humans to settle in one place, leading to the establishment of communities and the development of more complex food systems. With the ability to grow and store food, diets diversified and populations increased.

The Rise of Civilizations: Food and Social Structure

Ancient Civilizations

As civilizations arose in regions like the Middle East, India, China, and the Mediterranean, food and nutrition systems became more intricate. The ancient Egyptians, for instance, developed a social hierarchy centered around food, while the Chinese emphasized balance in their dietary practices. These early societies understood the importance of a varied diet, incorporating grains, vegetables, and proteins.

Medieval Period

During the Middle Ages, food became closely linked to religion and social status. Feasts and religious festivals showcased the abundance of food, while the wealthy demonstrated their prestige through elaborate meals. This period also saw the introduction of new culinary techniques and the exchange of ingredients due to trade.

The Age of Exploration: A Culinary Exchange

The 16th century marked the beginning of global exploration and the introduction of new foods and ingredients between the Old World and the New World. European explorers brought back potatoes, tomatoes, maize, and cacao from the Americas, revolutionizing European cuisine. This exchange not only diversified diets but also led to the development of new culinary traditions and techniques.

The 19th Century: Industrialization and Nutrition Science

Industrial Revolution

The 19th century brought dramatic changes with industrialization and urbanization. Advances in food production and preservation techniques, such as canning and refrigeration, allowed for the mass production and distribution of food. This period saw the rise of processed foods, including canned goods, refined sugar, and white flour, which became staples in the modern diet.

Scientific Advances

During this time, significant progress was made in the field of nutrition science. Researchers began to understand the role of vitamins and minerals in the human body, leading to the concept of a balanced diet. The increased availability of nutritional information helped shape public health policies and dietary guidelines.

The 20th Century: Modern Nutrition and Dietary Guidelines

The 20th century continued to build on the advancements of the previous century. The publication of the Dietary Guidelines for Americans in 1980 provided a framework for healthy eating, emphasizing the consumption of a variety of foods to meet nutritional needs. These guidelines have been regularly updated to reflect the latest scientific evidence.

Public Health and Nutrition

Public health efforts in the 20th century focused on combating deficiencies and promoting balanced diets. Food fortification, such as adding vitamins and minerals to staple foods, played a crucial role in preventing diseases like rickets and pellagra. Nutrition education campaigns aimed to inform the public about healthy eating habits.

The 21st Century: Sustainable and Personalized Nutrition

Sustainable Food Systems

The 21st century has seen a shift towards sustainable food systems. There is a growing emphasis on locally-grown, organic, and nutrient-dense foods. Sustainable practices, such as organic farming and vertical farming, aim to reduce environmental impacts and ensure food security. Consumers are increasingly seeking foods free from artificial ingredients, hormones, and preservatives.

Technological Innovations

Advancements in technology have transformed food production and nutrition. Hydroponics, aquaponics, and vertical farming allow for higher yields with less land and water. Additionally, food safety has improved with policies ensuring traceability and quality control.

Personalized Nutrition

The rise of personalized nutrition, driven by technologies like DNA testing and artificial intelligence, offers tailored dietary advice based on individual genetic makeup. This personalized approach aims to optimize health outcomes by considering unique nutritional needs and preferences.

Conclusion

The journey of food and nutrition from ancient practices to modern trends highlights the dynamic relationship humans have with their diets. Understanding this history helps us appreciate the importance of making informed choices about what we eat. As we continue to advance in the fields of food production and nutrition science, the focus remains on promoting health, sustainability, and personalized dietary practices for a better future.

Jointly Authored by Dr. Suman Paudel and Ms. Rojina Basnet !!!

For more insights and updates on food and nutrition, stay tuned to Research Sapling.

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References

- Public health nutrition: a historical perspective [PubMed](https://pubmed.ncbi.nlm.nih.gov/8120295/)

- A brief history of nutrition [Natural Healers](https://www.naturalhealers.com/blog/nutrition-history/)

- History of modern nutrition science [BMJ](https://www.bmj.com/content/361/bmj.k2392)

- The history and future of food fortification in the United States [PubMed](https://pubmed.ncbi.nlm.nih.gov/11842999/)

The Global Threat of Emerging and Resurging Infectious Diseases: A Call for Proactive Measures

The emergence and resurgence of infectious diseases represent a significant public health threat on a global scale. This issue is particularly pronounced in least developed countries with low and lower-middle incomes, such as Nepal. Despite advancements in healthcare, infectious diseases continue to impose a substantial burden on our society, with a notable increase in deaths attributed to emerging and re-emerging viral diseases and new virus infections compared to seasonal and endemic infections.

The Past Century's Pandemics: A Stark Reminder

The past century has witnessed several pandemics caused by RNA viruses, leading to substantial morbidity and mortality worldwide. These include outbreaks of diseases such as the Spanish Flu, Asian Flu, and more recently, the COVID-19 pandemic caused by the SARS-CoV-2 virus. The devastating impact of the COVID-19 pandemic serves as a stark reminder of the urgent need to address emerging infectious threats. In Nepal, the COVID-19 pandemic has severely strained the healthcare system, highlighted gaps in public health preparedness, and exacerbated existing socioeconomic inequalities.

COVID-19 in Nepal: Impact and Challenges

The COVID-19 pandemic hit Nepal hard, exposing the country's vulnerabilities in dealing with large-scale health emergencies. With limited healthcare infrastructure, inadequate medical supplies, and a shortage of healthcare professionals, Nepal faced significant challenges in managing the crisis. The pandemic resulted in widespread illness and death, disrupted daily life, and caused severe economic hardship.

Healthcare System Strain: Hospitals and healthcare facilities in Nepal were overwhelmed with COVID-19 patients, leading to a shortage of hospital beds, ventilators, and oxygen supplies. The healthcare system struggled to provide adequate care, and many non-COVID-19 health services were disrupted.

Economic Impact: The pandemic led to widespread job losses, reduced income, and increased poverty. Lockdowns and restrictions severely impacted industries such as tourism, which is a significant source of revenue for Nepal. The economic downturn has had long-lasting effects on the livelihoods of many Nepalese citizens.

Education Disruption: School closures and the shift to online learning created a digital divide, with many students lacking access to necessary technology. This has resulted in significant learning losses and widened educational inequalities.

Mental Health Crisis: The prolonged pandemic and its associated stressors have led to a rise in mental health issues, including anxiety, depression, and trauma. The mental health infrastructure in Nepal is not equipped to handle this increased demand for services.

Factors Influencing the Spread of Infectious Diseases

The spread of infectious diseases is influenced by various factors, including socioeconomic conditions, land use, climate, and biodiversity. Vector-borne and zoonotic viruses are particularly sensitive to changes in climate and biodiversity, highlighting the interconnectedness of human, animal, and environmental health. This interconnectedness underscores the importance of adopting comprehensive strategies to manage and mitigate these threats.

Case Study: Monkeypox and COVID-19

One example of a viral zoonotic disease is monkeypox, which has garnered attention due to recent outbreaks reported in multiple countries. The spread of monkeypox underscores the importance of adopting a One Health approach, which emphasizes collaboration between human and animal health sectors to detect, prevent, and control infectious diseases. This approach is crucial for effectively managing diseases that can jump from animals to humans, posing significant public health risks.

Similarly, the COVID-19 pandemic, caused by the SARS-CoV-2 virus, has highlighted the need for a coordinated global response to infectious diseases. The pandemic has shown how quickly a virus can spread across borders, causing widespread illness and death, and underscored the importance of international cooperation in disease surveillance, research, and response.

The One Health Approach: A Path Forward

In conclusion, proactive measures are essential to address the challenges posed by emerging infectious diseases, particularly those caused by RNA viruses. By adopting a One Health approach and enhancing preparedness efforts, we can mitigate the impact of pandemics and safeguard the health and well-being of our communities. This approach fosters collaboration across various sectors, including public health, veterinary health, and environmental health, ensuring a comprehensive response to infectious disease threats.

Taking Immediate Action and Long-Term Strategies

Immediate Actions

Strengthen Healthcare Systems: Improve healthcare infrastructure and access, particularly in outskirts of Nepal. This involves increasing the number of healthcare facilities, sufficient human resource ensuring adequate medical supplies, and training healthcare professionals.

Enhance Surveillance: Implement robust surveillance systems to detect and monitor infectious diseases promptly. This includes improving diagnostic capabilities, increasing testing availability, and ensuring timely reporting of cases with special attention at the border area of Nepal with India and China from where there is high influx of people. Surveillance program should be further strengthen by building capacitated quarantine facilities. 

Promote Vaccination: Ensure widespread access to vaccines, including COVID-19 vaccines and other essential immunizations. Public health campaigns should focus on educating communities about the importance of vaccination and addressing vaccine hesitancy. Use of national media like Radio, Television, Newspaper and social media can be implemented for addressing hesitancy. 

Provide Economic Support: Offer financial assistance to those affected by the pandemic, including unemployment benefits, business support, and social safety nets. This helps mitigate the economic impact and supports recovery efforts. Effective implementation and monitoring of social security programs endorsed by the government such as health insurance program, The senior citizen's allowance, The disability allowance, Endangered Ethnicity allowance, Bipanna Nagarik Aaushadhi Upachar  etc. 

Enhance Public Awareness: Increase public awareness about the importance of hygiene, vaccination, and early detection to prevent the spread of infections. Public health messaging should be clear, consistent, and accessible to all segments of the population. This message should be flowed from all the healthcare centers at each local level supported by national media. 

Long-Term Strategies

Invest in Research and Innovation: Invest in research to understand emerging pathogens and develop effective treatments and vaccines. This includes funding for scientific research, partnerships with international organizations, and support for innovation in healthcare. Research and collaboration activities should be led by national organizations like Nepal Health Research Council (NHRC). 

Foster International Collaboration: Encourage collaboration between governments, health organizations, and communities to address the root causes of disease emergence. Global cooperation is essential for effective disease surveillance, research, and response. Action should be initiated and regulated from the ministry level. 

Adopt One Health Approach: Promote the One Health approach, which recognizes the interconnectedness of human, animal, and environmental health. This involves coordinated efforts across sectors to prevent and control infectious diseases. All the stakeholders like ministry of health, ministry of agriculture and ministry of environment should come together in order to make collaborative effort on one health approach. 

Improve Environmental Health: Address environmental factors that contribute to the spread of infectious diseases. This includes promoting sustainable land use practices, protecting biodiversity, and mitigating climate change.

Strengthen Health Infrastructure: Build resilient health systems capable of responding to current and future infectious disease threats. This involves investing in healthcare infrastructure, training healthcare professionals, and ensuring access to essential medical supplies.

Promote Education and Technology: Enhance access to education and technology, particularly in rural and underserved areas. This includes expanding digital infrastructure, providing technology for remote learning, and addressing the digital divide.

By taking these proactive steps, we can build resilient health systems capable of responding to current and future infectious disease threats, ultimately protecting global health and ensuring a safer, healthier future for all. The COVID-19 pandemic has provided valuable lessons that should guide our efforts in preparing for and mitigating the impact of future pandemics, ensuring that we are better equipped to handle any public health crises that may arise.

                  Jointly Authored by Dr. Suman Paudel and Dr. Yogendra Shah !!!

 

Should Healthcare Practitioners in Nepal Stay or Leave?

Healthcare practitioners in Nepal are struggling with a profound dilemma: should they stay and work in their homeland, or should they seek opportunities abroad? On one hand, there's a deep emotional connection to serving the Nepalese people, honed by years of study and professional dedication. On the other hand, the healthcare governance system in Nepal often feels stifling, unresponsive to innovation, and underappreciative of expertise and contributions. This confusion is exacerbated when peers move abroad, enjoying better lifestyles and professional environments, prompting many to consider following suit. However, the reality in high-resource countries may not always align with the rosy depictions seen online and on social media.

This article delves into the primary hindrances faced by healthcare practitioners, paramedics, and professionals in Nepal, and explores actionable strategies to navigate these challenges while finding fulfillment in their roles within a resource-limited country.

1. Navigating Governmental Processes

 Upon entering the workforce, especially in government settings, healthcare practitioners must deal with extensive administrative tasks that go beyond their technical training. Understanding the governance model, federalism, roles of various government levels, institutional structures, procurement systems, and legal nuances is crucial. Unfortunately, medical education often neglects these areas, leaving practitioners ill-prepared.

Continuous professional development programs focusing on administrative skills, governance, and legal frameworks should be implemented. Practitioners can also seek mentorship from experienced colleagues and engage in workshops or short courses to bridge these knowledge gaps.

2. Developing Skills for Supplementary Income

Medical professionals often focus solely on their studies, missing out on opportunities to develop side incomes. With minimal salaries from government or private institutions, managing personal finances becomes a significant struggle.

Encouraging medical students and professionals to explore side ventures during their studies can be beneficial. Online freelancing, consulting, or even part-time teaching can provide supplementary income. Institutions should facilitate entrepreneurial workshops and provide resources on financial management.

3. Enhancing Technological Proficiency

The rapid advancement of technology often leaves healthcare curricula lagging. Students and practitioners may feel left behind, despite their academic prowess, due to insufficient technological skills.

Universities and institutions need to integrate technology training into their curricula. Offering courses on medical software, data analysis tools, and digital healthcare solutions can help bridge this gap. Additionally, self-paced online courses and certifications in relevant technologies can be pursued.

4. Building Research Competence

Research is integral to evidence-based practice, yet it is often seen as an extra burden in Nepal. Clinicians lacking research skills may find themselves disadvantaged in professional settings.

Encouraging a research culture within medical institutions is essential. This includes providing training in research methodologies, offering incentives for research activities, and fostering collaborations with academic and research institutions. Practitioners should also be encouraged to publish their findings and engage in continuous learning.

5. Gaining Financial Literacy

While healthcare professionals know how to earn, they often lack the knowledge of personal finance management, including investing, trading, and navigating fiscal policies.

Financial literacy programs tailored for healthcare professionals can be highly beneficial. Institutions can organize workshops on personal finance, investing, and taxation. Additionally, online resources and courses can provide the necessary knowledge for financial management.

6. Addressing Comparison and Lifestyle Expectations

Comparing oneself to peers abroad can create dissatisfaction and urge practitioners to leave Nepal. The allure of a better lifestyle often overshadows the challenges faced in foreign healthcare systems.

Practitioners should focus on building a fulfilling career within Nepal by leveraging their expertise to bring about change. Emphasizing the impact of their work on local communities and seeking professional satisfaction through contribution and innovation can help mitigate the desire to emigrate.

7. Understanding Intercultural Differences and Cultural Rigidity

Nepal's rich cultural diversity can be both a strength and a challenge. Cultural rigidity and lack of understanding can lead to frustration and discontent among healthcare professionals.

Promoting cultural competence and flexibility is crucial. Training programs on intercultural communication and sensitivity can help practitioners navigate the diverse cultural landscape of Nepal. Embracing and respecting cultural differences can enhance personal and professional satisfaction.

8. Overcoming a Sense of Entitlement

The educational system often instills a sense of entitlement, leading to unrealistic expectations regarding respect and job roles.

Fostering a culture of humility and continuous learning can help mitigate this sense of entitlement. Encouraging professionals to engage in all aspects of healthcare, including administrative and menial tasks, can build a more resilient and adaptable workforce.

Conclusion

While the challenges faced by healthcare practitioners in Nepal are significant, they are not insurmountable. By addressing gaps in knowledge, skills, and attitudes, practitioners can find fulfillment and success within their homeland. Embracing continuous learning, leveraging opportunities for supplementary income, and fostering a culture of innovation and research can pave the way for a rewarding career in Nepal’s healthcare sector.

The Rampant Use of Nutraceuticals in Nepal: A Growing Concern

In recent years, the popularity of nutraceuticals products derived from food sources that offer health benefits beyond basic nutrition has surged in Nepal. These products, which include vitamins, minerals and herbal supplements promise a wide range of health benefits, from boosting immunity to improving cognitive function. However, the unregulated influx of these products into the Nepalese market raises significant concerns regarding consumer safety and product efficacy.

Lack of National Regulation

Current director general of Department of Drugs Administration (DDA) had recently confessed on national newspaper that there is no regulation guideline on national level for the nutraceuticals' in Nepal, which on my personal opinion is the most pressing issue. As we know that pharmaceuticals are strictly regulated in the country via laws and bylaws but nutraceuticals fall into a grey area in terms of regulation. This lack of regulation means that there are no standardized guidelines for the import, manufacturing, or sale of these products. Consequently, the market is flooded with a variety of nutraceuticals, many of which have not been adequately tested for safety or effectiveness. Despite being well regulated by the national entity, standards of medicines being consumed by Nepalese population is worrisome, context of nutraceuticals is beyond imagination. 

The Influx of Imported Products 

Due to the absence of local regulations, Nepal has become a lucrative market for imported nutraceuticals. Products from countries with varying regulatory standards are readily available, often without proper labeling or quality assurance. Specifically, majority of Nepalese market is flooded with nutraceuticals manufactured in India and imported by local agents. We are not sure of regulations and monitoring status within India as numerous accusations are widespread on international news regarding safety concerns of products regulated by government of India. Condition might be further troublesome in Nepal as most of the imported products are not even registered in India. This situation is exacerbated by aggressive marketing strategies that tout these products as cure-alls for various health issues, leading to widespread use among the Nepalese population.

Misuse of Social Medial 

Social media platforms like Facebook ads have become hotbeds for exaggerated advertisements and false claims regarding nutraceuticals, preying on the vulnerabilities of consumers seeking quick health fixes. Influencers and marketers exploit the lack of regulation to promote these products with sensational promises of miraculous benefits, often without any scientific backing. This rampant misinformation, amplified by viral marketing tactics, misleads the public into purchasing and using products that may be ineffective or even harmful, further complicating the challenge of ensuring consumer safety in Nepal's burgeoning nutraceutical market.

Renowned Medical Professionals Prescribing Haphazardly 

Alarmingly, even some renowned names in the medical field are prescribing nutraceuticals haphazardly. This practice not only undermines the credibility of the medical profession but also places patients at risk. When trusted healthcare providers endorse these unregulated products, it gives a false sense of security to consumers, who may then use these supplements indiscriminately. The underlying reason as per my opinion is handsome amount of money being offered by the nutraceutical agents to the medical professionals on each prescription. 

Challenges in products Consistency 

Another significant issue is the difficulty in obtaining the exact same brand of product consistently. Unlike pharmaceuticals, nutraceuticals do not have generic equivalents, making it challenging for consumers to maintain a steady regimen. This inconsistency can lead to varying results and potential health risks due to differences in product formulation and quality.

Issues with Ayurveda and Alternative Medicines

The problem extends beyond nutraceuticals to Ayurveda and other alternative medicines marketed as health and immunity boosters. While these traditional practices were not initially in the mainstream, the haphazard prescription of nutraceuticals by medical doctors has normalized the use of such products. This shift has further complicated the landscape, making it difficult for consumers to distinguish between effective treatments and unproven remedies.

Solutions and Way Forward: 

1. Establishing Regulatory Standards: The government should develop and enforce comprehensive regulations for nutraceuticals. This includes setting quality standards, requiring proper labeling, and ensuring that all products are tested for safety and efficacy before they reach the market.

2. Educating Healthcare Providers: Medical professionals need to be better educated about the potential risks and benefits of nutraceuticals. Encouraging evidence-based prescribing practices will help ensure that patients receive safe and effective treatments.

3. Implementing Import Controls: Stricter import controls are essential to prevent the influx of substandard or unsafe nutraceuticals from abroad. This can be achieved by requiring importers to provide documentation proving that their products meet Nepalese regulatory standards.

4. Consumer Awareness Campaigns: Launching nationwide awareness campaigns to educate consumers about the potential risks associated with unregulated nutraceuticals. Providing clear information about how to choose safe and effective products will empower consumers to make informed decisions.

5. Promoting Research and Development: Encouraging local research and development of nutraceuticals can help ensure that these products are tailored to the specific health needs of the Nepalese population and meet high safety and efficacy standards.

Conclusion: 

The unregulated use of nutraceuticals in Nepal is a growing concern that demands immediate attention. Without proper regulation, the health and safety of consumers remain at risk. It is crucial for policymakers to develop and enforce guidelines that ensure the quality and efficacy of these products. By doing so, Nepal can protect its citizens and ensure that the benefits of nutraceuticals are realized without compromising public health

What are your thoughts on the current state of nutraceuticals in Nepal? Share your experiences and suggestions in the comments below. Let's work together to advocate for a safer, healthier market.

Hypocrisy of Modern Medicine : Example from Nepal

Have you ever pondered over the medications prescribed during your visits to a healthcare provider in Nepal? Did you pause to question the necessity, safety, and efficacy of those medications? If not, you might have either experienced exceptional care or fallen victim to the systemic inadequacies plaguing modern medicine in the country. Despite being touted as evidence-based, the reality is starkly different – there exists a glaring absence of locally generated evidence to guide the approval and marketing of allopathic medicines.

One glaring truth encapsulates the essence of medical practice in Nepal: "Not a single allopathic medicine prescribed in the country has undergone rigorous clinical trials to scrutinize its safety and efficacy." This revelation might initially evoke disbelief or skepticism, but it underscores a fundamental flaw in the healthcare landscape. Medical practice operates on the assumption that if a medication is available in the market and outlined in textbooks, it must be authentic. However, the suitability of these medications and treatment protocols for the Nepalese population remains uncertain. Moreover, the irony intensifies when medicines developed overseas does not even undergo trials on Nepalese population but makes direct entry in the Nepalese pharma market legally endorsed by country

 

A closer examination of Nepal's medical framework reveals a complex network of hospitals and healthcare centers scattered across the country. From central to provincial and local levels, healthcare facilities cater to the diverse healthcare needs of the populace. However, the reliance on allopathic medicine as the cornerstone of modern healthcare is juxtaposed against the backdrop of alternative medicine systems such as Ayurveda, Homeopathy, and Naturopathy. Despite being labeled as evidence-based, the monopoly of allopathic medicine is not without its shortcomings.

Pharmaceutical companies operating within Nepal often resort to reassembling active pharmaceutical ingredients (APIs) sourced from other countries, primarily India. Consequently, the majority of medicines labeled as "manufactured in Nepal" are, in reality, repackaged or replicated versions of Indian products. This reliance on external sources for medication underscores the absence of indigenous research and development capabilities within the Nepalese pharmaceutical industry.

The absence of a dedicated research and development infrastructure within domestic pharmaceutical companies severely hampers the possibility of conducting clinical trials within the country. Consequently, Nepal remains reliant on medications whose safety and efficacy have been established primarily in foreign contexts. This systemic inadequacy not only compromises patient care but also perpetuates a cycle of dependency on external pharmaceutical markets.

The implications of this paradox extend beyond individual patient encounters to encompass broader public health outcomes. Without locally generated evidence to inform medical decision-making, healthcare providers are left navigating a landscape fraught with uncertainty. Moreover, the reliance on imported medications limits the country's capacity for innovation and self-sufficiency in healthcare delivery.

Addressing the hypocrisy of modern medicine in Nepal requires a multifaceted approach encompassing policy reform, investment in research and development infrastructure, and greater transparency within the pharmaceutical industry. Collaborative efforts between government agencies, healthcare professionals, and pharmaceutical stakeholders are imperative to facilitate the generation of locally relevant evidence and enhance the quality of patient care.

In conclusion, the paradox of modern medicine in Nepal underscores the urgent need for systemic reforms to align healthcare practices with evidence-based principles. By addressing the underlying deficiencies in clinical research infrastructure and promoting indigenous pharmaceutical innovation, Nepal can aspire towards a healthcare system that prioritizes the well-being of its citizens. Only through collective action and unwavering commitment to transparency and accountability can the country overcome the hypocrisy that pervades its medical landscape.

Challenges and Opportunities of Clinical Research In Nepal : A Closer Look

Clinical research plays a crucial role in advancing medical knowledge, developing new treatments, and improving patient care. While numerous countries around the world have established a robust culture of clinical research, Nepal is yet to make significant progress in this area. In this blog post, we will delve into the factors that have hindered the development of a thriving clinical research culture in Nepal and explore potential opportunities for growth

The Landscape of Clinical Trials in Nepal

Nepal has been involved in a number of clinical trials; however, it has primarily served as a research subject rather than actively contributing to the design and execution of trials. Most trials are initiated elsewhere, leaving Nepal to participate and provide data as required by the sponsor. This raises questions about the country's role in clinical trials and its ability to leverage research for its own benefit.

Reasons For Lack of Progress 

1. Absence of Investigational Medicinal Products (IMPs): A significant factor inhibiting Nepal's progress in clinical research is the absence of its own investigational medicinal products or devices. Currently, clinical trials are conducted for products developed by external entities, limiting the potential benefits for Nepal. By developing its own IMPs and successfully conducting clinical trials on them, Nepal could harness economic benefits and contribute to its own scientific advancement. 

2. Inadequate Resources and Infrastructures: Clinical trials demand a dedicated workforce and suitable facilities. Nepal faces challenges in terms of both human resources and infrastructure. Well-trained clinical research personnel are essential to maintain protocol adherence and ensure data quality. Currently, there is a lack of organizations offering clinical research training and certification courses, contributing to the suboptimal structure of clinical research activities.

3. Regulatory Framework: The regulatory framework for clinical research in Nepal involves the Nepal Health Research Council (NHRC) and the Department of Drug Administration (DDA). Both of these organizations work in collaboration to control regulatory as well as ethical aspects of clinical trials respectively. However, in reality, both of these organizations are not clear and concise on their own roles and responsibilities and hence are functioning without any solid guiding documents underneath. Since any of the clinical trials are not well monitored / inspected from the governmental authority, the quality of the data hence produced is solely dependent on the integrity of the researchers. 

Opportunities For Growth

1. Developing Own IMPs - Nepal has the potential to embark on the journey of developing its own investigational medicinal products and medical devices. This would involve investment in research and development, fostering collaboration between academia and industry, and aligning efforts with the country's healthcare priorities. 

2. Building Skilled Workforce: Establishing dedicated organizations or courses for clinical research training can bridge the skills gap. A workforce equipped with the necessary knowledge and expertise will ensure the integrity of trials, adherence to protocols, and accurate data collection.

3. Enhancing Regulatory Clarity:  Refining the regulatory processes and guidelines can attract more sponsors and researchers to consider Nepal for clinical trials. Clear and efficient regulations inspire confidence among stakeholders and expedite the initiation and execution of trials.

Conclusion

While Nepal may currently face challenges in establishing a vibrant culture of clinical research, there are significant opportunities for growth and progress. By addressing the identified hurdles and leveraging its strengths, Nepal can transition from being a passive participant in clinical trials to an active contributor, fostering its own scientific and economic development. With focused efforts, collaboration, and strategic planning, Nepal can pave the way for a promising future in clinical research

Disparities on Out of Pocket Expenditure In Nepal - Seed of Social Injustice

When it comes to seeking medical care, one cannot ignore the financial aspect. Have you ever wondered if the amount you paid for healthcare services was truly justifiable for what you received? The disparity in healthcare costs between hospitals often leaves us questioning the fairness of the expenses incurred. In this blog post, we delve into the world of out-of-pocket expenditure and the factors that contribute to the variance in costs between hospitals.

Understanding Out-of-Pocket Expenditure

Out of Pocket (OOP) expenditure is the portion of medical cost that individuals pay directly from their own income or through debt, excluding contributions from insurance or social security. It's a crucial metric that sheds light on the affordability and fairness of healthcare services. Imagine visiting two different hospitals for similar health issues and discovering a significant difference in costs. This raises the question of whether the price gap is equitable given the services provided and the severity of the condition.

Factors Influencing Out-of-Pocket Expenditure

1. Care Providers Cost: The initial ticket cost charged by hospital can vary greatly. This charge often reflects the hospital's internal expenses, equipment quality, and staff availability. Higher charges might correlate with more advanced services, allowing patients to choose according to their financial capacity and medical needs

2. Inpatient Admission Cost: The cost of staying overnight in the hospital various services can vary significantly. This disparity can make sophisticated hospitals seem unaffordable to many.

3. Diagnostic Tests: The cost of the diagnostic test can be a major component of OOP expenditure. In some cases, excessive tests are ordered, inflating costs unnecessarily.

4. Medicine Import: Nepal's reliance on imported medicines increases their cost due to import expenses. A local manufacturing approach could alleviate this burden and reduce overall healthcare costs.

5. Insurance and Social Security: The absence of robust health insurance and social security schemes in Nepal contributes to high OOP expenditure. Strengthening these systems can greatly alleviate the financial burden on patients.

Tackling the Issues: Solutions and Pathways Forward

1. Enhancing Insurance Coverage: Effective implementation of health insurance can significantly reduce OOP expenditure, providing a lifeline out of the poverty trap. This might involve digitalization, private sector partnerships, and other innovative approaches.

2. Hospital Grading and Cost Transparency: Grading hospitals based on facilities and services, and disclosing standardized costs for each category, can empower patients to make informed choices and level the playing field.

3. Income Based Payment: Integrating annual income data into healthcare  records can guide patients towards suitable healthcare options, especially beneficial for those with limited education.

4. Domestic Medicine Production: Manufacturing essential medicines locally can alleviate costs until robust insurance and digital healthcare systems are established.

5. Stringent Regulation and Ethical Practice: Monitoring hospitals and enforcing ethical practices are essential steps. Implementing reward and punishment mechanisms can shift the healthcare industry toward a patient-centric model.

6. Commitment to Ethical Practice: Ethical responsibility lies with healthcare practitioners, providers, patients, and the pharmaceutical industry. Ethical practices are pivotal in ensuring the healthcare system's benefits are maximized for all.

Conclusion 

Navigating the labyrinth of healthcare cost requires a collective effort from regulatory bodies, hospitals, healthcare professionals, and patients. The journey toward justifiable healthcare expenses involves reimagining insurance systems, fostering transparency, and promoting ethical practices. By addressing the factors contributing to high OOP expenditure and implementing innovative solutions, Nepal can move closer to a healthcare system where costs reflect the value of services rendered, without leaving individuals burdened by financial strain

                                                                                                      Thank You !!!