Situated far from the hustle and bustle of the capital city, the plight of the people living in the hinterlands is likely to go unnoticed and even forgotten by the government. Were it not for the media, which highlight the problems and difficulties they face once in a while, citizens living in the comfort zones of the urban centres would not even know they existed.

While poverty and underdevelopment exist in some form in nearly all regions, the far west and the midwest are particularly prone to them, thanks to the neglect they have suffered from the state for decades.

Food shortages in the hilly and mountainous region have been a perennial problem while poor health and sanitation are just as big an issue, with people still dying of simple ailments like diarrhoea and dysentery.

As a result, the provinces lag behind other regions in the human development index, which measures life expectancy, education and per capital income, among others.

There is news that a food crisis is looming large in Bajura district in Sudurpaschim Province due to the drought. Even as heavy rains lashed other parts of the province recently, large swathes of farmland to the north-east of Bajura has seen no rains. So much so that the entire farmlands in Wai, Sappata and Jukot villages have not been cultivated for the past four years because there has been no rain. The Karnali River flows below the villages, but one needs a big project to lift water from it to the farmlands. Even in normal times, the food grown here supports families for only about 4 to 5 months. But now with farmlands remaining fallow, they are totally dependent on the market for foodgrains, which are expensive as they need to be hauled over long distances from the Tarai. If Bajura is facing a food shortage, the nearby district of Doti to the south is seeing a rise in common cold and fever with falling temperatures caused by snowfall.

The elderly and children have been particularly affected by the extreme cold, with government and private hospitals experiencing an increasing flow of patients.

Although doctors say there is no need for panic, the coronavirus pandemic is not over yet, and a large section of the population in the districts have not been vaccinated against the virus.

Since the provincial government cannot do much, the federal government must intervene to improve the food security and health facilities, while creating job opportunities for the youth so as to raise the living standard of the people there. Year after year, youths in their tens of thousands go to India to engage in menial work to tide over the family expenses.

If the situation was not so desperate, the youths would not have left for India in droves even in the midst of the pandemic. For too long, the open border with India has acted as a safety value for the unemployed youth in far-west Nepal. As a result, there has never been any urgency on the part of the state to create jobs there. This must change. For a start, the labour force from Sudurpaschim could be channeled to better earning destinations in the Gulf countries and Korea. It is, however, high time large projects, such as hydropower, were started in the region to absorb the every growing unemployed youths.

Local initiative

A 150-bed provincial hospital is to be built in Okhaldhunga's Toksel village of Manevanjyang Rural Municipality after dozens of locals agreed to provide more than 35 ropanis of land for its construction.

The hospital, once it comes into full operation, will provide quality health services to the people of Okhaldhunga, Solukhumbu, Khotang, Udayppur and other neighbouring districts. These hilly and mountainous districts lack a well-equipped hospital, and most of the people have to travel to Kathmandu or Dharan for quality health services.

The donated land has now been registered with the Ministry of Social Development of Province 1. As per the detailed project report, it would cost around Rs 2 billion. The local people who donated their land for the hospital deserve special thanks for their selfless contribution to the society. However, one of the biggest challenges that lie ahead is to run the hospital in a sustainable manner. The most challenging task for any rural hospital is to retain qualified doctors and technicians skilled at handling the medical equipment. In order to make the hospital fully functional, the provincial government needs to acquire skilled human resources along with medical equipment, and the people must get health services at affordable cost.

A version of this article appears in the print on February 16, 2022, of The Himalayan Times.