Long-form, referenced analysis from a decade inside Nepal's government health service — health systems and financing, emergency care, routine data quality, implementation science and responsible AI in public health.
Global health security in 2026 is not short of agendas; it is short of implementation. This article takes the six agendas that dominate the international agenda, states precisely where each one stands against primary WHO, UN, World Bank, OECD, IHME and Lancet sources, and then asks the question that matters in Kathmandu rather than Geneva: what does each one actually require of a district health office, a provincial ministry and a national surveillance unit?
The WHO Pandemic Agreement was adopted at WHA78 on 20 May 2025, but its Pathogen Access and Benefit-Sharing annex is still unfinished — negotiations were extended again in 2026, so the treaty's core obligations are not yet operative.
The amended International Health Regulations entered into force on 19 September 2025, which makes legal capacity, not political intent, the binding constraint for countries whose Joint External Evaluation scores remain low.
Dengue reached 14,434,584 reported cases and 11,201 deaths in 2024 — WHO calls transmission unprecedented, and the expansion is climatic and ecological, not accidental.
WHO's 2025 surveillance report found one in six laboratory-confirmed common bacterial infections in 2023 were resistant to antibiotic treatment, with resistance rising in over 40% of monitored pathogen-antibiotic combinations since 2018.
Climate change is rapidly altering disease transmission dynamics and exacerbating extreme heat vulnerabilities in low- and middle-income countries. Drawing on municipal health leadership and global health security frameworks, this analysis outlines practical implementation strategies to operationalize One Health and build resilient local health systems.
Non-communicable diseases and mental health conditions are overwhelming health systems built for acute infectious diseases in low- and middle-income countries. Successfully moving from siloed initiatives to integrated primary care requires rethinking workforce task-sharing, longitudinal data systems, and sustainable domestic financing.
The rapid emergence of artificial intelligence offers transformative potential for global health, but its deployment in low- and middle-income countries risks exacerbating inequities if built on fragmented data. True health systems strengthening requires bridging the gap between algorithmic hype and the ground realities of digital infrastructure, workforce capacity, and routine health information systems.
8 min read
Health policy · Global health security & governance
Global health security in 2026 is not short of agendas; it is short of implementation. This article takes the six agendas that dominate the international agenda, states precisely where each one stands against primary WHO, UN, World Bank, OECD, IHME and Lancet sources, and then asks the question that matters in Kathmandu rather than Geneva: what does each one actually require of a district health office, a provincial ministry and a national surveillance unit?
19 min read
Technical & digital health · AI, surveillance & governance
AI is entering surveillance work faster than governance is. WHO has published the guidance a national programme needs; this article turns it into decisions a surveillance officer can actually take, with the limits stated honestly.
Most implementation research proposals I review pick a framework for legitimacy rather than for function. This is how to choose between a determinant framework, an evaluation framework and an outcomes taxonomy — and how to combine them without producing an unmanageable study.
11 min read
Technical & digital health · Health information systems
Most national HMIS platforms are excellent at moving data upward and poor at supporting local decisions. This is the monthly data-quality workflow I use to make DHIS2 data trustworthy enough for a municipal health team to act on, anchored in the WHO data-quality review framework.
Nepal completed a formal WHO-tool assessment of its emergency care system and agreed consensus action priorities. Most of those priorities are executed at district and municipal level, where the legal duty to treat emergencies without prior payment already applies.
Nepal has good national NCD and mental health data and weak local use of it. Having coordinated NCD and mental health work at the Epidemiology and Disease Control Division, this is how I would translate the national surveys into a municipal programme that can actually be delivered.
Nepal's insurance scheme is no longer a pilot — it is national infrastructure with a structural problem. Enrolment expanded, renewal did not, and the risk pool is drifting toward the people most likely to claim. Here is what the published evidence says and which reform levers actually move the numbers.
Nepal moved from a single command line to 761 governments delivering health care. This is what actually changed on the ground — the legal mandate, the local planning cycle I ran for five years, and the failure points that any reform has to design around.