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This study aims to explore the effects of responsible international investment in a least developed country (LDC) on ethics and corruption in the local industry. While investment growth in least developed countries (LDCs) is essential to meet the United Nations Sustainable Development Goals, international investment in LDCs poses challenges, including corruption. The authors explore perspectives from relevant stakeholders on the influence, if any, on an LDC’s banking sector, of investment in the LDC by a multinational bank with an environmental, social and governance focus – using a case study of Standard Chartered Bank (SCB) in Nepal.

The authors conducted thematic analysis on: focus groups with current and former SCB Nepal management; semi-structured interviews with Nepal banking regulator representatives; senior staff from SCB global divisions; and management of other commercial banks in Nepal.

Knowledge transfer, organisational enablers and constructive international competition contributed to the dissemination of best practices within the Nepal banking sector, supporting the notion of beneficial spill-over effects of multinationals on LDC host countries.

Practical insights will aid LDC governments, international businesses, investment funds and donor organisations seeking to invest in/assist LDCs with economic development.

To the best of the authors’ knowledge, this may be the first case study on ethics and anti-corruption practices of a multinational bank in a LDC. Through a practice-driven focus, the authors provide “on-the-ground” insights to better understand the complex nature of corruption.

Nepal is confronted by an increasing number of natural- and human-induced disasters, making it the most disaster-prone country in the world. Landslides, floods, droughts, fires, thunderbolts, blockades, and earthquakes, among others, occur frequently. All these disasters take a high toll on people and cause heavy damage to physical properties worth billions of dollars every year. One of the recent examples in the history of disasters was the devastating earthquakes that struck Nepal in 2015 taking away human lives, destroying physical infrastructures, altering cultures, challenging institutions, and devastating the hope and ambitions of people. Thirty-three of the Nepal’s 75 districts were affected, at different degrees, and 14 out of 33 were badly damaged by the two major earthquakes on the 26th of April and the 12th of May 2015. This chapter provides a reflective dialogue on the current state of the disaster-recovery process with a focus on the delivery of recovery services aiming to (1) understand how key actors are responding to disaster-recovery works in Nepal and (2) identify knowledge gaps in the disaster response policy and research arenas in managing future disasters in Nepal.

This chapter focuses on the Maoist insurgency in the 75 districts of Nepal and tries to analyze the insurgency in a comparative perspective. We compare the 75 districts with the aim to address the following questions: Why does an insurgency emerge in certain areas? How is it linked to economic, social, or political factors? Why does an insurgency show a robust presence in some districts but fail to do likewise in others? We attempt to answer these questions by conducting multivariate regressions using longitudinal data to test our primary hypothesis that the onset of an insurgency and the continuation are functions of the same factors. We examine insurgency within one country, Nepal, and test our model in Nepal's 75 districts, in a single country context, using available data on the 10-year-long insurgency. We break down the Nepalese insurgency into two parts: the onset and the continuation. Our findings indicate that regions predominantly polarized by caste are more prone to the onset of insurgency than any other factor. Higher literacy rate, a proxy for government efficacy, renders insurgency less feasible, and difficult terrain has no impact whatsoever. However, after the onset, many of the explanatory variables are no longer significant for the continuation of the insurgency and grievances alone tend to be meaningless.

The history of Nepal gives some insight into its current status as a diverse and multilingual nation with more than 123 languages. Multilingualism is part of the founding philosophy of the country but since it was unified in 1768, government attitudes to language and language education have fluctuated. Though historically education in Nepal has been delivered exclusively in the Nepali language and, more recently, in English, the Government of Nepal is now committed to introducing mother tongue-based, multilingual education (MLE).

Nepal has among the lowest literacy rates in the world (UNESCO Institute for Statistics, 2015) and the government seeks to turn this trend around, particularly for students who do not speak Nepali as a mother tongue. The commitment to strengthening mother tongue-based MLE features prominently in the Constitution of Nepal (2015), the Act Relating to Compulsory and Free Education (2018) and the School Sector Development Plan (MOEST, 2018). This new constitution declares that “all the mother tongues spoken in Nepal shall be the national language” (2015 article 6).

Implementing these policy commitments in over 120 languages across seven provinces and 753 municipalities is the next challenge for the fledgling democracy. As a “wicked hard” policy area, doing so will require a solid understanding of local attitudes, beliefs, resources, and capacities. This chapter gives a unified review of the history, languages, ideologies, beliefs, and trends that currently influence MLE in Nepal and are likely to play a role into the future.

Birth and birthright, in relation to citizenship, are entangled in a complex politics of power and patriarchy as well as past and present notions of cultural and national identity in Nepal. The debates highlight how gender inequality intersects historically with social inequality in a highly stratified society based on religion, caste and ethnicity. The constitutional discussion that has been ongoing in Nepal since the end of the 10-year long civil war in 2004 highlights the need for a critical feminist approach that looks at the multi-faceted and intersecting relationship between citizenship, gender, political projects of imagined communities, social inequality and access to political power. Women have become responsible for the containment of attributes, values and identity within nation-state, regional boundaries, and communities or collectivities. They are constituted as both an asset and a threat to the nation-state should there be fluidity in borders or boundaries. With the struggle to produce and promulgate a new constitution in Nepal, we see how women’s interests and equality can be sacrificed in the name of protecting idealized social and political values as well as preserving the nation-state itself.

Conflict resolution and peace building has acquired much significance in the last few years (Siddiqi, 2003).

Nepal is exposed to multi-hazard risk and is highly prone to disasters such as earthquake, flood, landslide, and drought. The climate, topography, nature-based livelihood, and weak economy and institutional capability to deal with such disasters put the country at frontline of the highly vulnerable countries in the world. Majority of the population of Nepal live in rural areas which are characterized by poorly developed infrastructures. Several disasters in such areas induce temporarily or permanently displacements of the people. Vulnerable communities, households, and individuals lack the capacity to withstand shocks, while more resilient communities are able to reduce the associated risks. Migration during disasters is itself an adaptive response which is both the opportunity and challenge for developing a resilient community. This chapter presents the trends and patterns of disaster-induced displacements in Nepal and explores how disaster-induced displacements could be an opportunity to build back better to enhance the resilience of the vulnerable communities. This chapter also highlights the existing institutions and disaster management framework of the national policies and strategies at the federal, provincial, and local levels in the light of disaster-induced displacement, and recommend actions that need to be taken to manage the risk of disaster-induced displacements and enhance resilient livelihoods in Nepal.

Ensuring adequate access to food to all has remained a major challenge of the 21^st century. To aid the effort of hunger alleviation, many studies have quantified the prevalence of undernourishment (PoU), mostly at the national level. There has been limited attention to understanding the intra-country variation in undernourishment estimates.

Unlike past studies, this study tracks the substantial regional heterogeneity in the undernourishment status within Nepal. Employing Food and Agriculture Organization's methodology and Nepal Living Standards Survey data from 1995, 2003 and 2011, household energy consumption and requirements are computed to determine regional undernourishment.

Nepal's PoU declined between 1995 and 2003 but increased after 2003 affecting approximately 7.6 million Nepalese in 2011. The Terai domain – Provinces 2 and 5 – are found to be the most vulnerable to undernourishment concerns likely because of economic and natural shocks. Province 4 achieved higher progress in alleviating undernourishment during 2003, but its PoU doubled in 2011 (as in Province 6).

By examining where and how many are undernourished within Nepal, this study has provided a more accurate picture of the PoU for better-targeting assistance to improve the livelihood of its citizens.

Past studies indicate substantial variation in food access and PoU within Nepal. While they provide some answers to “where and how many” questions for some districts, provinces, belts and urban/rural domains at the cross-sectional level (or for selected locales), few have examined intra-Nepal heterogeneity, especially over time. Therefore, this study explores where and how many within Nepal have been undernourished during the past three decades.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

Nepal is one of the most natural disaster prone countries in the world. Variable climatic conditions and active tectonic processes have made her vulnerable to various types of natural disasters. In addition, other man‐made factors such as unplanned settlement, lack of public awareness, increasing population, weak economic condition and low literacy rate have also made her vulnerable to various types of natural disasters. With these factors in view, advanced technology and sufficient resources are really needed to mitigate natural disasters in Nepal. Moreover, various types of training and other educational programmes are highly needed to raise disaster awareness among the vulnerable population. Hazard mapping, vulnerability assessment and risk analysis are to be developed. Being a developing and agriculture based country insurance has not yet been widely developed in Nepal except in some big establishments and households. Therefore, the role of insurance has to be recognised in the risk management in Nepal. The Department of Disaster Management in the Ministry of Home Affairs is the focal agency for disaster management in Nepal, which formulates national disaster management policies and implements them. The preparedness and mitigation, immediate rescue and relief work, data collection and dissemination, and the mobilisation of funds and resources are the main responsibilities of the Department. Despite various problems, the Department is gradually moving forward to improve the disaster management situation in Nepal. Being a developing country Nepal needs support from international communities and friendly nations to strengthen her capabilities for disaster mitigation programs.