After seven years of medical studies abroad, Dr Bharat Pokhrel returned to Nepal with a mission to serve his community and strengthen the national health system. As a physician with Nepal Development Society (NeDS), he trains female community health volunteers to expand their roles beyond maternal and child health, tackling the growing burden of non-communicable diseases in rural areas.
In the picturesque outskirts of the Himalayas, within the Kaski district, where access to healthcare is limited, and traditions run deep, a quiet revolution is underway—led by women, guided by compassion, and powered by knowledge.
In 2024, we introduced Debaka Tiwari, a female community health volunteer (FCHV) working to improve control of type 2 diabetes and social trust in Rajako Chautara, her neighbourhood in Kaski district. The local government handpicks women like Debaka to enhance the community's health status and empower women in society— that complements the efforts of Dr Bharat Pokhrel, a physician working with our partner, Nepal Development Society (NeDS).
Through close collaboration with Nepal’s health authorities, NeDS equips both FCHVs and primary care providers—such as nurses, health technicians, and lab technicians—to strengthen the national health system’s capacity to respond to the growing threat of non-communicable diseases (NCDs). Through his training of FCHVs, Dr Bharat is not only improving diabetes detection and care in rural Nepal but also helping women become trusted health leaders in their communities.
Through 3-day training programmes, Dr Bharat equips FCHVs with the skills to screen for diabetes and hypertension, refer high-risk individuals, and follow up with proper documentation and care coordination.
“The training for FCHVs takes 3 days, and for the healthcare providers (HCPs) it is mainly on a single-day basis,” explains Dr Bharat. “After we conduct the training programme, we give them about 15-20 days. They will be allocated a specific area to screen individuals, so they will complete the programme within the given timeframe.”
In the meantime, NeDS’ project officers will monitor their progress. The monitoring is done in two ways – informed or spontaneous. Both serve the same purpose: to check if the volunteers are following the protocols, developed for the purpose by NEDS, government and experts, that Dr Bharat taught them.
“Once the health post enrols the high-risk participants identified by the FCHVs, they inform us (ed. NEDS), and then we schedule a screening camp. After diagnosis, I counsel the patient and I start the medication.”
The initiative’s effects are already being felt: more people are aware of their condition thanks to wider access to screening, which has led to a rise in diagnoses. FCHVs are now reaching both women and men, including elderly males who might otherwise be overlooked.
This marks a significant expansion of their role—until recently, the core package of services delivered by FCHVs focused primarily on maternal and child health. Their involvement in NCD screening represents a shift towards a more comprehensive approach to community health.
“I thought I am done with living abroad and being far from my community and my people,” says Dr Bharat, reflecting on his decision to return to Nepal after seven years of medical studies in the Philippines. While many of his peers have left the country in search of better pay and professional opportunities, Dr Bharat chose a different path—one rooted in service, family, and a deep connection to his homeland.
His return wasn’t without sacrifice.
“It takes a toll, once you keep doing the good thing but you are not getting anything in return—a good pay, a good salary,” he admits.
The reality is stark: over 2,200 of the 2,700 doctors registered annually with the Nepal Medical Council leave the country (PHC Nepal, 2025; Ekantipur, 2025). “More than 90% of my colleagues are already practising medicine in another country,” he adds. What keeps him grounded is his young family and the belief that his work is making a difference.
That belief is reinforced every time he visits a rural community and sees the impact of his training efforts. “Even though I stay alone in Pokhara, far from my family, I feel I’m solving something for my community,” he says. It’s this sense of purpose that fuels his commitment, even as he acknowledges the uncertainty of how long he can continue under current conditions.
Dr Bharat’s journey with NeDS began with curiosity—and a fair amount of scepticism. “In our community, the reputation of NGOs is really bad,” he explains. “They think that they just register the organisation to get the dollars and fill their pockets.” But his experience with NeDS challenged that perception.
“Once I was associated with NeDS, I realised there are good projects and activities that are clearly benefitting the community.”
This transformation from sceptic to advocate has made him a powerful voice for the role of NGOs in strengthening Nepal’s health system. His work has shown him that when well-designed projects are implemented with integrity, they can reach the most remote corners of the country and empower people—especially women—to take charge of their health.
. . .
Dr Bharat Pokhrel is working with the Nepal Development Society (NeDS) under project WDF20-1780, which aims to scale up a community-based model for the prevention and care of noncommunicable diseases (NCDs) in rural areas of Kaski district, building on a successful proof of concept.
Women in Nepal have become promising agents of change, improving control of type 2 diabetes and social trust. Now, a scale-up to rural areas is expanding the role of female community health volunteers in strengthening a vulnerable health system.