In 2001, we conducted a survey of 1500 randomly sampled households in Kathmandu to determine the costs people were incurring to cope with Kathmandu's poor quality, unreliable piped water supply system. From 2001 until 2014, there was little additional public investment in the municipal water supply system. In the summer of 2014, we attempted to reinterview all 1500 households in our 2001 sample to determine how they had managed to deal with the growing water shortage and the deteriorating condition of the piped water infrastructure in Kathmandu and to compare their coping costs in 2014 with those we first estimated in 2001. Average household coping costs more than doubled in real terms over the period from 2001 to 2014, from US$5 to US$12 per month (measured in 2014 prices). The composition of household coping costs changed from 2001 to 2014, as households responded to the deteriorating condition of the piped water infrastructure by drilling more private wells, purchasing water from both tanker truck and bottled water vendors, and installing more storage tanks. These investments and expenditures resulted in a decline in the time households spend collecting water from outside the home. Our analysis suggests that the significant increase in coping costs between 2001 and 2014 may provide an opportunity for the municipal water utility to substantially increase water tariffs if the quantity and quality of piped services can be improved. However, the capital investments made by some households in private wells, pumping and treatment systems, and storage tanks in response to the delay in infrastructure investment may lock them into current patterns of water use, at least in the short run, and thus make it difficult to predict how they would respond to tariff increases for improved piped water services.

Background. Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods. The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results. A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant ( P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion. Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.

Despite being politically sensitive, water tariffs are frequently administered without information about households' preferences for tariff structures. In this paper we examine the tariff preferences of 1,500 households in Kathmandu, Nepal. We first use a bivariate probit model to examine stated preferences for (1) an increasing block tariff (IBT) and (2) a positive fixed charge. We find that household preferences for IBTs and fixed charges are not easily explained by household socioeconomic and water use characteristics. Second, we ask respondents what they think a fair water bill would be for a randomly assigned quantity of water. We model the responses as a function of both quantity and household socioeconomic and water use characteristics. While households support a water tariff that results in a household's water bill increasing as a household's water use increases, we do not find evidence that households support an increasing, nonlinear relationship between water use and a household's water bill. Our results suggest that respondents desire affordable piped water services and water bills that are calculated fairly for everyone. Because the notion of fairness in Kathmandu varies, utility managers may have considerable latitude in choosing a tariff structure that focuses on other objectives, such as cost recovery, revenue stability, and economic efficiency.

South Asia is a hotspot for populations and economies adversely impacted by poor water security. This is evident in the case of Nepal where it has been estimated that 20% of households have no access to a domestic water source and two-thirds of the urban households live with inadequate water supply. Therefore, many depend on private solutions, such as private wells and purchasing water from informal water markets, to meet household water needs. Within this context, this paper examines whether private water vendors provide equitable access to both poor and wealthy households, whether they practice discriminatory pricing and whether poor households face a greater financial burden in meeting their household water needs. The analysis uses primary data collected from a 1,500-household survey conducted in 2014 and uses regression analyses to derive the results. The results reveal patterns of inequity in the private water market, but seemingly not purely due to an inherent bias against poorer households. Regardless, the market does not serve the poor adequately and given the lack of alternatives that poor households have, it points to an urgent need for the government to step in to counterbalance the deficiencies of the market.

Introduction: Immunisation is a cost-effective public health intervention worldwide responsible for the reduction of infant and child morbidity and mortality. Full immunisation is a state of obtaining all vaccination according to the Immunisation schedule of Nepal. Methods: The secondary data of Nepal was downloaded from the DHS Program. A total of 1709 children aged 16-23 months were analysed for descriptive statistics. All the analyses were weighted by its sampling weight. The full immunisation status indicates those who completed 1 dose of BCG, 3 doses of Polio, 3 doses of DPT and 1 dose of Measles. The independent variables are further subdivided into enabling, predisposing and external environmental factors. Results: Over half of children (52.6%) were from Terai, nearly a quarter (23.0%) from province 2. More males (53.5%) and the majority of (86.1%) children with birth order one to three were immunised. Mother aged < 20 years (62%), working father (96.1%), working mother (59.7%), educated father (87.3%) and educated mother (70.7%) had children with complete immunisation. Non-smoker mother (94.6%) had fully immunised children. Nearly three quarters (73.5%) from a middle and rich family, those with PNC within 3 days (35.9%), delivered at a health facility (64.2%), and had PNC check from the skilled provider (12.1%) had completely immunised their children. Conclusions: Significant differences based on external environment, enabling factors and predisposing factors for full immunisation status was observed. Specific interventions based on these factors are recommended.