Ramechhap district may be only 200 km to the east of Kathmandu, but it was till recently as remote as far-western Nepal.

Villagers had to travel three days on foot to reach Manthali, the district capital. The nearest roadhead was 70 km north in Charikot of Dolakha.� Soon, after the bridge over the Sunkosi is built, Ramechhap will be connected to the Sindhuli Highway and Kathmandu will be only four hours away. And all 55 VDCs of Ramechhap are now connected by roads.

However, despite the improvement in connectivity, Ramecchap is still lagging behind many neighbouring districts in education, nutrition and child survival. Things were much worse in 1984, Ramechhap was like Bajhang or Bajura in western Nepal in terms of development. That was when� Jagadish Ghimire started the Tamakoshi Sewa Samiti (TSS) to lift his home district out of poverty and deliver service that the government was not providing.

Ghimire and his wife, Durga, got TSS involved in improving local livelihoods, set up drinking water systems, improved sanitation, health and irrigation. TSS is almost a 'parallel government' in Ramechhap, establishing a 15-bed community hospital, much before the government built a district hospital. It has a 24-hour emergency and ambulance service and has a fund to treat poorer patients.

Although TSS still receives funds for some of its projects, it is striving to become self-reliant. The hospital, for instance, meets its operational costs through a cooperative and conducts health camps throughout the district in partnership with institutions like Dhulikhel hospital and Tilganga eye hospital. Says Ghimire "Self-reliance is the single most important indicator of local development. The purpose of the external support should be to create independence not dependence."

TSS's rural drinking water and latrine construction campaigns have benefited tens of thousands of families and dramatically improved public health in Ramechhap, lowering the infant and child mortality rates.

Talking about the need for targeted development Ghimire explained,"Women were spending most of their time collecting firewood and drinking water, so we felt that to improve their lives we had to make both those things more accessible."�

Today, besides the visible signs of prosperity with its rural electrification and roads, development indicators like rapidly declining maternal mortality and under-five child mortality, show just how dramatic the progress has been.

Suman Karmacharya joined TSS as a medical intern 18 years ago, and� remembers treating hundreds of patients in the fields outside the clinic. "Many suffered from easily preventable water-borne diseases such as diarrhoea, typhoid, cholera and jaundice," says Karmacharya, "today we don't get too many of these cases and that is because they have safe drinking water and improved sanitation."

TSS is remarkable because it always involves local communities. While the project brings knowhow and money, it is the local farmers who take responsibility to carry out activities. Local communities therefore have ownership, and generate their own money to run and maintain the water supply, irrigation or health schemes.

"The transparency and accountability of the organization makes it one of our most successful partners," says Bhagat Bista of the Swiss aid group, Helvetas, which has worked with TSS in over 50 irrigation projects.

It is perhaps because of local ownership and support that TSS projects in Ramechhap continued undisturbed even during the years of conflict.

Asked about� TSS's future projects, Ghimire says, "We are trying to maintain what we have. The hospital service needs to be upgraded as more patients seek its service and there is more demand for irrigation schemes."

HIGH ACHIEVERS

The Ramechhap district capital of Manthali is one of the few places in Nepal where a government-run school is more popular than private ones.

�Manthali Higher Secondary School and Martyr Memorial Campus could be role models for how to sustainably run high-quality schools in rural Nepal without having to charge exhorbitant fees.

The school and campus run classes from pre-primary to Masters level for 5,000 students, and education is free till Grade 8. The fees are as low as Rs 50 per month for high school and not more than Rs1,000 per month for the college.

The campus currently offers higher education in business studies, education and humanities and has plans to run rural development and sociology programs.

Gunja Bahadur Shrestha has been principal for 20 years, and says: "There are many private colleges in the district, but the affordability and quality of education we offer makes this campus the first choice of many students."