# National and geographic areas

## Average travel times

At a national level average travel times for all services increase steadily, rather than sharply, from the dry to monsoon seasons (see Figure 13 and Table 10). Population weighted average travel times across all municipalities, for all services, are at or under 2 hours travel in dry and monsoon seasons and mostly fall well below that. The differences between all financial institutions and commercial and development banks (classes A & B) only are marginal and largely indistinguishable. Private hospitals are on average less accessible than government hospitals.

The geographic breakdown of these averages in Figure 13 and Table 11 nuances our findings. Travel times again increase steadily across all services from the dry to monsoon season. As expected, there is a strong deterioration in accessibility moving upwards from the flat Terai into Nepal’s rugged highlands. Average travel times increase gently at first into the hills and then exponentially so in the mountains and high mountains, in many cases averaging full day round trips to services. An additional finding is the relative inaccessibility of services within the Shivalik region when compared to the Terai. Nepal’s south is commonly treated as one geographic unit, yet indicators in Shivalik municipalities fall slightly closer to those of Nepal’s middle Hills than the Terai. Lumping the Shivalik in with the Terai therefore obscures notable service accessibility challenges for the approximately 3.5 million Nepalis (8% of the total population) living there.

A few notable geographic trends for specific services stand out. Average travel times to health facilities and health posts increase much less dramatically in the hills and mountains than travel times to other services. By contrast, travel times to hospitals and district headquarters are much higher in the hills and mountains, averaging multi‐day round trips. Financial institutions fall roughly between these two extremes. An interesting finding that we cannot explain is that private hospitals are marginally _more_ accessible in the Shivalik than government hospitals, in contradiction of the general pattern of greater accessibility of government services.

## Isochrone times

Comparing Figures 15 to 17, administrative and financial services are less accessible than health services, particularly administrative services. However, while basic health care appears accessible to many, access to advanced hospital‐based medical care is considerably poorer: almost 10% of the population requires overnight travel to access a hospital. The implied difficulty and opportunity costs are troubling given that chronic or severe medical conditions may require multiple visits and/or travel while in pain or partially incapacitated. Without adequate overland access remote Nepalis may have to use financially ruinous helicopter evacuation for time‐ sensitive critical medical care. Additionally, almost 40% of the population lives more than 30 minutes from a health post or sub health post (SHPs), far beyond the Department of Health Services’ goal of under 10% from its 2016‐2017 strategy (DoHS Annual Report 2072‐2073).

Almost 40% of Nepalis live more than 30 minutes away from a formal (class A‐D) financial institution. Research indicates that small formal and informal local providers meet most financial services needs in remote areas; diseconomies of scale mean that their users usually pay more for fewer and worse quality services (Shakya _et al._ 2014). For those willing to travel finance companies and micro‐finance institutions (Class C and D financial institutions) are reasonably accessible throughout the country but commercial and development banks (Class A and B) can require overnight travel in some areas. The heavy opportunity cost of accessing more advanced financial services likely acts as a brake on economic activity and business expansion in remote areas. More worryingly it complicates the delivery of remittances and cash‐based social assistance to marginalized areas. Given that remittances constitute over 30% of Nepal’s GDP this is a pressing economic issue (World Bank 2018).