Nepal is one of the least-developed countries of the world. Estimates show that nearly 31 per cent of the population lives below the national poverty line, and 24 per cent live with less than a dollar per day income. The UNDP's Human Development Index (HDI) rank of Nepal in 2017 was 154 out of 169 countries, indicating a low standard of living of the people. Over the last decade, there have been noticeable improvements in the country’s health and sanitation situation. Infant mortality and under five mortality rates have decreased significantly, by 39 per cent and 48 per cent respectively. Likewise sanitation coverage has increased to 46 per cent. Girls’ enrolment in primary school has reached 87 per cent.

Despite such progress, Nepal still faces several problems including numerous child deaths from diarrhoea and acute respiratory infection, lower than targeted coverage of sanitation facilities, poor hygiene practices, and substantial gaps between sanitation and water supply, rural and urban, rich and poor, hills and lowlands, and the knowledge and practice.

The sudur Paschim province of Nepal has the lowest development indicators in the country. Districts in the hilly parts of the region are the most inaccessible in Nepal and the communities struggle to eke an existence in a rugged and harsh environment. Development seems to have bypassed parts of the mountainous sudur Paschim province and most basic facilities remain absent in many villages.

Darchula District is located in the Sudur Paschim Province of Nepal, which is one of the most neglected in the country exhibiting some of the lowest development indicators (ranked 67th out of 77 districts). Poverty is severe particularly among the rural population who are heavily dependent on forest and other natural resources. Farming is the predominant rural livelihood. There is social discrimination in terms of caste, gender and class. Though ‘untouchability’ is declared illegal by law, the Dalit people are still traditionally discriminated in the society. Gender discrimination, particularly domestic violence and other forms of harassment are common in the district. Many women work for around 18 hours per day. The women do the household chores and almost all of the agricultural farming. Seasonal migration is a long established practice and major livelihood and coping strategy. The majority of migrants travel to India (40%) or to other areas within Nepal (30%). Most families have at least one family member migrating for on average 6 months to India mostly for unskilled labour. Most of the communities experience a high occurrence of water-borne disease due to inadequate access to safe drinking water and poor hygienic practices including widespread open-defection. The diarrhoea outbreak in 2015 (from July to September 2018) has highlighted the above issues with thousands of people affected in the district. In addition, the target communities are remote and due to the lingering effects of the conflict have experienced little development and relief support from government and non-government agencies