Nontraditional Security Challenges in South Asia

Health and Human Security in Nepal and Possible Trajectories for 2025

89 the national bureau of asian research SRIDHAR K. KHATRI is Executive Director of the South Asia Centre for Policy Studies (SACEPS) in Kathmandu, Nepal. He formerly served as Executive Director for the Regional Centre for Strategic Studies (RCSS) in Colombo, Sri Lanka, and Executive Director for the Institute of Foreign Affairs in Kathmandu. He can be reached at . Health and Human Security in Nepal and Possible Trajectories for 2025 Sridhar K. Khatri Originally published in: Sridhar K. Khatri and Bishnu Raj Upreti, “Nontraditional Security Challenges in Nepal,” National Bureau of Asian Research, NBR Special Report, no. 36, January 2012.© 2012 The National Bureau of Asian Research. This PDF is provided for the use of authorized recipients only. For specific terms of use, please contact . EXECUTIVE SUMMARY This essay examines the current political canvas of Nepal, with a particular focus on health and human security issues, and explores possible scenarios for how the country might evolve through 2025. MAIN FINDINGS • Economic and social uncertainty, introduced by political actors and interest groups jockeying for benefits during the current political transition period, reduces the human security of the general public, which the new constitution is supposed to ensure. • Nepal continues to face major challenges in meeting minimum health standards and tackling the health disparities that exist among different population groups. Key health sector challenges faced by Nepal today include gender and ethnic/caste discrimination in provision of healthcare services, access to safe and adequate supplies of water, and basic access to health services. • There are three possible scenarios for Nepal looking ahead to 2025, based largely on potential trajectories in the country’s level of governance: a “bleak” scenario, in which parties fail to effectively complete the constitution-making process; a “business-asusual ” scenario, in which parties are successful in drafting a constitution but are unable to implement it; and an “optimistic” scenario, whereby cooperation allows for more effective implementation of the constitution, leading to appreciable changes in the country’s human development indicators. POLICY IMPLICATIONS • The key element in ensuring proper healthcare within a human security framework is the quality of governance in the target country. The dominant threat to both human security and the integrity of state structures in South Asia is posed by internal conflicts. • Nepal will need to focus on a steady human development approach with greater opportunities for the less-developed ecological regions and more balanced growth between the urban and rural areas. The government will also need to reach out to marginalized caste and ethnic groups, particularly the Dalits and Muslims, who rank lowest in the UN Human Development Index for the country. • Four significant drivers will influence Nepal’s future trajectory: the behavior of the country’s political parties; the degree and nature of the international community’s involvement in Nepal’s affairs; the impact of technology on the country’s political, economic, and social development; and the perceptions and behavior of the Nepali people vis-à-vis the state. 91 HEALTH AND HUMAN SECURITY u KHATRI N epal has undergone a phenomenal pace of change over the past 60 years. During this period, the country ended the 104-year rule of the Rana oligarchy, attempted to usher in democracy in the 1950s, became retrenched into absolute monarchial rule for the next 30 years, attempted to reintroduce democracy again after 1990, and witnessed a decadelong , costly Maoist insurgency after the mid-1990s. Currently, the country is engaged in redefining its democratic credentials by restructuring the state under the new banner of a democratic federal republic—a challenging enterprise for any nation. This time around, the task is being undertaken not through an institutional framework exclusively grafted from foreign models, but through a constituent assembly elected by the people. The tacit theme guiding this change is the focus on the people, which recognizes their inalienable rights to human security, guarantees decentralization through federalism, and promises greater public accountability of the state. This essay examines the current political canvas of Nepal, with a particular focus on health and human security issues, and explores possible scenarios of how the country might evolve in the next fifteen years. The first section introduces the concept of human security in the South Asian context and addresses the central issues relating to governance, the relationship between the state and civil society, and the idea of people’s empowerment. The second section presents a snapshot of health sector trends in Nepal, while...