There has been limited use of sociological and anthropological methods for understanding public health issues in Nepal [1-3]. In the area of mental health, specifically, these methods may provide unique insights into the experiences, expressions and healing of mental illness in Nepal [1, 3]. With increasing biomedical psychosocial interventions in Nepal, it is crucial to employ social science approaches that inform the development of mental health services. In this panel, we emphasize the importance of social science methods in the field of mental health research and intervention. First, Angdembe discusses on the use of traditional qualitative social sciences method of focus group discussions (FGDs) and key informant interviews (KIIs) to design a culturally adapted, community-based mental health intervention in Pyuthan. Second, Rai talks about the use of anthropological techniques of…

In this panel we explore issues around External Development Assistance and public expenditure, in particular in relation to the health sector. Although decreasing in its share to the overall health budget, Official Development Assistance (ODA) is a major source of health expenditure in Nepal. Beyond ODA, there has also been a significant increase in funding for health and development activities from private donors, including the Gates Foundation and others. This increase in scale and volume of funding in the health sector has been accompanied by an increase in the participation of various institutional actors and the introduction of new institutional arrangements for managing and spending resources, which has transformed the landscape of health sector development. While the discussion on the volume, trend and scale of external assistance in the health…

National Constitutions, the basic laws of the land, depending on whether they include or exclude different segments of the polity through the institutions they adopt, laws and policies they facilitate to be formulated, and norms they help to establish, can contribute toward peace/conflict, stability/instability and prosperity/poverty (Elkins, Ginsburg, and Melton 2009; Lutz 2006; Acemoglu and Robinson 2012). At the time the new constitution of Nepal was being promulgated by the Second Constituent Assembly with a super majority in September 2015, organizations of various marginalized groups (Dalit, indigenous, Madhesi, women), who collectively form more than two thirds of the population, were engaged in month/s long peaceful and not-so-peaceful socio-political movements to pressure the major political parties for the inclusion of their demands in the New Constitution. While the ruling political parties…

Nearly 16,000 Nepalis migrate to the Gulf and Southeast Asia every month seeking employment. Although there are no estimates but another large cohort also migrates to India in search of a livelihood. It is estimated that a full third (37%) of Nepalis in the age group 15-29 and a quarter (28%) aged 30-44 work outside the country (CBS 2011). Nearly half of all the country’s households have at least one member who is currently working abroad or was in the past (World Bank 2011). Remittances sent from abroad, which amounted to USD 5.8 billion in 2014, are believed to contribute nearly 30 percent of Nepal’s GDP (Nepal Economic Forum 2014). Labour migration thus has had a defining role in Nepal’s economy and social fabric. But the effect of this large-scale movement…

Donors and international institutions involved in dispersing foreign aid routinely employ contracts with intermediaries such as I/NGOs and private firms to carry out functions relating to health service development and delivery. Based on an ESRC-DFID funded study on the role and functions of aid funded maternal and child health projects and programmes in Nepal since 1990, this paper discusses how projects are conceptualized and designed, awarded and out-sourced, sub-contracted to local NGOs, implemented, managed and evaluated. In particular, this paper looks at two projects that are implemented in the community with a specific focus on capacity building of health workers and improvement of health services through community participation. Data for this paper is drawn from a detailed case studies of a) Strengthening Approaches for Maximizing Maternal, Neonatal, and Reproductive Health…

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is an international financial instrument that focuses on achievements of targets through investments in the control of these three diseases. It demands outcome-based evaluation metrics to link disbursement of resources to performance in lieu of achievement of clear and measurable results. All the grants from GFATM have a transparent performance framework and the recipients report their service delivery results against this framework. This paper explores how the GFATM strategy is operationalised in the context of Nepal. The institutional entities involved are the principal recipients (PRs), which receive funding directly from the GFATM and sub-recipients (SRs), which receive funding from their respective PRs. The PRs (Government bodies and International NGOs) and SRs (mainly INGOs and NGOs) are the main organizations involved…

Recent data suggested that total health expenditure accounted for 5.5% of Nepal’s Gross Domestic Product (GDP), an amount that was close to the average of 5% for other low-income countries but well below the global average of 9.2% (WHO, 2012). Public allocations to fund the health sector were around 10% of total government expenditure. This was higher than the average of 8.1% for other low-income countries and demonstrates government commitment to funding the health sector. In fact, government health expenditure translated into only 2.2% of GDP. While this amount was slightly higher than the low-income country average for that year of 1.9%, it was low for what is essentially the mandatory pre-paid component of a health financing system. The global average, for example, was 5.3%. A good sign, though, is…

At the time 90 percent of the members of the Second Constituent Assembly were endorsing the new Constitution of Nepal, residents of half of the country, mostly from the Tarai/Madhesh but also from the hills and mountains as well, had been protesting against the fast-track constitution making process. The protest movements transformed into protest against the new Constitution that the marginalized group members perceive to be discriminatory or that does not extend them equality through recognition of identity and autonomy, among other things. The protests have continued for five months while India has tacitly supported the blockade of the Madhesi front to pressure the ruling parties to amend the constitution. The two claims by the constitution makers and the groups engaged in the protests are contradictory – how can a…

Promulgation of the Constitution of Nepal 2015 has created further polarization in Nepalese politics. The protests organized by the Madhesi and indigenous Peoples against the constitution demonstrate that the long awaited constitution has fulfilled the political interests of the dominant ruling caste group, namely Bahun and Chhetri. Demands for immediate amendments corroborates the fact that the new constitution failed to be inclusive and failed to fulfill the political aspirations of the indigenous peoples. Drawing on Limbuwan's identity movement and particularly showcasing the  Limbuwan-oriented political parties' as well as organizations' protests against the new constitution this paper will seek to answer: a) why  Limbuwan, together with other provinces,  based on cultural and historical identity, could not be constitutionally ensured  or in other words why the constituent assembly could only promulgate the…

Nepal’s recently promulgated new Constitution has been highly contested. It has been rejected by historically excluded groups such as Madhesis, Janjatis, Tharus, and Dalits and the groups are currently demanding amendments in the Constitution in order to ensure more concrete provisions for their inclusion and representation in the state. Writing a new constitution through an elected body, Constituent Assembly, which could address the fundamental problems of various kinds of exclusion and inequality, was part of the peace agreement between the then government of Nepal and the insurgent Communist Party of Nepal (Maoists). Although, the peace process was formally ended, the question of addressing the questions of exclusion and inequality remains still highly contested. This paper examines the provisions of Nepal’s new Constitution in order to see how it has addressed…