Human Rights-Based Approach (HRBA)

The theme- My Health, my right—is in line with HRBA, one among the six guiding principles of the United Nations Sustainable Development Cooperation Framework . The HBRA fundamentally focuses on making duty holders or office bearers accountable and empowering underserved, marginalized, and poorest sections of the demography to become advocates for their own rights. For instance, in context of service delivery, affordability, acceptability and accessibility to quality health services is a fundamental requirement that should be afforded by the state. Hence, in this context, the underserved and marginalized should be empowered to hold officials and elected representatives to account. However, the right to clean air, good nutrition and decent environmental conditions and right to freedom from discrimination is not something that can be guaranteed by the state through the prism of right but attained righteously through a sense of collective civic responsibility.

Clean air

I ride a fossil fuel driven bike which helps me travel to work and fulfill my personal responsibilities. I acknowledge that I probably own a bike because of the lack of an accessible public transport infrastructure. However, that complaint cannot be the reason to not service my bikes at regular interval which helps minimize pollutants emitted from it. I can also think about walking to the office occasionally or periodically and sometimes use the public transport.

The status of air quality in Nepal annual report, 2021 suggests that vehicular emissions are one of the major cause of air pollution. Moreover, vehicle registration rate in Kathmandu Valley has been found to increase by 15 per cent per annum resulting in an estimated 4.5 million tons of CO2 emission per year in the valley for 2025, which is close to double the CO2 emissions with respect to 2020 figures.

Hence, as a resident of Kathmandu valley to ensure my right to clean air we will all have to start taking the responsibility of minimizing sources of air pollution at an individual level.  

Good nutrition

Recent findings of the Nepal Demographic and Health Survey, 2022 states that 69 per cent of children age 6–23 months consumed unhealthy foods a day prior to the survey. Likewise, research work suggests that, between 1970 and 2010, per-capita energy consumption of fat has doubled and sugar and sweeteners consumption has witnessed a nine-fold increase per-capita. Ievitably, Nepal is in a state of nutrition transition. In a globalized world, governments have no business of micromanaging what I can or cannot eat. Hence, in this instance too my right to good nutrition depends on my individual decisions around food consumption.

Clean city

School children gathering at a shop post school to get ice cream, chocolates and other junk items is usual scene around the place I live. However, what is more painful is seeing them throw away the wrappers right outside the shop. I have also witnessed these wrappers flying out of school buses. Well! It is a sad sight. However, what is equally painful is our inability to convince the school children about a basic civic responsibility which is to throw the waste into the bins or put it inside their pockets until they find a waste bin. Undeniably, I have a right to clean environment but for that I need to take the responsibly of disposing the waste into bins and where applicable convince others to follow suit.  

My right my responsibility

Nepal currently enjoys a demographic divided, a “demographic window of opportunity”, a status marked by prominence of working age population. Estimates suggests that Nepal will become an aged society by 2054 i.e.14% of its population will be 65 years and above. For Nepal to leverage this opportunity and become an economically prosperous nation we will have to live healthy and productive lives. However, the protagonist of Nepal’s growth story will not be the rights enshrined in the constitution on health and wellbeing, but it will have to be the unwritten social contract between the state and its citizens about fundamental civic responsibilities. Hence, idea of health as a right is misconstrued. 

The eight-wicket victory of Nepal’s Men’s Cricket Team against the United Arab Emirates in the semi-final of the ICC’s Asia region qualifiers for T20 World Cup has booked us a berth in the World Cup to be held in West Indies and the United States in June next year. Interestingly, for the shortest version of the games this will be the biggest World Cup yet, with 20 teams fighting it out for the cup. For the fans like me though, following the win, we have been battling with tsunami of emotions within ourselves because it has been nine long years since the golden generation of Nepali cricket led by the legendary Paras Khadka played at T20 World Cup in Bangladesh.

The watershed moment

The news about our World Cup qualification has brought back fond memories from that World Cup, which I am sure is true for any cricket fan who was witness to the euphoria, pride and celebrations of 2014 World Cup. The visuals of players singing the national anthem before each match, Shakti Gauchan going berserk after every wicket and nail-biting finish in Nepal-Afghanistan match are etched in our memories for life. The win against Hong Kong was special given that it was our first win at a World Cup. However, the win against Afghanistan was the highlight and more satisfying of the two. Current players have mentioned that they have been inspired to chase the World Cup dream because of Nepal’s participation at the 2014 edition of the T20 World Cup. Hence, on the hindsight, Nepal qualification for the 2014 World Cup is equivalent to India’s 1983 World Cup wining moment, which inspired the next generation cricketers to dream big—truly a watershed moment for Nepali cricket.

Inspirations for and beyond cricket

I am a 90s kid, and my generation grew up idolizing foreign cricketers. I have always watched my childhood cricketing heroes in television screen or magazines. The great thing for today’s kids is that they get to watch their cricketing idols playing in TU or Mulpani cricket ground or in domestic competitions across the country and even watch their matches in television channels that broadcast matches of the highest level. That’s the missing link between my and today’s generation.

If the visual of the 2014 T20 World Cup inspired Captain Rohit Paudel’s generation to book a place at the 2024 edition of the Cup, it is hard to fathom the impact of the upcoming World Cup on young cricketers and kids playing at home, streets and alleys across the country.

For sports to grow in any country it requires money, infrastructure, a system to groom and fructify young talents but what it direly needs and cannot be bought by money is inspiration, especially local inspiration, and that is the missing link I mentioned earlier. Success breeds inspiration and vice versa. Fortunately, the incredible success stories coming out of Nepali cricket, especially in the year 2023, has been nothing short of phenomenal. If the visual of the 2014 T20 World Cup inspired Captain Rohit Paudel’s generation to book a place at the 2024 edition of the Cup, it is hard to fathom the impact of the upcoming World Cup on young cricketers and kids playing at home, streets and alleys across the country. Undoubtedly, this will enthuse tectonic shift in the way upcoming cricketers will approach the game.  

Talking about inspiration, I present a quote from the movie Coach Carter: “Our deepest fear is not that we are inadequate, our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us…And, as we let our own light shine, we consciously give other people permission to do the same.” Indeed, this generation of cricketers have allowed their light to shine, permitting every Nepali to do the same. The success story scripted by our cricketers would be half told if we limit that it to the story of the bat and the ball or the authority with which they beat their opponents. The rest half of the story is about their determination to overcome all odds, undulating motivation to show up for practice amidst controversies surrounding Nepali cricket and their self-belief to challenge and shine against the best in the world despite the lack of basic infrastructure and exposure. I sincerely hope that story of Nepali cricket offers hope to the hopeless and inspire all of us to outperform our own expectation in our respective areas of work. If each one of us starts to walk on that path, the country will have leapfrogged its developmental milestones.

The level playing field

As per the Nepal Labor Migration report 2020, UAE is amongst the top five destination countries for labor migration. Thousands of Nepalis work across the UAE and fill our coffers with much needed remittance income, which I feel creates a hierarchal relationship between the two countries country. It is ironic that because of cricket we have the opportunity to restore some self-esteem and correct the self-inflicted inferiority or imbalance of power with the UAE at least on a cricket field by beating them. However, what we really need to beat is the lack of self-belief and determination that is preventing us from achieving our own world cup glories.

I would like to start by extending my gratitude to you. Despite the political upheavals, in the last five years, we have successfully made our way to the second periodic election following the promulgation of the 2015 constitution. Your and my journey from the time the constitution was adopted to this point has been filled with confusion, chaos, crisis, contention, and catastrophe but without a doubt it has also filled us with hope and demonstrated opportunities. The biggest positive has been that we have stuck to our democratic ideals as we continue to believe in the power of ballot as the panacea for our economic and social development. The beauty of democracy is that once in five years the political leadership of this country becomes an advocate alluring voters to side with them on specific agendas while voters like me become the deciding forces. Therefore, before the November 20 elections, while I have the power, I thought it is a good time to write to you about issues that worry me and probably something that should be concerning you too. I am a public health professional. But I will not be talking about health here, instead things related to our economy touching on public health issues. 

I am sure you are well informed about the rising life expectancy in Nepal. Since 1990, it has increased by 12.7 years resulting in a life expectancy of 71.1 years by 2019. However, the fact that more and more Nepalis are living longer means that there must be greater investments in creating healthy living spaces, driving disease prevention efforts, especially noncommunicable disease, including cost of management and treatment of such chronic conditions. While increasing fiscal space for the health sector could be achieved by improving the efficiency in our delivery mechanisms and budget absorptive capacity. Simultaneously, we need to work on expanding the size of the economy. 

You and I alike often boast of our demographic dividend—the engine accelerating our country’s economic growth. But it seems like in the next couple of years this engine that we are banking on may be running out of steam. As per a report from the National Planning Commission published in 2017, “Nepal will become an aging society around 2028…, and an aged society around 2054…”. This report further states that Nepal’s demographic window of opportunity—the demographic dividend which started in 1992—is ending in 2047. Hence, 2028 could be the beginning of the end. But the bigger concern here is the rising prevalence of chronic diseases amongst the working age population. Chronic health conditions reduce the productive years of life, impacting our economic potential. Hence, if we want to continue to dream and live in a prosperous Nepal, we have no option but to think about addressing these health challenges. My realization has been that topics such as noncommunicable diseases are primarily an economic agenda associated with a health agenda. But I bet you have already thought about it that way, or have you not?

Chronic health conditions reduce the productive years of life, impacting our economic potential. Thus if we want to continue to dream and live in a prosperous Nepal, we have no option but to think about addressing these health challenges. 

Unfortunately, the moment we press the economic accelerator the paradox of health versus development begins to challenge our ideals. The government seems excited about the reopening of Janakpur Cigarette Factory. As per media reports the government plans to restart operation of old factories by partnering with the private sector. I understand that we would like to see our economy grow but plans to boost production of tobacco products is without a doubt suicidal. So, the question here is how far should we go to press the economic accelerator? In the debate between idealism and realism, are you looking at the practicalities or the ethics? 

Meanwhile, as Nepal moves up the economic ladder, Foreign Direct Investment (FDI) as a key pillar to drive Nepal’s growth will get more and more reinforced. But you and I know that that FDI has been, due in part, responsible for nutrition transition shift from traditional diets to “diets rich in fats, sugars, meat and highly processed foods and low in fiber, and accompanied by a rise in sedentary lifestyles” in the developing economies because of the increasing availability and affordability of ultra-processed food.  A paper from Corinna Hawkes states: “In the 1980s, as liberalization accelerated, FDI began to shift away from raw materials for export to processed foods for the host market, as transnational food companies such a PepsiCo and Nestlé invested in foreign manufacturing facilities for foods such as soft drinks, confectionary, dairy products, baked goods and snacks.” She further states “FDI is thus playing a role in the nutrition transition by shaping the processed foods market and making more processed foods available to more people”. Meanwhile, it is surprising that, in 2015, globally based on revenue 69 of the top 100 economic entities were corporations. For instance, Walmart was found to be richer than Australia. 

Dear leaders, more than the wealth, what worries me most is the political influence that global food and beverage companies have demonstrated. The Indonesian government, for instance, recognized food and beverage companies as one of the five priority sectors in its economic plan.  The battle between economy and health never ends. But I think the question to you is how do you intend to pushback? Meanwhile attempts are made by transnational food and beverage companies to partner with health actors stepping on Goals 17 of the sustainable development goals which talks about partnerships. Are you for the partnership or against it? 

I am sure you are aware about the review held by the United Nations Committee for Development Policy in February 2021 which recommended Nepal for graduation from the least developed country (LDC) category. It means that, until 2026 we will continue to qualify for LDC-specific support. So, what happens after 2026? Does Nepal face a graduation shock? Will Nepal continue to receive similar support from the international community? These were some of the questions I asked myself. The answer I wanted was well captured in the concluding section of the report which stated: “most development cooperation will not be affected by LDC graduation. Important development partners such as the World Bank, the IMF, GAVI – The Vaccine Alliance, the Global Fund, the European Union, most of the UN system, and most bilateral partners (including south-south cooperation partners) do not consider, in determining the scale and nature of their assistance programmes, whether or not a country is on the LDC list”. On this I have two questions for you. First, are you happy that the foreign assistance is not going to be significantly disrupted? Second, are you happier that Nepal is graduating from the LDC category? 

Before you begin to think about it. I want to share a personal story in relation to Nepal’s economic graduation. In July 2020, the World Bank moved Nepal to Lower-middle income country status based on GNI per capita data for 2019.[3] Almost from the following day, I found that the Journal that I was planning to submit my paper required me to pay 50% of the processing charges which was previously free of cost because of my country’s low-income status. The sad thing here is not the requirement to pay for the processing charges of a scientific paper but the comfort that I was enjoying being in the low-income status. The disruption to this status quo should have come as happy news but instinctively I was sad. Unfortunately, I was happy and comfortable being categorized as the poorest. Are you comfortable with the low-income status? Dear leaders, it’s time we gave it a thought. 

We must start thinking about how we are going to fund our own development as the donor community moves from social development to mutual benefits arising from trade and commerce. 

We both agree that the least developed or low-income status is just a phase in our economic development. As Nepalis you and I must start thinking about how we are going to fund our own development as the donor community moves from social development to mutual benefits arising trade and commerce. We will need to find new and sustainable sources of funding our investments and interventions. 

In the last ten years, the urban population of Nepal has nearly quadrupled. In 2011, 17.7 percent of the population resided in urban areas; in 2021, the percentage rose to 66.08 percent. Urban-rural migration, natural growth, and expansion of urban areas by local government restructuring have been cited as the primary reasons. While the first two reasons, due in part, contribute to the rise, in Nepal’s context, the restructuring of local government areas at various points in the last decade has led to this massive rise.  Meanwhile, irrespective of how urban space is defined, these urban municipalities are engaged in designing blueprints for their future cities. The impact of built environments on NCDs is well established. It has been observed that the linkages between NCDs and built environments are talked about in the context of physical activity, food, mental health, and urban planning. This offers a unique opportunity to influence the urban municipalities to think about how they plan their future cities from a public health lens. I would love to know if you are excited about this opportunity. 

By this time, you must have started thinking that everything which I have mentioned above is way more than what we can chew and to even think about intervening we might have to constantly punch above our weight. This reminds me of a conversation in the movie Invictus. The movie is based on the famous Rugby World Cup Victory by the South African team in 1995. In a scene, Morgan Freeman (in the role of Nelson Mandela) invites Matt Damon (playing the role of Francois Pienaar, captain of the South Africa’s World cup winning Rugby team) to his office to inspire him to think about winning the 1995 Rugby World Cup.  The global event was happening right after the end of apartheid in South Africa and Nelson Mandela wanted to inspire his team to win the cup to unite a broken nation. At a point in the conversation in that scene, the president says “…in order to build our nation we must all exceed our own expectations”.  Rightly so, in our case too, you and I need to exceed our own expectations about what we can do. Please think about it.

Yours sincerely
Niraj Shrestha
Student of Public Health

Consequently, communication during this global crisis is no longer just about getting people to abide by public health measures. It can be argued that the secondary impacts of Covid-19 have opened or widened existing cracks in the state-citizen relationship and the relationship among citizens. Hence, it is essential to reflect upon some fundamental rules of communication while we aim to repair the loose threads in the social fabric of Nepali society. 

Communication is a mind-set 

Communication begins with what we think. The first rule of communication is that it is, in principle, a mindset. Therefore, it should be practised rather than drafted.  In the final week of April 2021, the District Administration Office, Kathmandu, decided to impose a lockdown, citing a surge in new cases of Covid-19. The office is well within its rights to take the call, and we as citizens have a responsibility to support it. But like any other time in the past, we got to see the directives about the duration and modality of the lockdown with no clear explanation on the timing of this step, triggers that would determine the length of the lockdown, the order and the manner in which authorities plan to re-open different sectors, the mechanism to support those families and individuals who might struggle to keep themselves fed and so on. Understandably, in a crisis of this scale, authorities may not be able to reach every last person who needs help. Still, it is essential to demonstrate a transparent mindset and communicate the action plan as clearly as possible. Thus, communication is indeed a way of thinking which authorities can apply by demonstrating transparency and accountability. When things are well communicated, it empowers citizens to have a stake. Automatically, they become stakeholders. A flaw in the design of the Covid response in Nepal has been the mindset that encourages the citizens to be treated as followers and not stakeholders. As followers, people may choose to disobey the government directives and guidelines. But, as stakeholders, there will be a sense of ownership over government actions, which can help improve compliance. 

Communication is trust 

The issue of ownership has been contested at the government level too. Nepal’s Covid response has mainly been led and controlled by Kathmandu through an ad-hoc mechanism—the Covid-19 Crisis Management Center (CCMC). Although the mechanism has been replicated at the provincial, district and local government level, the decision-making process has been top-down, with the federal government issuing directives and guidelines. The provincial and local governments have been treated as implementing agencies in a centralised response with no representation at the apex body. Although the federal, provincial, and local governments have been working together, the sub-national governments do not have a stake in influencing the Covid-19 response independently of the federal directives. The federal government, through its actions, has quite openly communicated to the provincial and local governments that they cannot be trusted to handle the crisis. Hence, a sacred rule of communication has been broken. Effective communication requires trust, which the federal government could have used to inspire innovative sub-national responses and open opportunities for scaling up exemplary models at the national level. Furthermore, a lack of trust among the governments does not communicate confidence or breed hope among citizens in need of one.

Communication during the global pandemic crisis is no longer just about getting people to abide by public health measures. 

Communication is respect 

When we offer our respect to another individual, we actively communicate through our body language. This non-verbal communication includes appropriate facial expressions, gestures, bodily movement, postures and eye contact, which indicates to the next person that we are comfortable with who he/she is, respect their dissenting views, understand their context, and have our undivided attention. Moreover, failure to portray respect may end an effective communication.  Communication demands respect. However, we have dared to break this cardinal rule. Amidst the pandemic, the President issued an ordinance to amend the Security of the Health Workers and Health Organizations Act, 2066 (2010). The amendment has increased the jail term and the fine amount in case of assault, picketing, offensive behavior, and vandalism in health institutions. The move has been inspired by the recent attacks on health workers, such as one on the doctors and nurses in the Covid ward of Bheri hospital. What are we trying to communicate to our brave medical personnel? Are we saying that our sudden outburst of unwarranted anger is better justified than the marathon effort of health workers to save lives?  Let us breed some respect among ourselves and put up a united front.

Communication is data 

Often what defines us has the audacity to break us. What defines us as a nation is our ability to unite in overcoming unprecedented circumstances created by the pandemic when anything less is not an option. But the aftershocks from the first wave of the pandemic in the country has undoubtedly dented the spirit of unity in diversity. As per a World Bank Survey, 25 percent of the economically active population in Nepal reported job losses, while 19 percent experienced absence from work for an average of 4.4 months in 2020. However, among those lucky enough to keep their jobs, 46 percent reported income losses. The survey also revealed that more women (30 percent) than men (23 percent) suffered permanent job losses. Meanwhile, a national level survey conducted in December 2020 reported that people engaged in the tourism sector, production of cash and high-value crops, sale of livestock and its products, including daily wage workers involved in off-farm activities, faced severe income losses because of the pandemic.

A flaw in the design of the Covid response in Nepal has been the mind-set that treats the citizens as followers, not stakeholders. As followers, people may choose to disobey the government directives and guidelines. But, as stakeholders, there will be a sense of ownership over government actions.

Further, as per estimates, the entire nation’s gross domestic product contracted by 1.9 percent in the fiscal year 2020. But with the economy requiring some sprinting to catch up with pre-crisis growth estimates, Nepal witnessed a surge in new cases and deaths from Covid-19 since the second half of April 2020. Probably we are all divided into pro-economy and pro-public health factions. Undoubtedly, the pandemic has impacted the Nepali population disproportionately, and it is indeed one of the most polarising issues of our time.  People are sad, frustrated, and emotionally battered, and every segment of society is left with its own set of concerns, needs, and priorities.

There needs to be a localised communication strategy, ideally at the local government level, to address the differential impact from a communication viewpoint. However a localised messaging requires a learning system that feeds data about the disproportionate effect of the pandemic on communities. Therefore, communication is shaped by data, and it is essential to strengthen the local government’s ability to collect and use the data.   

Communication demands self-reflection 

We communicate best with ourselves, and now, more than ever, it has become essential to do some introspection. Let us ask ourselves if we have any qualms about accepting that we have ourselves to blame for the second wave of Covid -19. We acted carelessly, and now we are facing the consequences. But self-blame is the easy part. The challenging part would be to remind ourselves of the time we triumphed over life’s challenges with distinction. The pandemic has once again pushed us down. It’s time to communicate with ourselves and inspire a win. 

nirajshrestha44@gmail.com