Nepal’s Constitution promises free basic care, non-denial of emergency treatment, and healthier living conditions. Nearly a decade on, the gap is not the wording of Article 35 but the mechanics of delivery: predictable financing, clear accountability across federal tiers, enough health workers where need is greatest, and enforceable standards for both public and private providers.
In 2015, Nepal elevated health from a policy goal to a constitutional right—a bold choice in a country where geography and inequality still shape access. But rights can outrun systems unless implementation is treated as a measurable program with defined roles, realistic costing, and consequences when commitments are not met. Nepal’s approach is notable compared to South Asia. While most constitutions in South Asia mention health as a principle or duty, some countries depend on courts or statutes for access. Nepal clearly states its entitlements, similar to Bhutan, unlike most of its neighbors.
What holds Nepal back today is less the wording of Article 35 and more the everyday mechanics of delivery: reliable financing, legible accountability within federalism, a workforce that reaches remote districts, and regulation with teeth as private provision expands. If Article 35 is to be treated as a serious guarantee, budgets, standards, and oversight must be treated as non-negotiable—not optional.
What Article 35 promises—and why it matters
Article 35 commits the state to free basic health services, bars denial of emergency care, recognizes a patient’s right to information, and links health to safe drinking water and sanitation. It reframes preventable deaths, untreated emergencies, and catastrophic medical bills as governance failures—not inevitabilities.
Desperate search for missing girls as nearly 80 dead in Texas f...
Nepal has adopted implementing instruments—such as the Public Health Service Act (2018), National Health Policy (2019), and sectoral laws on insurance, reproductive health, children, senior citizens, and water and sanitation. The unfinished work is enforcement at the point of care.
The implementation gap: federalism, financing, workforce, and the private sector
Federalism was meant to bring services closer to communities, but overlapping mandates can blur responsibility—who pays for drugs, staff facilities, manages supply chains, and answers when services fail. The right to health needs publicly defined roles, joint planning and budgeting, and visible performance so citizens can see what is promised versus what is delivered.
Financing is where the right to health becomes real. “Free basic services” is a payment promise that requires timely, transparent funding for facilities and essential commodities. Underfunding shifts costs back to households and weakens emergency readiness—ambulances, oxygen, blood, duty rosters, and referral systems, making it hard to honor the constitutional ban on denying emergency care.
Staffing remains the most visible bottleneck, especially outside major cities, creating a two-track system where the right is clearest on paper, where services are thinnest. Private facilities can narrow access gaps, but without consistent standards, price transparency, and enforceable oversight, they can also widen inequity. A constitutional right, therefore, requires system-wide regulation, including accreditation and licensing, that applies to every facility that treats Nepalis.
Turning Article 35 into everyday care: what to do now
First, finance the entitlement predictably. Steady increases in public health spending—especially for primary care—make “free basic services” credible. A commonly cited benchmark is public health spending of at least 5% of GDP, supported by better procurement and strategic purchasing, and by targeted excise taxes (tobacco, alcohol, sugar-sweetened drinks) where feasible. Expanding fiscal space through targeted excise taxes (tobacco, alcohol, sugar-sweetened drinks), cleaner procurement, and strategic purchasing can help close the gap between promise and delivery.
Second, make accountability legible under federalism and enforce standards across the whole system. Define responsibilities across levels of government, align plans and budgets, and publish simple dashboards (staffing, stock-outs, wait times, emergency readiness). Tighten licensing and accreditation, enforce treatment protocols, improve price disclosure, and make grievance redress workable for patients.The government should publicly decide who owns which service standards, staffing norms, and supply-chain responsibilities across federal, provincial, and local levels, and then back those decisions with joint planning and budgeting rather than parallel plans. Simple performance dashboards—coverage, stock-outs, staffing, wait times, emergency readiness—would allow citizens to see where gaps persist. At the same time, regulation needs to be strengthened: licensing and accreditation should be tightened, standard treatment protocols updated and enforced, prices and services disclosed clearly, and grievance redress made workable.
Third, prioritize people, primary care, and proof. Map the workforce by district, fully digitize and automate human resource information and career paths, and use incentives to staff underserved areas. Strengthen insurance pooling and purchasing to reduce out-of-pocket spending, while investing in primary health care—modernized health posts, community outreach, and referral systems, including expanding enrollment and benefits for vulnerable households, so that insurance translates into timely care, not paperwork. Consider consolidating health-related social protection under a single health insurance mechanism, making participation mandatory for civil servants, and requiring digital recording and reporting to improve governance. Track minimum standards independently and require time-bound corrective action when performance falls short.
Finally, primary health care has to be put back at the center—modernized health posts and PHC centers with digitalization, MDGP posting per palika for curative services, stronger outreach through community health volunteers, and functional referral systems—supported by independent monitoring to track whether constitutional minimum standards are met. When performance falls short, corrective action should be clear, time-bound, and public.
Conclusion: Rights require delivery
Nepal’s right to health is a public contract: protection for people when they are sick, injured, or most vulnerable. The Constitution has set terms; delivery now depends on financing primary care, staffing facilities, enforcing standards, and publishing results that the public can verify. Done well, Article 35 becomes reassurance when families need it most.
The author is a public health physician. Views are solely of the author and do not represent any institute he is associated with.
-1200x560-1774441847.webp)
