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Globally, HIV is considered a complex global pandemic. The devastating effects of HIV/AIDS are profoundly alarming as it continues to be one of the leading causes of deaths in the world. In recent years, it is increasingly realized that HIV is more than just a public health issue. Rather it is a social issue that causes severe development challenges in human history. 

The spread of HIV embraces social inequalities that specifically impact the poor, socially marginalized and vulnerable communities. The socio-political, cultural, economic, historical and psychological factors contributing to HIV/AIDS are equally important to consider while addressing the HIV epidemic in a larger context. Anthropologists are interested in understanding prevailing cultural beliefs, social norms, value systems and local practices that place people at risk of HIV. 

In addition to biomedical and public health sciences, anthropology as a discipline has significant contributions to generate evidence that has greatly enhanced epidemiological and biomedical understanding of HIV epidemic. Apart from this, there is an emerging need to explore the political economy of HIV that shapes people’s behaviors in different socio-political and cultural contexts. The intersecting yet diverse social inequalities and structural barriers have both direct and indirect impacts on people’s nuanced understanding of the HIV epidemic and their access to the services they need. 

The issues of sexuality, gender, risk groups, stigma and discrimination, social and behavior change within and across cultures can be meticulously accessed with an anthropological perspective. In most societies, local knowledge, biosocial processes and cultural influences on patterns of infectious diseases are often neglected. Linking these wider social determinants of HIV is crucial for sustained local responses. 

Moving away from traditional approaches for HIV response, we need a paradigm shift that demands human rights-based, people-centered policies, community-led interventions and resilient health systems. Gender and social inclusion in HIV response is critical as there are differential effects of the epidemic on people who are poor, socially excluded and vulnerable. 

The evidence shows that social vulnerability to HIV is more prominent in specific population groups such as migrants, sex workers, people who use drugs, men having sex with men and transgender communities.  Their social, cultural, legal and economic disadvantages have largely contributed to the high risks of HIV and vulnerabilities. 

From the HIV response perspectives, there are increasing needs of community-led interventions, which are more culturally appropriate. Such interventions are likely to be more effective as community engagement is ensured to create an enabling environment for social and behavior change among the vulnerable groups. In essence, overcoming socio-political, cultural, religious and economic barriers is a key challenge to end the epidemic. 

The cultural understandings of HIV are essentially diverse in different contexts. Anthropological inquiry to growing needs of public awareness of HIV for prevention has made clear emphasis on social and cultural environments where vulnerable groups are realistically experiencing their own livelihoods in their everyday life. Social resilience and adaptive wisdom are critical to cope with the devastating effects of HIV on population groups who are socially excluded and vulnerable in the communities. 

While integrated bio-behavioral surveys and assessments are largely focusing on quantitative research methods and approaches, implementation of ethnographic field research is relatively low. The anthropological approaches will help explore wider inequalities of class, gender and ethnicity in terms of risks and vulnerability to HIV. Therefore, engaging anthropologists in HIV responses is crucial in addressing social concerns from people’s perspectives, designing community-led interventions, undertaking ethnographic field research for evidence-informed policy and strategic actions.   

Given our biological knowledge and the availability of effective medical and behavioral solutions, anthropological perspectives are useful to have greater details of why HIV continues to spread. More importantly, these perspectives aim to explore what impacts does HIV have on human populations. Ethnographic field research collects the stories of local realities and social sufferings experienced by people living with HIV in their everyday life and their choices for healthcare and social services.  

In this context, the basic health belief model developed in the 1950s has been instrumental in obtaining the information related to an individual’s perceived susceptibility, severity, benefits and barriers regarding any threat related to HIV or health conditions or behaviors. The community-led responses require effective representation and meaningful engagement of people living with HIV and other key populations at high risk of HIV infection. 

In all social hierarchies, it is necessary to examine how HIV policies and strategic priorities are shaped by socio-political, economic and cultural contexts in terms of inclusivity, equity and diversity. The disparity between rural and urban, rich and poor has evoked a serious concern in terms of people’s access to prevention, treatment and care services. Unfortunately, the policy responses to ensure the right to healthcare are not sufficiently addressed yet within and across cultures.

At the core, anthropological perspectives offer a broad overview of the social, cultural, political, economic and psychological factors shaping the HIV/AIDS epidemic. The wider determinants of HIV are significantly influencing HIV vulnerability cross-culturally, and the ways in which governments, civil society and development partners are working together for sustained responses in different contexts. Therefore, the new approaches for HIV responses must focus on humanity, dignity and right to health to scale up person-centered HIV care across the communities.

The author is a health policy analyst and has an interest in anthropology

The Constitution of Nepal has established basic healthcare as a fundamental right of its citizens. In the context of the federal governance system, it is the responsibility of the state to ensure easy access to quality health services for all. The national health policy 2019 primarily aims to develop and expand a health system based on social justice and good governance. Moreover, the policy has laid emphasis on the social health protection system by integrating the most marginalized sections within and across societies. 

At a recent press conference, Health Minister Pradeep Paudel presented his key health priorities and action plan to ensure people have easy access to quality health care services at all levels. The rationale of these priorities is largely based on the guiding principles of national health policy, 16th plan and the 2030 agenda for sustainable development. Ensuring equitable access to healthcare is a primary agenda of health sector reforms. 

In the federal context, the first and foremost priority is to develop a solid strategic roadmap to improve coordination with clarity on roles and responsibilities within and across three levels of governments in order to harmonize effective implementation of national health policies, strategic guidelines and the emerging priorities. The idea of establishing an integrated health infrastructure development project is innovative and timely as it provides a clear picture of existing human resources, health infrastructure, health financing mechanisms, logistics and supply chain management at all levels. 

Undoubtedly, this strategic approach will facilitate federal, provincial and local governments to identify new opportunities and gaps, and address existing challenges in delivering quality healthcare services. Strengthening the institutional capacity of local health governments and health facilities is one of the critical challenges in the health sector due to limited human resources, inadequate health infrastructure and supplies, poor monitoring and evaluation systems of healthcare services. 

Therefore, the ambitious action plan to increase the coverage of health insurance as well as other social security schemes is easier said than done. Evidence suggests that national health insurance and other social protection services are facing serious implementation challenges. However, it is yet to be seen how the new priorities of the health minister are implemented in the months to come. The ground reality is that without realistically addressing persistent structural barriers in health systems and ensuring effective implementation of policy and regulatory frameworks, one can not simply hope for significant reform in the health sector.

Other emerging issues such as mental health, non-communicable diseases, disaster and health emergencies need a more pragmatic approach for actions to enhance the capacity of local governments for multi-sector response in the health sector. Interestingly, migrant health has also received  priority in order to address the health care needs of migrants and their families. 

By formulating a new population policy, there is an increasing focus on strategizing demographic dividend for sustainable socioeconomic development. The health security of marginalized and indigenous populations is another priority, but again needs a clear strategic roadmap for implementation. Among many other priority areas, one of the praiseworthy initiatives is to improve nutritional status of children under five years of age, adolescents and mothers by enhancing the institutional capacity of provincial and local governments to effectively implement the multi-sector nutrition plan at the communities. 

Though there is explicit focus on urban health systems, climate change and associated environmental health risks for consideration, it is interesting to see how these issues will be effectively mainstreamed in federal health systems for timely action. In addition to enhancing the capacity of hospitals across the country, improving physical infrastructure of the health facilities in the rural areas is a high priority in the health agenda. 

Moreover, there is a critical need to strengthen procurement and supply chain management by ensuring transparency and efficient practices to avoid any interruptions in supplies of drugs and other essential logistics. Ensuring safety, quality and efficacy of medicines is crucial. At the same time, public awareness on road safety is equally important to reduce the mortality, injuries and disability. Health promotion and communication strategies for behavior change are also critical to a healthy lifestyle. 

Therefore, the key stakeholders are now enthusiastically looking forward to effective implementation of the priorities as highlighted by the health minister. Without good governance and strong political commitments, the ambitious plans are less likely to deliver the expected results. The implementation mechanisms and structures must be strengthened with clear terms of reference and a strategic roadmap for reform. Establishing robust monitoring and evaluation systems should be a high priority action point to track the progress and realistically address the bottlenecks in health systems at all levels. 

Despite some notable progress in the health sector, the federal health system has a long way to go to meet the wider expectations of people in accessing and utilizing quality healthcare services at the local level. There is still hope that effective implementation of the new priorities in the health sector will have profound implications in ensuring equity and social justice at large.  

The author is a health policy analyst

Over the past two decades, the world has made remarkable progress in the fight against tuberculosis (TB). However, TB is still a serious challenge from a global health and development perspective.  According to WHO, more than 10m people continue to fall ill with TB every year. More importantly, a heavy burden of TB is on poor, vulnerable and socially marginalized populations.

In this context, the strategic interventions primarily focus on a unified response to end all the sufferings by addressing social determinants of TB. However, in many low-income countries, there are still inadequate policies and strategies to support implementation of universal health coverage, social protection, and regulatory frameworks to prevent and end TB.

Nepal has set the goal to end TB by 2035. The first-ever prevalence survey in 2018-19 shows that TB incidence and prevalence in Nepal are 245 and 416 per 100,000 people, respectively with a majority of TB patients from productive age groups. Interestingly, the prevalence among men is more than in women. Considering this reality, Nepal’s strategic plan to end TB (2020/21-2025/26) offers fresh hopes to many TB patients in terms of an easy access to timely diagnosis, treatment, prevention and care.  

An ambitious plan

By 2025, the ambitious strategy aims to significantly increase treatment coverage, success rate, uptake of new diagnostics and new drugs, and reduce catastrophic costs. The strategic priorities primarily include integrated patient-centered care, treatment and prevention, multi-sector engagement, and research for creating synergies for a unified response. Putting patients at the heart of the delivery, the strategy calls for consistent actions to ensure early detection, treatment and prevention for all TB patients.

A recent review of the strategic plan to end TB suggests that there are significant gaps in strengthening prevention and treatment services, community engagement, multi-sectoral coordination and accountability in the federal context. While social protection services for improved service delivery are critically needed, the rollout of new tools and innovative digital technologies are crucial for an effective TB response. This will help ensure treatment for all people with TB, including the drug-resistant strain.

A priority agenda

Engaging the private sector is a priority agenda in TB response. However, there are limited interventions to strengthen implementation of the public-private partnership strategies at all levels. Experiences from Bangladesh, India and Myanmar suggest that non-governmental organizations can play a critical role in providing essential TB services at the community level.

Effective implementation of the strategic plan is crucial at the local level. Because of inadequately-trained human resources for TB services, it is a challenging task for local governments to provide quality TB services. Therefore, concerted efforts are needed to ensure supportive supervision, periodic review, monitoring and evaluation, and timely feedback mechanism for actions at the local level.   

Despite persistent challenges of ensuring human and financial resources, Nepal has implemented a TB-free initiative at the local level for enhancing political leadership and ownership in TB response. The scaling up of the TB-free initiative is critical to strengthen local health policies and harness the power of multi-sectoral engagement for timely notification, diagnosis, prevention, treatment and care.

Inadequate efforts

However, existing efforts are inadequate to enhance the capacity of local governments in participatory and inclusive planning of a TB-free initiative. More focus is needed in the area of ensuring meaningful engagement of TB patients so that their representation, voiced experiences, and choices of prevention, treatment and care are realistically addressed at all levels. While TB is heavily influenced by socio-cultural, economic and health risk-related factors such as undernutrition, diabetes, HIV infection, and smoking, multi-sector actions are needed to combat the epidemic.   

More importantly, there are high-level global and regional events that have significantly reaffirmed commitments toward ending TB. In Sept 2023, the political declarations adopted at the UN High-level Meeting on TB include commitments toward universal access to TB services in both high and low-burden countries, with time-bound targets of reaching, with health services, at least 90 percent of people with or at risk of TB between 2023 and 2027. Moreover, there is a critical need to increase investments, and fast-track the development and availability of new tools to prevent, diagnose and provide treatment for TB.  

Undoubtedly, TB is largely a social disease that poses significant development challenges. There are growing needs to reduce human suffering and the socio-economic burden of TB by providing mental health and social protection services at the community level. Toward this end, anthropology of infectious diseases is instrumental in understanding interaction among socio-cultural, economic, political and biological variables in prevention and treatment of TB.

In this context, it is evident that TB is disproportionately common among disadvantaged populations. From an anthropological perspective, the relationship between poor health and poverty is a consequence of biosocial and biocultural factors. Still, stigma and discrimination associated with TB is another challenge to provide necessary care and support in the families. Therefore, apart from TB prevalence surveys, it is equally important to better understand people’s indigenous knowledge, attitude and health–seeking behavior to prevent and provide treatment for TB in the communities.

Urgent action necessary

To sum up, urgent actions are necessary to ensure universal access to TB prevention, treatment and care at all levels. The strategic priorities must focus on multisectoral actions to address wider determinants of the TB epidemic and effective management of the co-morbidities. In addition, there is an emerging need to strengthen health systems for ensuring essential TB services during disasters and pandemics such as Covid-19. 

The author is a health policy analyst

Safe water, sanitation and hygiene (WASH) is critical in public health. There is growing evidence that millions of people globally lack adequate WASH services and consequently suffer from or are exposed to a multitude of preventable illnesses. Lack of safe WASH services not only have adverse socio-economic and cultural impacts on people’s lives, but also weaken health systems and threaten health security at large.

While there are significant efforts from governments and civil society to strengthen, scale up and sustain inclusive and resilient WASH services, it is yet to explore how people’s health, their social-wellbeing and future resilience benefits in different socio-cultural, economic and political contexts. More attention is needed to improve access to WASH services in healthcare facilities, schools, families and public places and harness the community engagement toward Universal Health Coverage (UHC).

Provision of safely managed and sustained WASH services can greatly contribute to better health, nutrition and education in the families and communities. Shifting the locus of WASH services from infrastructure delivery, it is high time to establish inclusive, sustainable and resilient WASH systems where people’s voiced experiences, needs and choices are socio-culturally addressed in local policies, strategies and interventions.  

More significantly, WASH-related diseases and risks are wide-ranging, and these are exacerbated by a range of factors such as climate change, population growth, migration and urbanization. The infectious diseases and risks, among others, include diarroheal disease, neglected tropical diseases, maternal and neonatal sepsis and infections from unsafe healthcare waste management.

Undoubtedly, the health risks will have profound impacts on people’s social well-being and their quality of life. At the individual level, it undermines dignity and personal safety with the prevailing fear, anxiety and stress.  In the healthcare facilities, healthcare seeking behavior, safety and morale of the service providers are largely affected due to the poor provision of WASH services.   

According to WHO, 42 percent of healthcare facilities lack hand hygiene facilities at the point of care and 40 percent do not have systems to segregate waste around the world. Good hand hygiene is one of the most effective ways to reduce healthcare-associated infections and can reduce the risk of diarrhoeal diseases. Compared to hospitals, smaller facilities like clinics, health centers and health have limited access to water and sanitation services.

Therefore, integrating WASH into health systems can increase synergies and impacts on health programs such as maternal, neonatal and child health, nutrition, neglected tropical diseases, infection prevention and control, and many others. Therefore, such an integration is more likely to reduce the burden of multiple diseases and help break the vicious cycle of disease and poverty. Understandably, infectious diseases are most common among poor and marginalized populations having limited access to safely-managed WASH services.

Among WASH in health initiatives, integrating hygiene behavior change into routine immunization is a historic progress in Nepal. With the technical support from WaterAid Nepal and other implementing partners, hygiene promotion through routine immunization initiative is a nationwide scaled-up model of integrating hygiene behavior change in health systems that aims to empower mothers of children under 15 months of age in adapting key hygiene behaviors. With this intervention, evidence suggests that there is significant reduction in diarrhea and other WASH-related diseases.

Additionally, poor management of menstrual health and hygiene has a negative impact on adolescent girls and women. Still, many girls have to miss school due to menstrual cramps, heavy bleeding and fear of leakage. Therefore, a comprehensive package of WASH services is necessary for better health and education outcomes.

We continue to face healthcare waste that exposes health care workers, waste handlers, patients and their families and the community to preventable infections, toxic effects and injuries. There are critical needs of ensuring safe waste management practices in hospitals and healthcare facilities by promoting WASH in healthcare facilities in partnership with other technical agencies and relevant experts. 

Considering the critical needs of WASH in urban areas, city-wide inclusive sanitation (CWIS) is gaining priority in recent years. Recently convened ‘National Citywide Inclusive Sanitation Conclave 2023’ offered a good platform for stakeholders to share their experiences and learning in the area of WASH, and advocate for local governments to invest more in addressing WASH-related issues and challenges.

As we see, there is a growing emphasis on the sustainability of WASH services, including the need to promote community-led approaches to WASH service delivery. Despite some remarkable progress, there is an urgent need to significantly increase political commitment and ownership to deliver reliable, resilient and inclusive WASH services at scale. More concerted efforts are needed to strengthen multi-sector engagement and partnerships to increase investments in the area of WASH systems strengthening for better health outcomes at all levels.

The author is a health policy analyst

Globally, HIV still remains a major public health problem. According to a recent UNAIDS report, 29.8m of the 39m people living with HIV globally are receiving life-saving treatment. Access to antiretroviral therapy has expanded massively in sub-Saharan Africa and Asia and the Pacific, which together are home to about 82 per cent of all people living with HIV. 

The evidence suggests that social inequalities and diverse epidemic trends affect progress in the HIV response in Asia and the Pacific. The HIV epidemic in the region disproportionately affects people from key populations, especially young people (aged 15–24 years), and their sexual partners. Young people accounted for around a quarter of new HIV infections in the region in 2022. There are ongoing efforts to expand access to combination HIV prevention services, including harm reduction services, self-testing and provision of pre-exposure prophylaxis (PrEP). However, the coverage of HIV prevention is still low across key populations. 

In the fight against HIV, the communities living with, at risk of, or affected by HIV are leading the way. They are at the frontline of progress in the HIV response. This year’s World AIDS Day is more than a celebration of achievements in the global response. This is an urgent call to action to enable and support communities in their leadership roles. This is largely because communities connect people with people-centered public health services, build trust, innovate, monitor implementation of local policies and services, and hold service providers accountable. However, there are still limited efforts to unleash the full potential of community leadership to enable the end of AIDS. 

However, some critical challenges such as policy and regulatory hurdles, funding strategies, limited technical capacity, and poor recognition of communities’ role can constrain the progress of HIV prevention and treatment services at large. If these obstacles and challenges are removed, it is more likely that the progress toward global HIV response can be significantly advanced. 

Therefore, the communities’ leadership roles need to be made core in national HIV response. More importantly, an enabling policy and regulatory environment is needed to facilitate communities’ role in sustained provision of comprehensive HIV services, ensures civil society space, and protect the human rights of all.  

Undoubtedly, community-led organizations have long been the backbone of the HIV response. They raise the genuine voices and concerns of the people living with HIV and affected communities, alarm the human rights violations and advocate the critical needs of timely prevention, treatment and care services to the most underserved and marginalized populations. Their roles should not be undermined as they can add even greater impetus to the national HIV response. 

Nepal’s HIV Policy and Strategic Plan (2021-2026) importantly highlights the significance of community-led HIV response and aims to promote meaningful representation, participation and engagement of the people living with HIV and affected communities in planning, implementation, monitoring and evaluation of the national response. The strategy also provides a useful framework for engaging community-led organizations in effectively reaching out to the unreached populations, who are at high risk of HIV and other infectious diseases.

In our context, the national HIV response still faces critical challenges of limited human resources, inequitable coverage of services, inadequate monitoring and evaluation system and the sustainability of HIV services at local level. During the disasters or health emergencies such as Covid-19 pandemic, it is very challenging to ensure the continuity of HIV prevention, treatment and care services in the communities.  

Therefore, the capacity enhancement of the community-led organizations and their networks is critical in ensuring sustained prevention, treatment and care to the affected communities, which are poor and most marginalized. In the federal context, the role of local governments is important to support community-led organizations for their engagement and leadership in evidence-informed policy making and ensure domestic resource mobilization for community-led response. Additionally, local governments can invest in robust, resilient, equitable and publicly-funded systems for health and social protection for people living with HIV and their affected families, and promote people-centered and context-specific integrated services for HIV.

Like many other countries, Nepal has implemented community-led monitoring initiatives as an integral part of national HIV response. This is simply an accountability mechanism for HIV responses led and implemented by local community-led organizations of people living with HIV, networks of key populations, other affected groups or communities. Therefore, through the CLM process, community-led organizations increase their technical capacity to gather, analyze, use and own data. This evidence can significantly help ensure evidence-informed action to improve HIV services in the communities. Therefore, strengthening community-led monitoring mechanisms at all levels should be a priority agenda for accelerating national HIV response. 

There needs a strong political commitment and accountability to put people first and invest in evidence-based HIV prevention and treatment services. In many countries, national HIV policies have prioritized inclusive approaches that respect people’s human rights. They have made significant attempts in engaging people living with HIV and affected communities across the HIV response. More concerted efforts are needed to address the societal and structural factors to protect and promote their health and well-being. These mainly include gender and other socio-cultural inequalities, stigma and discrimination, and human rights violations. Therefore, promoting gender equality and confronting gender-based violence can make a lasting impact on HIV response. 

The author is a health policy analyst and former consultant at UNAIDS

In recent years, population and sustainable development issues are increasing priorities of the governments, political parties, development partners, youth-led civil society, media, private sector and communities at large. Looking back at history, the landmark International Conference on Population and Development (ICPD) was held in Cairo in 1994. This conference enormously transformed the global thinking as well as narratives of population and development with a bold political and development agenda. More importantly, placing people’s dignity and rights are at the heart of sustainable development.

While 179 countries including Nepal adopted the key strategic priorities of the ICPD, there is increasing recognition that inclusive sustainable development demands a clear focus on  human rights, including reproductive rights, empowering women and girls, and addressing inequalities as well as the needs, aspirations and rights of people. Therefore, the national commitments of the ICPD have been highly relevant to adapt to inclusive development policies, strategies, plans and programs, which help promote people-centered development.

Almost 30 years after the ICPD conference, among many others, there has been remarkable progress in the health and population sector. Despite significant health gains, there still are challenges to ensure the rights and choices of women and girls, mitigate the impact of the Covid-19 pandemic and the full realization of the sexual and reproductive health and rights agenda. The ICPD agenda and Sustainable Development Goals (SDGs) are closely aligned to eliminate poverty, achieve gender equality and secure the health and well-being of all people.

Considering the emerging needs of advancing the ICPD agenda in the context of formulating 16th Periodic Plan which is led by the National Planning Commission, the Ministry of Health and Population recently organized a national conference on population and development with support from UNFPA and other partners. The conference provided a unique opportunity for governments, political leaders, development partners, youth-led civil society, media and communities to share the country progress of the ICPD and discuss critical issues, challenges and opportunities for actions.

More importantly, among many others, Nepal’s commitments and progress in the health and population sector were reviewed and discussed at the conference. These include integration of comprehensive sexuality education in school curriculum, legalization of safe abortion, ensuring availability and accessibility of safe abortion services and adolescent-friendly health services. There has been remarkable progress in improving access to sexual and reproductive health services, advancing gender equity and women's empowerment, and integrating population dynamics in development policies, strategies and plans.

While reviewing some health and population indicators, the maternal mortality ratio has come down from 281 per 100,000 live births (2006) to 151 (2021). The births attended by skilled health personnel have gone up from 9 percent (1996) to 80 percent (2022). The total fertility rate has decreased from 4.6 (1996) to 2.1 (2022). The adolescent fertility rate has decreased from 127 (1996) to 71 (2022). The modern contraceptive prevalence rate has gone up from 26.0 percent (1996) to 43.0 percent (2022), whereas the unmet need for family planning has slightly dropped from 24.6 percent (2006) to 20.8 percent (2022).

Nepal has given priority and respect for international human rights treaties and signed political commitments that recognise reproductive rights. The Constitution of Nepal, 2015 guarantees the right to safe motherhood and reproductive health as fundamental rights. Over the years, the government has adopted several policies, strategies and plans to guarantee women’s access to reproductive health services. In 2018, the government enacted the Safe Motherhood and Reproductive Health Rights Act, which defines the right to reproductive health and provides the necessary foundation for safe, accessible and quality reproductive health services.

Despite these significant gains, it is necessary to strengthen health systems so that they can deliver equitable health outcomes on the basis of a comprehensive approach. There are increasing needs for health financing, human resources for health, strengthening procurement and distribution of medicines and vaccines, infrastructure, information systems and service delivery at the local level.

On the other side, governments should focus on universal access to comprehensive and integrated quality sexual and reproductive health services for all women, men and young people to reduce the unmet need for family planning. Particular attention is needed in ensuring access for adolescents and youth for universal access to HIV prevention, treatment, care and support.

More notably, the Nairobi Summit on ICPD+25 took place in Nairobi, Kenya from 12 to 15, November 2019, to mark the 25th anniversary of the International Conference on Population and Development (ICPD+25). During the Nairobi Summit, Nepal made important national commitments to advance the ICPD agenda that largely focuses on universal access to sexual and reproductive health rights, women’s empowerment and their rights in order to achieve sustainable development goals (SDGs).

The commitments largely aim to end violence against women and children, early and forced marriage, ending preventable maternal deaths and ending unmet need for family planning. We need significant investments in young people including their health and well-being by ensuring that they are able to exercise their reproductive rights through upscaling of adolescent-friendly services and comprehensive sexuality education.

There are critical needs to ensure the basic humanitarian needs of affected populations, including sexual and reproductive health care and gender-based violence prevention and response, are addressed in humanitarian contexts. Moreover, health financing policies, instruments and structures are essentially needed to ensure effective implementation of the strategic priorities of the ICPD agenda in the changed context.

In order to accelerate the progress of the ICPD agenda in the federal context, Nepal has prioritized  poverty reduction, health, sexual and reproductive health rights, education, gender equality and women empowerment, adolescence and youth, international migration, urbanization, data and evidence for policy-making.

Population aging is also a matter of concern for development. At the implementation level, there are increasing needs of capacity enhancement of provincial and local governments to mainstream the ICPD priorities in their policies, plans and budget. Meaningful participation of adolescents, youth, people with disability, migrants, sexual and gender minorities, media and civil society representatives from poor and marginalized communities can ensure the inclusive population and development policies at all levels.

Additionally, there are emerging challenges of climate change, pollution, food insecurity, increasing risks of non-communicable diseases, health emergencies, pandemics, disasters and migration for foreign employment. In order to effectively address these issues, multi-sector coordination mechanisms or platforms are needed to harness the partnerships and collaborative actions to create synergies at all levels.

While population and sustainable development are inextricably linked, it is also necessary to consider the population distribution, socio-cultural and political dynamics, ethnic and indigenous diversity, religion and sustainable livelihoods of communities across the country. With a holistic people-centered approach, the essence of ICPD agenda and SDGs can be further harnessed.

The author is Health and Population Consultant at UNFPA