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KathmanduYou could almost discern a tinge of hope for the regional grouping in Narendra Modi’s December 8 SAARC Day message. “SAARC has made progress, but more needs to be done,” he wrote. In a clear allusion to Pakistan, he added, “Our efforts for greater collaboration have repeatedly been challenged with threats and acts of terrorism.”

Such an environment, he continues, impedes “our shared objective of realizing the full potential of SAARC”. Realizing the full potential of SAARC? The pick of words is odd coming from someone who supposedly wants the regional body dead. He offers more morsels of hope: “SAARC, set up as an organization to build a connected and integrated South Asia, aims at promoting the development and progress of all countries in the region.” Again, why talk up SAARC’s goals if he is determined to ditch it?

When I put this question to Keshav Prasad Bhattarai of the Nepal Institute for Strategic Studies (NISS), he had a curious reply: “What India is trying to do is turn SAARC into another BIMSTEC.” How so?

“How else do we understand a SAARC minus Pakistan that India seems to be pushing for?” he asks. “But it is laughable to imagine a SAARC that has Afghanistan but not Pakistan.” Bhattarai seems to be on to something. In the past few years the Modi government has invested a lot in trying to isolate Pakistan, both regionally and globally. Now, with the new Indian policy of welcoming only non-Muslim immigrants from India’s neighboring countries, Modi is putting down a marker.

The way anti-Muslim hysteria is being whipped up in India, it’s hard to imagine Modi adopting an accommodating line on Pakistan. The goal of the recent statement on SAARC Day could thus have been to hammer in the point that the regional grouping could have done wonders if not for Pakistan.

Nepal is invested in SAARC, having played an important role in its establishment and as the host of its secretariat. Nepal is also the current SAARC chair. But are we flogging a dead horse? Even when India and Pakistan were on talking terms, how effective was the regional grouping?

Without SAARC, India and Pakistan will have one fewer platform to talk with each other. The only other regional grouping both are members of is the Shanghai Cooperation Organization. After all, during the last SAARC Summit in Kathmandu, Modi had felt the need to meet Nawaz Sharif secretly. The less the two nuclear powers talk, the deeper will be the suspicions, and the greater the chances of unrest in the region.

As things are, with India as the fulcrum of South Asia, SAARC does not seem to have a viable future. Perhaps the best we can hope is for it to continue as a platform for Tier 2 diplomacy. An Indian government not drunk on partisan Hindu support would realize that India’s economic rise will remain stymied so long as tensions with Pakistan persist. South Asia minus Pakistan is a geographical impossibility. You cannot wish away a country of 200 million, however much you hate it.

For an administrative unit to be a municipality, it has to have a hospital with at least 25 beds, according to the Local Government Operation Act 2017. Only seven municipalities in Province 5 meet this criteria. The remaining 25 municipalities do not have a hospital with 25 beds; 10 of them have a 15-bed hospital each. There is no new initiative to add beds. 

Universal Medical College in Siddharthanagar municipality in the district of Rupandehi has 50 beds. So do Crimson Hospital in Tilottama municipality and Devdaha Medical College in Devdaha municipality. These are private medical colleges. 

Prithvi Chandra hospital in Ramgram municipality in the district of Nawalparasi also has 50 beds. But Lumbini Sanskritik municipality and Sainamaina municipality (both in Rupandehi) are without hospitals, compelling locals to travel elsewhere for medical treatment. 

The plan to make Pyuthan Hospital in Bijuwar a 50-bed hospital has been gathering dust for over a decade. Patients from Pyuthan as well as from the neighboring districts of Gulmi, Rolpa and Arghakhanchi visit this hospital, and many of them struggle to get beds. Those from areas bordering India also have to travel across the frontier for treatment. 

The Ministry of Health and Population has recently started the process of increasing the number of beds at a primary health center in Swargadwari municipality, Pyuthan, to 15 from the existing three. Two years after it was declared a municipality, there is no sign of a 25-bed hospital. Local representatives are in fact glad to get a 15-bed medical center. 

Likewise, two years after Sitganga in Arghakhanchi district was declared a municipality, residents cannot get specialized medical services locally and have to travel to Kathmandu, Butwal or Bhairahawa; the primary health center and health post there provide only general medical services. The municipality has recently started the process of converting the health center into a 15-bed hospital. Municipality Chief Surya Prasad Adhikari says there is no space to build a bigger hospital. 

District Hospital Rolpa has only 15 beds. Rolpa Municipality Chief Purna KC says the hospital, built with an investment of Rs 310 million, has the approval to upgrade to 50 beds—and yet nothing is happening. 

Similarly, District Hospital Gulmi is in the process of getting 50 beds; the ministry has already signed off on an upgrade. “But the approval notwithstanding, the hospital has neither the required number of doctors nor proper physical infrastructure,” laments municipality chief Dilli Raj Bhusal. 

Netra Raj Adhikari, chief of Shivaraj Municipality in Kapilvastu, bemoans that locals have to depend on private clinics and health centers for medical services. Of the 11 wards in the municipality, only eight have health centers. 

Bishal Subedi, head of the Pyuthan Medical Center, says the federal ministries’ strategies are not in lockstep with the requirements set by the Local Government Operation Act 2017. “Municipalities must have a 25-bed hospital; a 15-bed hospital is not enough,” he emphasizes.

Diplomatic license 
A confident Nepal confronts India

The Indian political establishment and bureaucracy hate to admit it. But India’s Nepal policy has undergone a forced and dramatic change thanks to China. Former Indian ambassador to Nepal, Ranjit Rae, may be wrong on some things but he is bang on in his assertion that after the 2015-16 blockade, the Indian establishment has been occupied with keeping Kathmandu in good humor, lest Nepal slides farther into the Chinese orbit. The over-promising and under-delivering India has been shaken awake. A cross-border oil pipeline quickly came up, and there is fresh impetus on all kinds of Indo-Nepal connectivity projects. 

According to the Indians, Narendra Modi would have come to Nepal if not for President Xi’s Kathmandu trip. Perhaps Modi did not want to be overshadowed by Xi. But this cannot be the whole story. If the Indians were irked by the zealous welcome Xi was accorded in Nepal, they have not let it show. What we see instead is India’s greater readiness to make all kinds of concessions to Nepal: from offering it new transit facilities to keeping mum when Nepal erupted over Kalapani. 

The Madhesis have been conveniently forgotten post-blockade. India now insists it is not competing against China in Nepal. When India tried to punish Nepal for daring to promulgate a national charter without its say-so, Nepal got closer to China. This rang alarm bells in New Delhi, even though the likes of Rae continued to maintain that China can never replace India in Nepal. Hence the rather acerbic Rae, who was also a firm supporter of the Madhesi cause, was replaced by Manjeev Singh Puri, an affable businessman with no ardent ideological moorings. If China wanted to be business-like in Nepal, so would India. 

The Indian policy on Nepal is now geared toward accommodating Kathmandu after futile attempts to punish it for straying. We see something similar happening in Sri Lanka, as India tries to accommodate the newly-elected Rajapakshas, long known for their sympathies to China. In the Indian eyes, they were the ones who handed Hambantota to the Chinese on a silver platter. Yet the Lankans have elected them back to power and India has now accepted it as a fait accompli.   

India is finding its options shrinking in this multipolar world, as it struggles to get even Bhutan, whose security it oversees, to toe its line vis-à-vis China. The recent by-elections in Nepal have showed the ruling NCP’s hold on Nepali politics is as strong as ever, and it will be sometime before the Nepali Congress or any other party can break the communist grip. India has no option but to deal with the communist leadership. 

It would not be an exaggeration to say that under PM Oli, Nepal gets more respect from India than it ever did after the 1990 change. Try convincing Oli or the NCP that the outreach to China is counterproductive. Or that their efforts to revive SAARC is futile. An increasingly confident Nepal is opening up to the outside world. The days when Nepal was under India’s exclusive sphere of influence are gone. To their credit, the Indian political leadership and intellectuals seem to realize this.   

Ganga Devi Gautam from Tatopani in the north-western district of Jumla gave birth to four children, hoping one of them would be a son. Her family was unhappy that Gautam had not had a son—until she finally gave birth to one in her fifth attempt. When that happened, her family and neighbors, accompanied by a band, reached the hospital to celebrate the occasion. They also organized an abir jatra (a colorful procession) and a communal meal. Gautam’s family members started treating her better. 

When word spread that Laxmi Raut from Thantikandh, a rural municipality in Dailekh, gave birth to a son, her family and relatives also went to the health center with a band. They also celebrated the occasion by doing an abir jatra, to the surprise of the health center’s staff. 

These two are representative examples of gender discrimination. In Karnali Province (where both Jumla and Dailekh fall), girls are discriminated against right from the womb. Family and relatives do not celebrate the birth of a girl because of the entrenched belief that while a son takes care of the parents in old age, a daughter leaves home after marriage. 

As a result, most couples face societal pressure to have a son, and women keep producing babies hoping they would finally give birth to a male child. Meanwhile, having so many babies wrecks women’s health. 

Pushe Nepali, 65, from Tila rural municipality in Jumla got married when he was just 14. His wife gave birth to 11 daughters in the hope of having a son. Because of the dire financial situation of the household, it was difficult to raise 11 daughters, three of whom died. Says Pushe, “I wanted a son but ended up with many daughters. I regret it now.”

Because she did not give birth to a son, Jhan Maya Rokaya from Kanakasundari rural municipality in Jumla was thrown out of her house by her husband, who faced family pressure to do so. The Rokayas have six daughters together. Jhan Maya’s case is not atypical; most women in Karnali have to endure domestic violence if they do not give birth to a son. 

Also on the rise in recent years are cases of female feticide, which is common even among educated folks. Latest statistics show that female birth rates have gone down in the provincial capital of Birendranagar. Local and provincial governments have introduced various schemes to check the trend. To encourage couples to have daughters, the provincial government has started opening a bank account in the name of all girls born in Karnali Province and depositing Rs 500 every month in their account for 20 years.

Khandachakra municipality in Kalikot, another district in the province, has started handing over a cash gift to couples who give birth to a daughter. Says municipality chief, Jasi Prasad Pandey, “We are facing the problem of a skewed sex ratio, so we have had to provide incentives for couples to have daughters. Any couple in the municipality giving birth to two daughters at most and undergoing sterilization will be given Rs one lakh in cash.”