Public health and peace building in Nepal.

www.thelancet.com Vol 374 August 15, 2009 515 On May 4, 2009, Pushpa Kamal Dahal, the Maoist Prime Minister of Nepal, resigned, adding yet another stage to the transformation of Nepal from bullets to ballots. The Maoists had initiated a leg islative agenda to “secure rights for all minority people in Nepal”. Politicians and everyday Nepalese alike spoke of the “New Nepal” with great promise, and health as a human right became a central component of that promise. But with the resignation of the Maoist cabinet, after only 9 months in power, and the ensuing impasse in forming a coalition government led by the new Prime Minister Madhav Kumar Nepal, it remains to be seen if promoting public health will still be a priority. Since the cessation of the civil war in 2006, Nepal has seen a large infl ux of development aid, with around US$700 million committed for fi scal year 2008–09—a substantial proportion of its $3 billion budget according to the Ministry of Finance. When the Maoist party announced its budget in September, 2008, it was accompanied by the slogan “New Nepal, Healthy Nepal”. Nepal has committed to meeting the Millennium Development Goals (MDGs) by 2015. Already faced with a large disparity in health outcomes between urban and rural, high caste and low caste, Nepal’s progress towards the MDGs is further challenged by its precarious political situation. Nepal off ers an intriguing case study of the challenges of meeting development and public health goals in post-confl ict countries. According to Claude Bruderlein, the director of the Humanitarian Policy and Confl ict Research Center at Harvard University, Cambridge, MA, USA, “Nepal is not a standard case. In order to understand public health in Nepal it is important to stay above the cynical view of Nepal as a failed state and below the development narrative of the ‘New Nepal’. The truth is somewhere in between.” The case of Nepal illustrates how political legacies and social forces mould the public health agenda. Most