What drafting a constitution taught me about public health

I spent most of my career believing that better medicine was the answer to bad sexual health outcomes. My time in the Constituent Assembly complicated that belief in a useful way.

A clinician treats the person in front of them. Policy determines how many people ever reach a clinician at all — whether sexuality education appears in a school curriculum, whether a rural health post stocks what it needs, whether a young woman can seek care without a chaperone.

The gap between a right and a service

It is one thing to write health into a constitution. It is another to build the referral pathway that makes the right usable in Khotang or Kalikot. Much of the work after drafting is unglamorous: training, supply chains, and persuading institutions that sexual health is health.

Where I think the leverage is

Teachers and primary health workers. They reach far more adolescents than specialists ever will, and most of them have had no training in how to answer a direct question about sex without flinching. The Nepal Institute of Human Sexuality exists largely to close that gap.

Clinical practice remains my main work. But I no longer think of education and policy as something separate from it.