Malnutrition in Nepal : Devolution of authority is the answer

According to the Ministry of Health and Population (MoHP), 40% of children under five are underweight in Nepal due to Protein Energy Malnutrition and it would “take another 100 years” to remedy the problem (THT, August 18). The 1998 Human Development Report said that “the extent of nutritional deprivation among children is both pervasive and deep and is rooted in long-term inadequacies in food intake.” A 1994 World Bank paper on population and family planning had reported that the percentage of households consuming less than the recommended level of food was 47% in rural hills, 40% in urban areas, 31% in the mountains and 23% in rural Tarai. With persistently high population growth rate, the situation is much worse. Thus, widespread malnutrition has for long been undermining the health of a big proportion of Nepalis in formative years.

The problem of malnutrition is, however, rooted in the chronic malgovernance of MoHP. In the Panchayat days, a woman minister with little aptitude pres-ided over this vital sector, only to bolster her own political health by materially charming specific power centres that thrived under the royal umbrella. During the NC regime, the entire public health system was demoralised by a chauvinist doctor turned minister by bringing the system under clinician medical doctors in the districts.

More recently, the previous United Left Front minister’s much publicised priority was to provide “free indoor and emergency services to the poor and destitute” in district hospitals, which, at best, would benefit 100,000 poor in the country. He was apparently carried away by the immense publicity value of his gimmick during elections. The Maoists’ decade-long “people’s war” only worsened people’s health and that of their children. The present minister too has been complaining about insufficient budgetary allocation for 2007-08, even as he presides over one of the most heavily donor-funded ministries where, more than anything else, strategy reforms are urgently needed. Thus, whatever the form of government or politics, the net effect for the people’s health has remained negative.

Nepal is 84% rural; 78% people are depe-

ndent on agriculture — a sector that suffers from massive under-employment (47%) and contributes less than half the proportion of GDP. Per capita land availability was a meagre 0.15 ha in 1998, and top 5% people owned 40% agricultural land, and bottom 60% only 20% in 1990. Only a small proportion of households produce food sufficient for the whole year. Food shortages in Nepal are, thus, acute and widespread, and the rural poor are its most obvious victims among whom Dalits and Janajatis figure prominently. The MoHP officials are reportedly poised “to do the same thing differently”, whatever that means, knowing fully well that malnutrition is a multi-faceted problem requiring inter-sectoral coordinated intervention. Our bureaucrats may have many inclinations but searching for creative alternatives is not among them, simply because our archaic civil service rules place no premium on innovation.

Despite the 2005 Paris Declaration on Aid Effectiveness, that, among others, underscores “Harmonisation”, “Managing for Results” and “Mutual Accountability” in the administration of aid, the health-related donors have done little to institute a multi-disciplinary approach to malnutrition. By and large, most of the expatriate donor officials, who have swarmed into Nepal in thousands, have conveyed little sense of accountability.

Malnutrition being an inter-sectoral concern, the National Planning Commission is aptly positioned to turn it into an inter-ministerial agenda. While nutritional awareness remains an MoHP area of expertise, it also needs to be significantly complemented by access to sufficient food intake, which, in turn, is a function of income and employment opportunities for the rural poor. Unlike in the past, there are many success stories in the latter area, mostly revolving around microfinance initiatives. Sufficient devolution of authority to the communities would have gone a long way in achieving complementarity, resulting in measurable improvements in children’s nutritional status.

Unfortunately, our politically-anointed planners seem clueless and unwilling to learn as to how to make it happen. Instead, the present NPC is planning to develop 15 VDCs as model local bodies, which smacks of “model panchayat” initiative of half a century ago.

With all these odds stacked up against them, where do our hapless malnourished Nepali children stand? There is one hope. As one final act of compassion, the Prime Minister might just want to leave a legacy behind. As the head of state, government and NPC, with one stroke of his pen, he could promote irreversible devolution of authority so that the parents themselves would have the authority and resources to take care of their children’s health, and would remember him for it.

Shrestha is a development anthropologist