Nepali Times
Communities making kids healthy



WATCHFUL MOTHER: A Nawalparasi parents check on her child\'s growth and health

Dhaubadi village in Nawalparasi is so remote that many urban Nepalis don't even know it's just 280 km southwest of Kathmandu. But this community has proven that local development is possible without relying on the central government.

In seven years, village women here have managed to reduce child malnutrition from 38 to 16 percent, while nationally the rate of stunting, a sign of early chronic under-nutrition, has dropped only 16 percent in 26 years.

According to the government's Demographic and Health Survey, around 51 percent of children below five years of age are affected by stunting. Around 48 percent are underweight and 10 percent are wasted or too thin for their height, an indicator of acute malnutrition.

The main causes for these problems are low food intake, high rates of disease, poor child and maternal health care, inadequate access to sufficient basic health services and unsanitary conditions.

But nutrition experts in the government and the United Nations Children's Fund (UNICEF) are positive that child malnutrition can be reduced even in the poorest villages and among illiterate, socially and economically backward communities. "The village communities can be mobilised through education and awareness and empowered to take action to improve the situation by assessing the reasons and causes," said Pragya Mathema, UNICEF's nutrition officer.

On this premise, in 1999 the Ministry of Local Development with support from UNICEF started its Decentralised Action for Children and Women (DACAW) program, which is being implemented in 15 districts around the country and has helped cut malnutrition rates from 40 to 17 percent in those districts.

"We know now why our children suffer from malnutrition," said barely literate Karuna Acharya, a young mother of eight-month-old Kalpana. Acharya has learnt about healthy feeding, sanitation the symptoms of under-nutrition and how to respond to it from DACAW's local community mobilisers.

Thousands of young mothers like Acharya in the 15 districts have benefited from the program, forming their own committees to educate pregnant and new mothers about the importance of child nutrition. "The women now sit together, identify problems and find ways to solve nutritional problems," explained mobiliser Yam Kumari Rana in Dhaubadi. She added that the mothers are so conscious about the health of their newborn children that they queue up every month at the village's health monitoring centre to check whether their children are gaining weight.
"Such community-level initiative has been successful in combating malnutrition," said UNICEF's Pradeep Shrestha in Nawalparasi.

But such success has been limited to a few districts and the rest of the country still has a major child malnutrition problem. According to UNICEF's 2005 report Nutrition in Nepal, there has been slow progress in reducing the problem. For example, stunting among children aged six to 36 months has fallen only 16 percent over the last 26 years. "It will take up to 2040 before the Millennium Development Goal of a 50 percent reduction of child malnutrition in Nepal will be reached," said the report.

At that rate, it will take another 75 years before the malnutrition level reaches an acceptable level, it added. "The only way for Nepal to swiftly reduce child malnutrition rates is by empowering communities and mobilising them to get involved in community-level nutrition work," explained Rajendra Devkota, secretary of the Nawalparasi DDC. "There is a need to replicate such an initiative in the rest of the country. Both aid agencies and the central government should act," he added.

(11 JAN 2013 - 17 JAN 2013)