More than 16 percent of children under five years of age in Lumbini Province have been found to be suffering from wasting, the most immediate, visible, and life-threatening form of malnutrition.

The malnutrition problem is the gravest in Lumbini, worse than in Karnali or Sudurpaschim provinces, which have 3.8 and 5.1 percent children suffering from wasting, respectively, according to a preliminary report of the Nepal Demographic and Health Survey-2022.

“We made a lot of effort to improve the nutrition status of Karnali and Sudurpaschim provinces,” said Lila Bikram Thapa, chief of Nutrition Section at the Family Welfare Division of the Department of Health Services. “But severe problems have surfaced in the districts of Lumbini Province that are actually more accessible than those of Karnali and Sudurpaschim.”

Nutrition is one among several health problems where Lumbini lags other provinces. At present, several local units in Banke district have been witnessing a massive measles outbreak.

The outbreak in Nepalgunj Sub-metropolitan City has spread to Kohalpur Municipality, Narainpur Rural Municipality, Khajura Rural Municipality and Duduwa Rural Municipality.

One death and 246 cases of infection had been reported until Friday evening. Officials conceded that there could be hundreds of other cases in the communities as not all cases get reported.

In October 2021, several local units of Kapilvastu, another district in the province, witnessed a massive cholera outbreak, which indicated the poor water and sanitation conditions in the area.

The Ministry of Health and Population has been planning a mass drug administration campaign in Kapilvastu, Dang and Banke districts that have the highest infection rate of lymphatic filariasis, also known as elephantiasis.

This is the 13th consecutive year that the authorities have launched a mass drug administration drive to control a mosquito-borne parasitic disease caused by filarial worms transmitted by various mosquito species including Culex, Anopheles, and Aedes.

It is the second major infectious disease after leprosy that causes permanent and long-term disability in Nepal.

Kailali of Sudurpaschim Province and Morang of Province 1 are also anticipating a mass drug administration campaign from health agencies to eradicate filariasis. The disease has largely been controlled in most of the districts with five rounds of mass drug administration programmes.

“We also have problems in maternal and child health,” said Dr Bikash Devkota, secretary at the Ministry of Health and Population in Lumbini Province. “Problems are concentrated in areas where the home child delivery rates are high and the immunisation status is low.”

Floating population, scattered slums, high density of working-class people, and lack of awareness and poor access to health services are some challenges officials have identified in improving the health indicators.

“Coverage of health care programmes in marginalised local Muslim communities as well as other backward communities is low,” Dr Binod Giri, chief at the Provincial Health Directorate of Lumbini, told the Post over phone from Nepalgunj. “This is not only a problem of our province; it’s the same with others as well. We are aware of the health indicators of our province and have several programmes to address the problems.”

Lumbini Province has four medical colleges—Nepalgunj Medical College, Universal College of Medical Sciences, Lumbini Medical College and Rapti Academy of Health Sciences. There are also several other advanced hospitals in the province.

Giri claimed that the province is “doing good in healthcare services and problems may lie only in the reports”.

Public health experts, however, say the sole focus on clinical services does not help improve the health indicators.

“Only a few can afford to take clinical services after they suffer from health problems,” said Dr Krishnam Man Shakya, a public health expert. “We should not forget that a large chunk of the population cannot afford the clinical services at big hospitals.”

Experts said non-health interventions—awareness drives, improved financial conditions of people, their education levels, and sanitation conditions—can go a long way in improving health indicators.

To improve the indicators, they added, authorities must do micro planning, and ensure coordination among all stakeholders, including agencies of all three tiers of government as well as international aid agencies.

“Our elected representatives give priority to purchasing ambulances and building health facilities,” Shakya said. “Those things are visible, helping them show that they are doing something. But these may not make much difference in improving the overall health indicators.”