In 2009, a renowned international non-governmental organisation pledged with the Ministry of Health to provide free mid-day meals to children of the entire Karnali region. But, the organisation later informed officials that it could only offer free mid-day meals for six months due to a funding crunch.

“We accepted the programme and allowed the donor to provide free mid-day meals for six months,” said Dr Shyam Raj Upreti, former director general of the Department of Health Services. “We lacked a sustainable plan at the time—and we still lack one.”

The issue is not only of the mid-day meals but most programmes of healthcare, including those related to nutrition, run in crisis mode every time, due to a lack of sustainable planning and budget sources. Overdependence on donors and the lack of a sustainable plan threatens the progress made over the years through huge investments, according to health experts.

“When a crisis happens, aid agencies step in with funds, but when the situation calms down, they stop funding,” said Upreti. “This is called the African model of healthcare. When the government does not take ownership of the programmes of aid agencies and fails to allocate a budget to continue them, achievements made over the years are jeopardised.”

The Health Ministry, which has stopped providing free fortified flour in all five districts of the Karnali province since this fiscal year, said the programme will not resume in the upcoming fiscal year either due to a budget crunch.

Health officials admit that the progress in improving nutrition in Karnali Province may have already been reversed due to the suspension of the programme this fiscal year. They also concede that an indefinite halt to the programme will have adverse impacts in the long run.

“We don’t have the budget to resume the programme next fiscal year also,” said Lila Bikram Thapa, chief of the Nutrition Section. “Thousands of pregnant women, new mothers, and young children have been deprived of fortified flour, which was crucial in reducing severe malnutrition.”

Malnutrition is a silent crisis in Nepal. The country has made significant progress in reducing stunting among children under five. Stunting decreased from 57 percent in 2001 to 25 percent in 2022, according to a report of the Nepal Demographic and Health Survey-2022.

Even though the survey report showed some improvement in the country’s overall nutrition status, progress is not the same in all provinces. The problem is more prevalent in the Karnali Province.

According to the report, over 30 percent of children under five in the province are stunted, the highest in the country, which is an indicator of chronic undernutrition. The province is also the poorest and most food insecure compared to the national average.

As part of a super flour distribution programme launched in 2014, the government would provide three kg of flour—fortified with all necessary micronutrients—to pregnant women, new mothers, and children aged six to 24 months every month to combat chronic malnutrition in the province. For this, the Health Ministry used to allocate Rs50 million every year.

However, in the ongoing fiscal year, the nutrition programme’s budget was slashed by around Rs100 million and this is the main reason for the stoppage of the fortified flour distribution programme.

Besides halting the flour distribution, the budget cuts will also impact awareness programmes, which are crucial for reducing the burden of problems, according to officials.

Nutrition experts warn that slashing Karnali Province's nutrition budget will have long-term consequences and could undo decades of progress in the sector.

They argue that authorities should have promoted locally available foods, made people aware about the importance of nutritious foods, and continued the fortified flour programme to improve nutrition conditions, and reduce dependency on freely distributed foods.

Experts stress that authorities must continue awareness programmes to educate people about the importance of healthy eating and the nutritional benefits of locally-available foods.

Doctors warn that malnutrition during pregnancy increases the risk of complications, maternal and neonatal deaths, as well as the likelihood of low birth weight. It is a major impediment to growth, which ultimately affects human capital and economic productivity.

Experts say that nutrition has a direct link to the overall development of the country. They add that malnutrition affects children's physical and mental growth, ultimately affecting the country’s economic health.