At first sight, the cluster of houses built with corrugate iron sheets in Martadi, the district headquarters of Bajura, resembles a settlement recently hit by the earthquakes. This far-western district, however, was not affected by the 2015 quakes. These freshly built makeshift houses have been built by recent migrants who have moved into town seeking better economic prospects now that Martadi is connected to the national highway network.

One of the steep narrow lanes in the district headquarters leads to the office of the newly-elected mayor of Badimalika Municipality, Padam Bahadur Baduwal. Tall and lanky, Baduwal is seated in his office busy with paperwork, occasionally instructing people over the phone. On a wall facing his table is a long flex with multiple signatures at the bottom. This flex is a reminder of a commitment paper signed by the elected representatives of this municipality pledging continuous effort towards improving the nutrition status of its residents.

There are 10 points in these commitments ranging from creating a conducive environment for children to attend schools and providing nutrition allowances to mothers and children, to developing this municipality as ‘nutritious municipality’ in the next five years and ending child marriages.

“The children serve as mirrors upon which the state of the society is reflected,” says Baduwal, speaking about the ten commitments. “Our children in Bajura district face a lot of hardships. But things should change and we are committed to improving their lives.”

According the Baduwal, in a novel pilot project, his municipality has already begun allocating Rs 2,000 per month as nutrition allowance for expecting and postpartum mothers.

Similarly, in Turmakhad Rural Municipality of Turmakhad, Aachham, Chairperson Puspha Raj Sharma and vice-chairperson Amrita Buda have expressed similar commitments. So have 308 local units in 30 districts across the country.

In a country that sees many commitments and little implementation, the recent pledge by the locally elected representatives could become an exception to the norm as the authorities have not only vowed action, but have actually allocated local funds for nutrition programmes. More importantly, the commitments by local governments also serve as a testimony to how issues related to nutrition is becoming a political agenda, and no longer relegated to just the health sector and service providers.

Global to local

Numerous studies corroborate how investment in nutrition for any country has long-term benefits given its proven rate of return. Apart from producing a mentally and physically healthy workforce, investment during the first 1000 days [nine-month pregnancy (270 days) and another two years (730 days)] equally reduces the healthcare costs that the country has to invest upon in later years.

A country marred by a generation of malnourished children, who end up either stunted or wasted, will end up draining more resources from the society in the long run. According to Raj Kumar Pokhrel, the chief of the Nutrition section of the Child Health Division of the Department of Health services, this in turn has a life-long knock-on effect on the quality of life that they are able to attain. “As a result of malnourishment, their opportunities in life are severely reduced and failing to enhance their capabilities means that the children, once they grow up, are not productive enough to sustain a healthy life. It is the surest way to relegate them to a vicious circle of poverty,” he says.

Taking into account the long term effects of malnutrition on an individual and the society, it was agreed in 2009 and 2010 that a global movement should be launched engaging as many countries as possible. Named the Scaling up Nutrition (SUN) Movement, that initiative is now a global movement involving 60 countries. Nepal was the fifth country to join the movement.

Nepal has been reaffirming its commitment to this global nutrition movement given the country’s alarming mortality rate that has been linked to malnutrition—according to the National Planning Commission’s estimates, malnutrition in Nepal contributes to about 50 percent of child deaths, or about 25,000 deaths per year. The SUN movement thus became an impetus for the Nepali government to prioritise nutrition in the country, while pulling together global resources for nutrition programmes. Since 2013, the government has been implementing the Multi-Sectoral Nutrition Plan (MSNP), the first phase of which was implemented in 28 districts. And the results have been encouraging.

Data show that the prevalence of stunting of children under the age of five was 40.5 percent in 2011. That has been reduced to 35.8 percent in 2016. Similarly, wasting has been reduced to 9.7 percent in 2016 from 10.9 percent in 2011. The government now aims to reduce stunting to 28 percent by 2022; wasting by 7 percent and low birth weight by 10 percent.

Dr Geeta Bhakta Joshi, who was recently awarded the “Scaling Up Nutrition (SUN) Champion Award, 2017” and is the nutrition focal person at the NPC, said the government has understood the ramification of malnutrition of children and their mothers on the development and the economy of the country. “The recent endorsement of the second phase of the MSNP programme by the government shows its continued engagement in ensuring that people in the country do not have the face what has been a long-standing problem of malnutrition,” says Dr Joshi.

Currently, the NPC is leading the programme that brings together all the concerned government agencies that have direct and indirect contribution in enhancing nutrition. In sum, the programme is being implemented through the involvement of nine government agencies and ministries. 

In the MSNP-2, the Ministry of Health is tasked with increasing breastfeeding, supplying micro-nutrients supplementation and management of severe acute malnutrition cases, among others. The Ministry of Education will work to expand its school day-meal programme, while helping in improving knowledge and practices on nutrition.

Similarly, the Ministry of Water Supply and Sanitation is assigned with the task of ensuring the increased access to safe drinking water and encouraging use of improved toilets. The Ministry of Agriculture Development will increase accessibility, availability of food while reducing the workload for women, especially expecting and postpartum mothers. While the Ministry of Livestock Development will increase accessibility, availability and consumption of animal source foods.

A political milestone

As Nepal moves into a federal structure with the successfully held local-level and federal assembly and provincial parliament elections, the commitment shown by locally-elected representative, according to experts, is a significant milestone in shaping nutrition as a political agenda, in the years to come. “It is really encouraging that nutrition is being taken up by politicians too. This is a political milestone in the mobilisation of government mechanism and the speeding up of efforts in improving the nutrition status of the children and adults. This all will certainly contribute to a healthy workforce, the full benefits of which might not be immediately evident in the short term, but ones that the country will reap in the coming decades,” said Dr Ramesh Kanta Adhikari, a child health specialist.