Publications: Nutrition in Nepal - A Media Monitoring Report - Kartik 2074

Two positive news were reported this month in the media. First one was, Prof. Dr. Geeta Bhakta Joshi, member of the National Planning Commission receiving the 2017 SUN Nutrition Champion Awards for outstanding achievements in promoting nutrition in Nepal. Among many other things, Prof. Joshi was awarded for leading the process of including nutrition as a key component of Nepal’s 14th National Periodic Plan (2016-2018) and leading the formulation of the Multi-sector Nutrition Plan II (MSNP 2018-2022). The second news was also related to the extension of Multi Sector Nutrition Plan.

The Government of Nepal has put the issue of nutrition and food security in its top priority. Nutrition has been identified as one of the important agendas of national development. There has also been a strong high level commitment from the government and external development partners. The government has started providing allowance for women opting for institutional delivery. Regardless of numerous ongoing activities and programmes in various parts of Nepal very little progress has been noted.

This media monitoring sought to track down stories on nutrition in Nepal as reported by the media in an attempt to identify the current picture and the progress made in this regard. Specially, this report synthesises the current context of malnutrition in Nepal in terms of nutrition related interventions, malnutrition trends and have insights on how external development partners, NGOs, business and other relevant stakeholders are engaged in nutrition in Nepal.

Methodology

This media monitoring study was conducted for the period of one month from 18^th October to 16^th November (covering the month of Kartik 2074 BS). HERD team collected various stories by conducting daily media monitoring of 17 national mainstream and online news sources viz.: The Himalayan Times, My Republica, The Kathmandu Post, Kantipur, Naya Patrika, Rajdhani, Annapurna Post, The Rising Nepal, Nagarik, Gorkhapatra, Nepali Times, Himal Khabar Patrika, Nepal Samacharpatra, Online Khabar, Setopati, Pahilopost and Nepal Khabar. In addition, random searches were also conducted in the internet with the key words ‘nutrition’ and ‘food security’.

The monitoring team managed to gather a total of 13 media stories related to nutrition during this period. The collected stories were recorded in a spreadsheet i.e. Microsoft Excel detailing the date, title, sources and links to the story. This study involves a three step process i.e. information finding, information recording and analysis. The collected stories were then synthesised and categorised into various themes and sub-themes. The major findings from our media monitoring study are as follows:

Major Finings

The major findings from the stories in the media have been broadly classified into the following three categories i.e. Current Scenario, Issues and Efforts Made.

Current Scenario

According to the news published in Nagarik Daily in two months of conduction of the Integrated Management of Acute Malnutrition Program conducted by DPHO-Panchthar, 68 malnourished children were found in the district. Not only the children of poor families were malnourished, children from economically stable families were also found suffering from the same problem in the area. Most of the malnourished children were found in Tumbewa village, which was recently declared as the extremely backward area by  Nepal government. No cases of malnutrition had been reported in Falgunanda rural municipality until now.

Free treatment along with readymade nutritious food have been provided to the confirmed malnourished children. These services are being provided through two PHCs and 9 health posts.

According to the news published in Nari Monthly magazine, a sister publication of Kantipur, the Department of Health has stated that many babies are being deprived of breastfeeding due to lack of awareness related to breastfeeding in Nepal. According to the data of World Health Organization, due to the lack of breastfeeding practices, 30 trillion rupees is spent for the alternative substitutes of mother’s milk. In Nepal, anaemia was seen in almost 68.7 percent of 6-23 months’ children, one among 4 children are found to be obese and two third children are found to be malnourished.

Nepal has been rewarded with the UN’s ‘UN SUN global champion award 2017’ for making exemplary work in reducing the women and children malnutrition.

Global Nutrition Improvement Campaign (Scaling up Nutrition Mission) for eliminating malnutrition is being conducted under the leadership of United Nations Assistant General Secretary. Out of 60 member countries of the campaign, eight countries including Nepal have been rewarded.

This is an appreciation of the movement and initiative for eliminating malnutrition made by Nepal in the sector of public health says Gitabhakta Joshi, member of National Planning Commission.  This achievement sends a message that Nepal can conduct such social programs effectively in this international program.

The first multi-sectoral nutrition plan was implemented in 2013 from 28 districts in coordination with National Planning Commission for reducing malnutrition. Under this program, Golden Thousand Days, programs for nutrition, Suaahara (Integrated Nutrition Program), SABAL project, Feed the Future: Farmers, Agriculture and Food Security Project were also implemented.

Although there has been some improvement in the situation of stunting during this period, the problem of malnutrition still remains worrisome. Government statistics show that 25 thousand children will still die every year due to malnutrition. The government has been preparing to implement Second Multisector Nutrition Plan from the next phase to address the problems of malnutrition as well as other public health problems.

The estimated budget of the plan is 42.4 billion NPR. The budget has been divided to the National Planning Commission and Ministry of Health, Agriculture Development and Livestock, Drinking Water and Sanitation, Women, Children and Social Welfare, Education, Federal Affairs and Local Development.

The full report of 2016 Nepal Demographic and Health Survey,  suggests that Province 2 fares poorly in health indicators including nutrition, teenage pregnancy, family planning coverage, new-born deaths, vaccination coverage and exposure of women to domestic violence.

The report calls for serious health intervention in province no 2. For instance, a mother from Province 2 gives birth to three children against 1.8 children in Province 3 while the national average is 2.3. Besides, 27 percent of the mothers aged between 15 and 19 years were found to be pregnant in the state.

In Province 2, only 65 percent of children between 12 and 23 months were administered basic vaccination while the vaccination coverage in Province 4 is 93 percent. The basic vaccination includes BCG, measles-rubella, and three doses each of DPT-HepB-Hib and polio vaccine. The condition is not good in the province in terms of neonatal and infant mortalities either. Thirty per 1,000 live births are likely to die within the first month while 52 per 1,000 live births are wasted before year 1. Also, only 45 percent of the births were delivered in a health facility.

In the last two decades the infant mortality has decreased. According to NDHS, infant mortality rate was 180 per thousand in 1969 which has now has fallen to 32 people per thousand. Similarly, the NDHS report shows improvement in sanitation to 63 percent, breastfeeding practices to 66 percent and family planning has reached to 53 percent.

Similarly, the survey has shown improvement in child nutrition in the last two decades. Child birth is 2.3 percent. The report has also has shown improvement in awareness related to HIV/AIDS, sexual health, nutrition and blood pressure

Issues

In an OPED published in The Kathmandu Post, PC Wasti has pointed how hunger and malnutrition has increased the trend of migration. In rural areas of the hills and mountains, it is hard to get one square meal a day. The land, without irrigation facilities, does not produce enough food. If one migrates to the city, one can at least have a meal of rice daily. In the villages, one has to wait for a festival to eat meat; but in the cities, it is very easy to get any kind of meat. Hunger and malnutrition stalk the villages. Knowledge about nutrition is limited or non-existent. Foods with very low nutritional value are widely consumed. Nutritious crops such as millet, barley, buckwheat and wheat are considered to be inferior. Legumes and pulses are produced, but not consumed in adequate quantities. They are sold to earn money so as to buy market foods. Milk and eggs are luxuries and are sold to buy household necessities. Green leafy vegetables are not valued much and fruits are not considered to be essential foods.

Families cannot afford child appropriate foods, so the young ones eat what the rest of the family eats. As a result, the children are malnourished and enter school with an inadequately developed brain. They can’t get good grades and can’t do well when they become adults. People, therefore, don’t want to live in rural areas, the hills or the mountains. This is the reason why the trend of migration has peaked its way.

According to the news published in MyRepublica, on paper, we are an agricultural country, with 68 percent of the population dependent on it. In reality, the country has to import large quantities of cereals, vegetables and fruits it consumes. The main reason is the drastic reduction in the output of our farms, thanks to the massive outmigration of young people to work abroad, who would otherwise be tilling their fields. With no food grains, and even fewer vegetables and fruits grown locally, the unhealthy instant noodles are all rage in our villages. Widespread flooding this August in Tarai-Madhes, the country’s traditional ‘bread basket’, decimated what little was growing in the fields. Since these foods have to travel long distances to arrive at Nepali markets, the prices of daily consumables like fruits and vegetables are also increasing alarmingly.

According to a recent survey of World Food Programme, the prices of daily edibles in Nepal, assuming comparable incomes, are among the highest in the world. Food items in Nepal are nearly twice as pricey compared to Pakistan and three times as pricey compared to India. Nepali economists attribute such inflated food prices to easy money from remittance and increase in wage rates, thanks to an acute labour shortage. The risk is that soon a big segment of the population—26.1 percent of the youth aged 15-29, for instance, is unemployed—could be priced out of the Nepali food market. The country is still far way off from having a famine. But, with the current level of food inflation, cases of under-nutrition and malnutrition could steadily increase, significantly impacting the health and wellbeing of millions of Nepalese. 

According to the news published in The Express Tribune, the Global Nutrition Report 2017  — which tracks global nutrition targets including national progress against globally agreed targets for maternal, infant and young child nutrition (MIYCN) — showed that Nepal 13.1 per cent on nutrition interventions.

The report’s analysis shows that 88 per cent of countries face a serious burden of either two or three forms of malnutrition – childhood stunting, anaemia in women of reproductive age and or overweight adult women.

Moreover, it notes that no country in the world is on track to meet targets to reduce anaemia among women of reproductive age, with the number of anaemic women actually increasing since 2012. In the 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends including childhood stunting — children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity; anaemia in women of reproductive age — a serious condition that can have long-term health impacts for mother and child; and  overweight adult women — a rising concern as women are disproportionately affected by the global obesity epidemic.

Through five areas including sustainable food production, strong systems of infrastructure, health systems, equity and inclusion, peace and stability, the report finds that improving nutrition can have a powerful multiplier effect across the SDGs. Indeed, it indicates that it will be a challenge to achieve any SDG without addressing nutrition.

Efforts made

According to the news published in Kathmandu Tribune, delegates from 56 member countries around the globe took part in the five-day long meeting that saw deliberations on the situation of food production, demand and supply of food, reasons behind hunger and the state of world hunger and possible ways to minimize them at the International Council Meeting of the Food-first information and Action Network (FIAN).

National Human Rights Commission Spokesperson, Mohna Ansari emphasized on the need to increase the access of people to natural and productive resources for a decent living, and to ensure right to food.

Himalayan Association Cultural Nepal, an organisation formed by the Nepali people living in Portugal has provided financial help to two sons of Shyamlal Sunar from Rolpa. The decision was based on the widely covered news of the malnourished children, by the National news committee during the nutrition week in Baishak. The money has been handed over to Chief of Rolpa Municipality and Ward member of ward number 4, Rolpa municipality together.

A total of 61,500 rupees was provided. Total 5000 rupees will be used on a monthly basis for the treatment of the malnourished children. The organization has stated that if the fund is utilised properly they will provide additional support. Shyamlal had taken his sons to the nutrition rehab centre in Dang with the help of different agencies, where his sons stayed for 2 months. Sunar was very happy with the improvement of the health of his sons but upon arriving home, he found that his wife was not there. It has been nine months since his wife left him and his children. He is now in stress as there is no one at the house to take care of his children. If he stays home, he won’t be able to work and they will not have food to eat.

Children below five years age across the nation were administered Vitamin ‘A’ and de-worming tablets on November 2 and 3. The Health Ministry had set a goal to administer vitamin ‘A’ to 2.7 million children from six months to below five years and de-worming tablets to 2.3 million children from one year to below five years.

More than 50,000 female health volunteers were mobilized for the same. The children from six months to two years from 28 districts of Tarai would also be administered with power Bal Vita (the multiple micronutrient powders) and with iron supplement as anaemia has been found in the children there.

The female health volunteers have been asked to carry out check-up of the children so as to identify whether or not the children are suffering from malnutrition.

The recent meeting of the National Planning Commission (NPC) has passed the draft Second Multi Sector Nutrition Plan for the next four years (2018-2022). The plan will be implemented after being approved by the Council of Ministers. The program will be expanded to 753 local units, informed NPC member, Geetabhakta Joshi.

Earlier, the first multi-sectoral nutrition scheme was implemented from January 1, 2013. The plan aims to reduce stunting from current 36% to 28%, reduce underweight rate of neonates from 24 percent to 10 percent within the plan period. The program has set ambitious targets such as increasing the people consuming safe drinking water from 26.6 percent to 52.5 percent. Currently, 69.5 percent of children completed their basic education while the program aims to increase it up to 85 percent.

Through the plan, improvement in the consumption and equal access to all nutrition related special health services will be done, informed Joshi.  The plan aims to make improvement in the health related habits/behaviour. In order to create enabling environment for improving the nutritional status, improvement in the plans, policies and multi sectoral co-ordination will be made. The estimated budget of the plan is NPR forty-two billion, two hundred eighty million. The budget has been allocated and divided among National Planning Commission and the Ministry of Health, Agriculture Development and Livestock, Drinking Water and Sanitation, Women, Childhood Social Welfare, Education, Federal Affairs and Local Development.

Most of the budget has been estimated to be spent on programs under Ministry of Health that is 29 percent of total budget and on education programs i.e. 25 percent of total budget. The budget can exceed during the implementation of the program, says Joshi. Out of the total required amount, about two-thirds will be received as foreign aid from the donor organizations and development partners. Commitment has been provided by European Union, UNICEF, USAID and other donor agencies to support the plan.

Discussion

Despite numerous efforts from government, donor agencies and many organisations malnutrition still remains a challenge in Nepal. This media monitoring has strengthened the fact that the concerned bodies need to speed up their work in addressing the current scenario. Malnutrition has hampered the overall development of the nation as well as an individual, so it needs to be eliminated as early as possible.

This month, the number of news published is less than the previous month. The reason behind the less coverage is the media focus towards the upcoming House of Representatives and Provincial election. Very less coverage for the issues related to nutrition was made. The Nepali media has been more interested in covering the political issues rather than the emerging health issue like Malnutrition.

Even after various attempts from the government as well as private sector, malnutrition is still rampant among children in many parts of the country.  Sixty eight cases of malnutrition was reported in Panchthar this month, most of which were found in Tumbewa village. Not just the children from poor families were malnourished, children from wealthy families were also suffering from the same problem. Those children are being provided with necessary support from the PHC and health posts. If the children are taken to a health facility and provided adequate care, they can be healthy but delay in treatment will hamper in their overall development.

Lack of awareness regarding breastfeeding practice has also added to the problem. The Department of Health has stated that many babies are being deprived of breastfeeding due to lack of awareness related to breastfeeding in Nepal. In Nepal, anaemia was seen in almost 68.7 percent of 6-23 months’ children, one among 4 children are found to be obese and two third children are found to be malnourished. There is a need to raise awareness regarding the breastfeeding practice and encourage the women to do so. If exclusively breastfed, the child will be immune enough to tackle with many diseases.

For making exemplary work in reducing the women and children malnutrition, Nepal was rewarded with the UN’s ‘UN global champion award 2017’. This has shown that the efforts made by Nepal in addressing the issue has been noticed by international bodies. This also encourages the government as well as concerned stakeholders to do better.

The health indicators have been an important aspect in the development of the health sector. The 2016 Nepal Demographic and Health Survey’ report , has suggested that Province 2 fares poorly in health indicators including nutrition, teenage pregnancy, family planning coverage, new-born deaths, vaccination coverage and exposure of women to domestic violence. The report has called for serious health intervention. There is a need to refer the report and address the weaker aspects so that it doesn’t hamper the Sustainable Development Goal (SDG) objectives.

Nepal has been making progress in reducing maternal and infant mortality rate. Progress has also been made in sanitation, breastfeeding practices, child nutrition and family planning. There has also been progress in the level of awareness related to HIV/AIDS, sexual health, nutrition and blood pressure.

Although improvements are seen, malnutrition and hunger has increased the trend of migration in Nepal. Having enough food for one meal a day is a struggle in rural areas of Nepal. Hunger and malnutrition stalk the villages. As the people are able to manage meal in the city, they migrate. Knowledge about nutrition is limited or non-existent in the rural areas. Foods with very low nutritional value are widely consumed. Nutritious crops such as millet, barley, buckwheat and wheat are considered to be inferior. Legumes and pulses are produced, but not consumed in adequate quantities. They are sold to earn money so as to buy market foods. Milk and eggs are luxuries and are sold to buy household necessities. Green leafy vegetables are not valued much and fruits are not considered to be essential food.

As the families can’t afford nutritious food, the child eats whatever is available as a result he/she is malnourished. This affects their growth as well as development. There is a dire need to increase awareness regarding nutrition. Existing programmes needs to be expanded and new programmes needs to be implemented to raise awareness.

In order to address the situation of food production, demand and supply of food, reasons behind hunger and the state of world hunger and possible ways to minimize them delegates from 56 member countries around the globe took part in the International Council Meeting of the Food-first information and Action Network (FIAN).

This type of platform helps to understand the issues and learn from others. If the findings and suggestions are used wisely, it can help in the betterment of the scenario.

Media coverage can create a very positive impact in tackling the scenario of malnutrition. After the situation of Shyamlal Sunar’s two sons was widely covered by the media, Himalayan Association Cultural Nepal, an organisation formed by the Nepali people living in Portugal provided financial help to the family. The children were treated and are now healthy.

Such funding from various donors has been supporting in improving the scenario of malnutrition. When the funds are utilised properly, it also inspires others to provide support.

The recent meeting of the National Planning Commission (NPC) has passed the draft Second Multi Sector Nutrition Plan for the next four years (2018-2022). The plan will be implemented after being approved by the Council of Ministers. The program will be expanded to 753 local units. This plan will contribute in reducing stunting and underweight rate in neonates. The program has set ambitious targets such as increasing the people consuming safe drinking water from 26.6 percent to 52.5 percent. Currently, 69.5 percent of children complete their basic education while the program aims to increase it up to 85 percent. The plan aims to make improvement in the health related habits/behaviour. This plan will be carried out in coordination with many bodies and is expected to improve the scenario of malnutrition in the country.

Conclusion

This is the last media monitoring report for this series. Most of the news related to nutrition is about the increasing numbers of malnourished cases, efforts made, food security, factors associated to malnutrition and efforts among others. However, this month, the Nepali media has reported few encouraging news which will ultimately contribute to improve the situation of nutrition in Nepal.

Nepal has been rewarded with the ‘UN SUN global champion award 2017’ for making exemplary work in reducing the women and children malnutrition. Such events shows the progress made so far and also encourages the government to do better.

The news regarding the National Planning Commission (NPC) passing the draft Second Multi Sector Nutrition Plan for the next four years (2018-2022) is also very encouraging. This is a step towards making the country malnutrition free. The plan will be implemented after being approved by the Council of Ministers and will be expanded to 753 local units.

This plan will be very effective in reducing problems like stunting and underweight rate of neonates among others. In addition it will address problems like sanitation, safe drinking water and education. This will ensure the improvement in the consumption and equal access to all special health services related to nutrition

Looking at the news flow in the media for the last twelve months, it seems like most of the journalists lack knowledge and seriousness regarding the role of nutrition in the sustainable development of the Nation. An awareness campaign on the issue for the journalists is highly recommended. 

Photo:Prof. Dr. Geeta Bhakta Joshi, member of the National Planning Commission receiving the 2017 SUN Nutrition Champion Awards

Study Team
Dr Sushil Baral
Rajesh Ghimire
Kritagya Regmi
Aanchal Parajuli
#This report is produced by Health Research and Social Development Forum (HERD) as part of monthly media monitoring study conducted by Research Uptake and Communications Unit at HERD. The media monitoring exercise will be conducted for a year from Mangshir 2073 BS to Kartik 2074 BS.