Aligning with the Sustainable Developments Goals (SDGs), the constitution of the federal democratic republic of Nepal (2015) has mandated that
Every citizen shall have the right to free basic health services from the State, and no one shall be deprived of emergency health services… Every citizen shall have equal access to health services… Every woman shall have the right to safe motherhood and reproductive health.
These constitutionally enshrined rights are the result of a long struggle to ensure health as a human right in Nepal. Currently, Nepal has the legislation mandating universal access to health care services, and has also started planning towards universal health coverage (UHC). The Health Insurance Bill was approved by the Government of Nepal (GoN) in October 2017. This envisions the mandatory health insurance for all Nepalese. The Clause 21 of the Bill states that all family members in each household should enrol in the health insurance program, so that their access to needed health services are ensured without suffering from any financial hardship while paying for the services.
Most of the SDGs and indicators are highly relevant to improving health and nutrition. Health and nutrition are now considered essential constituents of development at all sectors such as agriculture, education and rural development. Nepal is in agreement with the global food agenda and recognizes the need to respect and uphold right to adequate food, nutrition and health. The GoN has consequently developed a comprehensive range of policies and strategies to promote nutrition. In this context, the first multi-sectoral nutrition plan (MSNP) (2013-2017) was formulated and implemented by the GoN. Priori to the MSNP, efforts to improve nutrition programming in Nepal were driven by the health sector and were disintegrated, with slight engagement from other sectors like agriculture, education, water and sanitation, etc. Rollout included restructure and development of national and below level coordination and steering committees, technical working groups and pilots in selected districts. Subsequent scale-up was informed by lessons learned during the MSNP implementation and accordingly recommendations were put forward to address identified challenges. Taking stock of the achievements under MSNP I pointed to the necessity of continuing these efforts and thus MSNP-II (2018-2022) has been conceptualized. Now the MSNP II is being implemented to further scale-up essential nutrition-specific and sensitive interventions in Nepal with an aspiration to achieve health and nutritional related targets of the SDGs. The nutrition specific interventions are largely being delivered through the health sector, and the nutrition sensitive interventions by the education, agriculture, livestock, water and sanitation, women and children sectors in collaboration with local governments. This is a good example of several sectors working together to achieve the health goals.
In the first and second MSNP, Nepal has not only a roadmap for pursuing a more comprehensive and synchronized multi-sectoral nutrition strategy, but also considerable national momentum for sustaining its advancement. It cannot secure health and nutritional related SDGs until Nepal addresses the persistent food and nutrition challenges undermining opportunities for Nepal’s poorest, most vulnerable and hard to reach population.
Despite these efforts, more emphasis should be given for a sustained political commitment to accountability that extends from national-level politics to sub-national levels to channel sustained momentum for the fight against health and nutrition-related problems. Ensuring good health is an end in itself, but it is also a vehicle for economic development that Nepal desperately needs now. The strong role of multilateral agencies in Nepal can work to ensure right to health. Ultimately, successes in health and nutrition depend on committed people who generate real impact on the ground.
A real life example from Parsa district, Nepal
Bindu Devi (name changed) is a 28-year-old mother and a resident of ward number four of Basdilwa village of Parsa district in Tarai, a low land area of Nepal. She had five children, three sons and two daughters. Her husband, age 35, supported the family by driving an auto-rickshaw. When Bindu Devi’s youngest daughter was months old, she seemed to be suffering from sever acute malnutrition (SAM). The district MSNP team immediately informed the nearest health post in-charge and she was found to be suffering from SAM (body weight was only two and half kilograms and came under ‘red line’). The root cause of SAM was the lack of exclusive breastfeeding. Bindu Devi was not able to take proper nutritious food during her post-natal period, which resulted in her child suffering from SAM. Her baby was successfully treated and gained one kilogram of weight and was out of the ‘red line’. Bindu Devi promised that she would provide nutritious diet to both her daughter and herself and take proper care of all her children. She realized that adequate nutrition could be achieved from locally available food products such as fruits, meat and vegetables. She was happy too see the progress of her daughter as she was getting healthier day by day.
The SDGs are ambitious. Fulfilling this ambitious agenda will require realistic and effective evaluation mechanisms that help to keep Nepal’s efforts on track in heath and nutritional related activities.