To Achieve Health For All
Nutrition Is A Priority

By Mohan K.C.

THE state of children in the developing countries is far from satisfactory. It is not that no attention has been given to this. In fact, specialised efforts have been made as regards reducing infant mortality rate but yet there is a long way to go before real progress can be made. nepal as a developing country has its own constraints as regards providing each and every village with the health service facilities that is so necessary to see that the future citizens of the country survive their full life term.

There may be some diseases for which treatment cannot be found. In this country, as a special case, most of the diseases that afflict the infants and children are reported to the heath service centres or hospitals only at the eleventh hour when it is almost impossible for the doctors to do anything to save their lives. The medical professionals cannot be blamed in most of the cases though there may be stray cases of negligence. The parents or the society in general have to be made aware of the health care that is needed for the pregnant mother and the foetus besides safe delivery and post-natal care. This is glaringly lacking in our country as it is inhabited mostly by people stricken by poverty, illiteracy and a general lack of awareness.

In many a cases even preventable diseases prove fatal just because of lack of knowledge, information or sheer negligence. This might be some harsh words to say as no parent would like their infant’s premature death. The reason behind it is simple: the health posts are not at the doorstep nor are the health personnel at such posts or centres readily available.

Even where there is a provision of doctors or health assistants, many a times they are found missing. This is further compounded because of the insufficient supply of essential drugs. The diagnosis is made when the health worker is available but when necessary medicines are missing, there’s hardly a way out. This is the state of affairs in many parts of the country, mainly the remote rural areas. This might be the reason behind the high rate of infant and maternal mortality.

The establishment of health posts or centres alone do not suffice unless they are well equipped with necessary instruments and an adequate supply of life saving drugs. This is also not the whole story, the reluctance of the villagers to avail health care facilities is also a disappointment. The first recourse that the villagers in general resort to is the traditional and faith healers or the shamans. Herein, there is no denying that they too have a vital role in providing health services though not in the form of the scientific one. But, nowadays some changes have come around with the traditional healers being trained in basic modern medicine system. They have a more effective role at the grassroots level as people have faith in them. The two-in-one role has proved effective in many areas specially related to the treatment of diarrhea, a most "killer" disease by our local standards. But when shamans supplement their age -old knowledge with Jeevan Jal, the result has been in reducing infant and child mortality rate significantly.

According to World health Organisation (WHO) and UNICEF, about 11 million children die of preventable disease every year around the world and mainly in the developing world. The figures arrived at is quite shocking yet it is true and authoritative. The main diseases cited as leading to such great mortality are pneumonia, diarrhoea, malaria, HIV/AIDS, measles and above all malnutrition. Malnutrition according to WHO and UNICEF, 60 per cent of the deaths result in death in childhood.

Nepal too faces the same problems which result in high infant and child death rate. Malnutrition must be given prominence as the major cause of such deaths before the child reaches prime age. Given the poor economic status of the Nepalese people, a balanced diet or adequate supply of daily requirement of calories is not met. This is the case as most of the people bank on subsistence farming and the food production is barely enough to feed a family of five or more for not more than half a year. therefore, high rate of malnutrition related deaths does not come as surprise.

It is not only that the health services must be strengthened but the nutritional needs of an infant, child and even the pregnant and nursing mothers must receive attention. This means that the agricultural productivity must be enhanced and then awareness raised as to the nutritional requirement of all. Only such a strategy can work. holding seminars, workshops or placing or airing advertisements in newspapers or on radio will not give the desired results. A radical planning and implementation is the need and not just statistics.

Water Supply Management In Rural Areas

By Shiva Chandra Shrestha

DRINKING water is the basic need of all the people and the government is committed to achieve this objective. The water supply coverage achieved till the end of the 8th plan period in 1996/97 was estimated to be 61 per cent of the total population. The Ninth Plan has targeted to provide basic water supply services to extra 9.7 million people and increase this coverage to reach 100 per cent by the year 2001/02 in the sanitation sector. The Ninth Plan has aimed to increase the coverage of sanitation services from 20 per cent to 40 per cent of the total population. In the approach paper for the Tenth Plan, the water user groups have been given special significance in the selection of drinking water projects/programmes. Sanitation (latrine construction) has been given priority on the basis of the density of population.

The Rural Water Supply and Sanitation Project is being implemented by the Rural Water Supply and Sanitation Fund Development Board and it is financed by an IDA credit. The revised cost after Mid Term Review Mission (Nov. 1999) of US$ 19.07 million comprises of IDA finance of US$ 16.1 million, the government finance of US$ 0.67 million and the community contribution of US$ 2.3 million. The project is also utilising a UNDP grant assistance of US$ 0.33 million to provide the services of a Technical Advisor. The project's objective is to promote sustainable and cost effective demand-led rural water supply and sanitation schemes with full emphasis on community ownership.

The project is planned for implementation in five years commencing from 15/7/1996. The project is to serve or will serve 900 communities all over the country benefiting 550,000 people.

The Board allocates resources on a grant basis to selected partnership between support organisations (SOs) national/international NGOs and private sector firms and beneficiary communities. Also, local consulting firms known as service agencies (SAs) are hired for assisting the Board in providing technical support to communities support organisations.

Some comments on major indicators of eligibility criteria for the schemes are worthy of mention. The benefit cost ratio is one of the major indicators for the selection of the schemes before implementation. The cost calculations are more realistic than benefit calculations. In order the upgrade the validity of their ratio, the calculation of real benefit actually achieved by the community/households is to be reviewed.

The internal rate of return is also considered as an indicator for the assessment purpose. Here also, the problem is the more realistic valuation of all types of costs and benefits like health benefits and costs of community mobilisation and so on. The general rate of ERR (22 per cent) may not hold good now and therefore a review of the same in the present scenarios of economic conditions is called for just as the water supply water per capita cost has been revised for the analysis. The calculation of time saving and their valuations are also to be revised due to the differences noted in actual practice as against the estimates at the time of the project formulation. Needless to say, more efforts need to be made towards the quality assistance of water, as water must be worthy of consumption from the point of view of human health.

Since the expenditures paid to the SOs and SAs are not reflected by way of assets, it would be more realistic to analyse the total budgetary expenditures up to a certain period instead of analysing the balance sheet of the Fund Board. Hence the cumulative expenditure up to Oct. 15, 2001 from the year 1996/97 are given as follows:

The partners for the implementation of the projects are the Fund Board, the support organisations, the communities and the Sas, the service agencies. This kind of institutional arrangement presupposes that there is appropriate co-ordination among them with their reasonable level of efficiency and integrity. Any lapse at any time of action would lead to wastage, which is to be minimised.

Since the communities are willing to contribute roughly 30 per cent of the scheme construction cost, it is but natural to extend such facilities when the community contribution increase to 40 per cent or more.

The policy of hiring the support organisation has given rise to a number of SOs willing to be involved in the rural water supply systems as a partner for the execution of the project. But their quality of services has not yet improved to the extent expected. The Fund Board has to play an active role in enhancing their efficiency and for this purpose their selection criteria may also be changed to accommodate capable and independent areas. And along with the present level of 10 per cent, overhead changes may also be subjected to provision revisions. The support agencies (SAs) are being paid for their services and this also requires revisions so as to encourage capable SAs by limiting their margin to a desirable level by appropriate revisions in areas wherever required.

There is a strong emphasis on the monitoring and evaluation of the schemes for their success. If the people do not get water as planned, the whole exercise would be a waste as the project is based on the people demand for rural water Supply and Sanitation Services rather than incidence of poverty. All the agencies - the line ministries and the funding agencies and executive agencies including auditors have to be watchful to see that the benefits are really passed on to the needy villagers. This demands very strong knowledge on the part of the community to critically judge the performance of both SOs and SAs and the Fund Board.

The success of the system ultimately depends on the capability of communities who should monitor all the activities of all the agencies in the system. There are cases of completed projects handed over to the consumer groups/societies which could not be operated by them and finally the projects had to be handed over to the government for their re-operation. Such a kind of bitter experience should be avoided entirely. The government and the Fund Board should be searching sources of fund other than foreign loans in order to continue the useful modality of the project in the years to come in the interest of the people who are still facing the problem of drinking water.

The Pros & Cons Of Internet Culture

By Sushil Gautam

MODERN scientific discoveries have made man’s life easier, faster and reliable. His unsatisfying instinct has led him to this stage and the same will led him to a fictional state in future. And, at that point too, he would be searching for something new and something more. Thus this is how Internet entered being a gateway to the future.

In the recent years, with the big boom in the field of Information Technology the whole world has now diverted towards it’s charm. Not only the developed nations, but also the growing economies of South-East Asian countries including India have made a remarkable breakthrough and have changed the living standard of people. Now the whole perspective is somewhat different; this IT generation cool, new and more confident is leading a quiet revolution. The growing economy of Asia has created a huge market. The Inter regional trade has now flourished. To support this fact, a recent study showed that Malaysia’s 53 per cent of export went to Asia in the third quarter of 1999.

In fact, Asia’s Internet boom proves that technology levels the playing field between the rich and the poor nations, and could actually reverse destablishing trends like international labor migration and brain drain. A new concept called jobs e-jobs, is rapidly taking root in development circles. The progress in this field has also given birth to a new era of enthusiastic young generation with different vision and dynamism. The Internet has now established itself as a basic source of information and e-business is spawning opportunities and a sense of individualism.

Many scholars, technocrats and social critics believe that these change and the Internet, in particular, are transforming economic and social life. They argue that the Internet leads to more and better social relationships by freeing people from the geographic constraints or isolation brought about by stigma, illness or busy schedule. According to them, the Internet allows people to join groups on the basis of common interests rather than convenience.

However, analysts disagree as to the nature of these changes and whether the changes are for the better or worse. Some argue that the Internet is causing people to become socially isolated and cut off from genuine relationships, as they hunker over their terminals or communicate with anonymous strangers through a socially impoverished medium. They believe that Internet provides a social entertainment that could compete with social contact as a way for people to spend their time. Whether the Internet is increasing or decreasing social involvement could have enormous consequences for society and for people’s personal wellbeing. This social disengagement is having major consequences for the social fabric and for individual lives. At the societal level, social disengagement is associated with more corrupt, less efficient government and more crime. At the individual level, social disengagement is associated with poor quality of life and disminished physical and psychological health.

Sex videos, photos, e-gambling etc are hot items in e-market as they are cheaper, safe from social aspect and easier to access. Needless to say that the impact of those illicit things in our society could prove disastrous and badly affected would be the young generation. Actually, the new generation wanted change, Internet showed the way and even acted as a mediator.

These days the younger generation sit in front of the computer make virtual friends, talks, share their high tech dreams and above all they forget themselves like they have exchanged their colourful life, their soul with machines. Mechanical devices, computers and their virtual world are pulling them towards a mysterious world where they had never been before. Cyber Cafes are their favourite hangout. Chatting in net adds more excitement to them, than talking directly. They don’t want to be their parents "baby doll". But, are we aware that social and moral values, cultural and religious identity hold some meaning? Wouldn’t it be better to realise before arriving at an irreversibles situation.

Researchers and social critics and debating whether the Internet is improving or harming participation in community life and social relationships. Nonetheless, greater use of the Internet was associated with decline in participants’ communications with family members in household, decline in the size of their social circles, and increases in their depression and loneliness. So, one thing we must realise that growth in anything brings change, which gives birth to new responsibilities and new challenges. As no one can control the future, he must plan to manage it.