Opinion (Spotlight Weekly)

Decade Of Progress

By Stewart MCNab

The launch of the Nepal Family Health program not only validates a major new investment in the future well-being of families and communities throughout Nepal but also bears testament to the effectiveness of many child survival interventions developed, tested and implemented, here in Nepal. Indeed, today's ceremony presents the opportunity to reflect and recognize the many gains that have been achieved on behalf of child.

The last decade has seen extraordinary progress for children in Nepal. Infant and child mortality rates have steeply declined. The scourge of polio has almost been eliminated, vitamin A supplementation has significantly reduced mortality and disability, immunization against preventable disease reaches out to almost every child and iodine deficiency disorders have been drastically reduced. These are major and measurable gains for which the country, and everyone involved in health, can be justifiably proud.

These achievements would not have been possible without partnerships ñ and the hard work of officials in the Ministry of health, multilateral and bilateral organizations, financial institutions, individuals, non-governmental groups, private sector organizations including JSI, whose energy and devotion have helped shape and drive public health policy. Many organizations have been involved in that process. Today, I would particularly mention the role of USAID, which, over the last decade, has provided critical support to a range of highly effective maternal and child health programs, both with financial resources and technical assistance. In representing UNICEF, let me state that USAID's sustained support to child survival in Nepal has been outstanding.

Among the many implementers, JSI has been an effective and pragmatic partner in advancing knowledge and action on many key issues in the field of community health. In particular, projects undertaken on controlling diarrhoeal disease, acute respiratory infections through the involvement of female community health volunteers has been acclaimed, here in Nepal and also internationally. The support to vitamin A supplementation is recognized to be a groundbreaking and practical intervention that is now averting the deaths of 40,000 Nepalese children every year. Similarly, the holistic approach to child health, IMCI, has made significant progress in many districts. These are all milestones, which have made an enormous difference to the lives of so many families and charted a new course in the field of community health.

But despite the many gains, all of us in this room are fully aware of the challenges that must be confronted if access to quality health services is to be available to the majority of families in Nepal. Indeed, in the current situation in which the insurgency is destroying basic development infrastructure and depleting resources, the challenges to primary health care are mounting by the day. We are aware that the burden of disease falls disproportionaly on young children but in these difficult times when services cannot properly function, logistics are affected, the movement of health workers are restricted, it goes without saying that children and women will suffer the most.

While violence and conflict have emerged as recent threats to the health of children, poverty has been a consistent constraint to the proper growth and development of children. And no where is poverty more evident than in its effect on the growth and development of children. Poor nutritional status is a major underlying factor in the high levels of morbidity and mortality in Nepal. Malnutrition weakens the child's immune system creating a vicious cycle of infection and wasting which stunts both the physical and mental growth of the child.

It is estimated that malnutrition, in one degree or another is associated with over half of all deaths of young children.

Official survey data indicates that child malnutrition has shown little, or no improvement in 25 years. More than half the children in Nepal remain chronically undernourished and underweight. This, despite three decades of planned national development and millions of dollars of investment. Without advances on this front, it will be difficult maintain the pace of mortality reduction.

Such facts and figures may paint a sobering and depressing picture. But let me tell you, if it is any consolation, that Nepal ranks better than 50 other countries in the world in terms of child death rates. Thee are a dozen countries in the world with double the U5MR of Nepal, and about a dozen countries where, unlike in Nepal, life expectancy is declining rather than increasing.

We at UNICEF are acutely aware that against all odds, Nepal is still making positive gains in health compared to many other countries. Though still relatively high, under-five mortality rate has declined from 300 in 1960 to 200 in 1980, 150 in 1990 to 91 in 2000 ñ significant progress indeed. As we begin a new Nepali year, it is important to occasionally look back and remember how things were in order to see more clearly where we are heading in future.

If progress is to be sustained, it is essential that all of us who care passionately about Nepal, and have the capacity to contribute to its development, work together to construct a positive vision of the future, particularly for its children. I am sure that the new Family health program will make a major contribution in turning that positive vision into reality.

(Excerpts of speech delivered by Stewart McNab, UNICEF Representative, at the launch of the Nepal Family Health Program)