National 4 (Spotlight Weekly)

‘Nepal Lacks Gender-Sensitive Population And Development Planning’

— J. BILL MUSOKE

As the resident representative of the United Nations Population Fund (UNFPA) in Nepal, J. BILL MUSOKE has been actively working in the areas of population and health. After the publication of the preliminary census results and National Demographic Health Survey, Musoke spoke to KESHAB POUDEL on various issues of demographic change in Nepal. Excerpts:

What is your assessment of the 2001 Census in terms of overall growth?

We are very positive about the census undertaking. Whoever is trying to examine the census results, must do so in the context in which it was conducted. For various reasons, 2001 was not a normal year for Nepal. The undertaking was disrupted due to the royal palace killings and also because of the insurgency. Despite these disruptions, it was a well-accomplished task. The overall results, which are still to be confirmed, seem to be in sync with population projections and the overall trend. I would like to congratulate all those who helped to accomplish this task at a difficult time, especially the Central Bureau of Statistics (CBS), and, through the CBS, His Majesty's Government of Nepal.

How can the country benefit from the census results?

Decennial census taking is a regular phenomenon around the world, and Nepal is no exception. This undertaking provides much-needed data on the composition of the population ó age and sex structure, ethnic and linguistic composition, its size, population growth and many socio-economic indicators such as literacy, economically active population, marital status and mobility of people. Census taking is a relatively expensive and time-consuming exercise. But the data is very rich. It is often free from all the biases and errors usually associated with sample surveys and the data is robust for any analysis. It is therefore, extremely important that once the data is collected, it should be analyzed, disseminated and used to provide comprehensive feedback to policy makers on population characteristics, so that appropriate policies and programs can be formulated and implemented to have the desired effects on development.

How credible are the results?

Here in Nepal, as far as I know and have seen, most of the analysis is of a ritual type ó the CBS preparing census tables and bringing out a monograph on the census. Census data is grossly under analyzed, scantly disseminated and under-utilised in this country. This situation must change, as there are several academic institutions that could undertake such analysis as part of their routine training.

How do you view the emerging demographic patterns in the country?

There are discernible patterns in Nepal's population. Fertility and mortality are steadily declining, people's mobility from one place to another is increasing and the population seems to be growing in absolute numbers notwithstanding the observed declines in the overall growth rate. The results of the Nepal Demographic and Health Survey, which was conducted in 2001, provide further support to the overall trend depicted by the census. The relationship between population size and growth is often not understood, especially when seen in the light of ongoing activities such as family planning and reproductive health programmes. Even through there will be appear to be remarkable improvements in parameters such as the growth rate, contraceptive prevalence rate (CPR), total fertility rate (TFR) and crude death rate (CDR), the population size will continue to grow for a long time because of the built-in momentum, which is embedded in the youthful structure of Nepal's population.

How can decision makers make full use of the census findings?

I have already said that census data is extremely rich and should be utilized for social development. For the first time, the 2001 census collected data on gender-specific issues and caste-ethnic groups. At a time when there is greater need of gender and socio-economically desegregated data, this must be considered an achievement by the 2001 census organizers and donors. In view of scarce resources, it will be absolutely essential for the government to rationalize its needs and make hard choices in terms of analysis and dissemination. This census could not have been achieved without the collaborative efforts of His Majesty's Government, the UN system, including the UNFPA, and civil society. I hope that the data will be analyzed to obtain the much-desired attributes, especially gender and social economic indicators, to enable decision makers to take the right decisions.

Do you see specific findings that contain special relevance to policy planning?

During the next 25 years, adolescent and youth population of Nepal is projected to increase by 65 percent. This is a critical mass entering the childbearing age and parenthood with far reaching implications on fertility, health transition, mortality, especially infant, child and maternal mortality, and on the prevention and control of HIV/AIDS. Together with the child population, this group represents the momentum for growth in Nepal's population, which I alluded to earlier. All aspects pertaining to this group need careful planning and programming if Nepal is to realize its population stabilization goal. The census provides a much-needed and valuable database to plan Nepal's development. What still remains is its detailed analysis, dissemination and proper use for development purposes.

What impression do you get from the report of Nepal Demographic Health Survey 2001?

The 2001 Nepal Demographic Health Survey (NDHS) survey provides recent and valuable information on fertility; family planning; infant and child mortality; maternal and child health and nutrition; and respondents' knowledge on HIV/AIDS. This survey report has been published at an opportune time, as it provides valuable information that will be used in finalizing the 10th Health Plan. UNFPA is also in the process of finalizing its 5th country program in line with the government's 10th Plan. The survey is the sixth in a series of national-level population and health surveys and the second comprehensive survey conducted as part of the global demographic and health surveys program, the first one having been conducted in 1996. It is a comprehensive, well-done study. I would like to congratulate the team effort

of the Ministry of Health's Family Health Division, New ERA and ORC MACRO who planned and conducted the survey, as well as USAID for funding it.

Does UNFPA have any new proposals to support these achievements?

Like many developing countries, Nepal is faced with the challenge of managing its population to achieve accelerated socio-economic development. Nepal has been trying to manage the population problem and will continue to do so in the foreseeable future. Hence, UNFPA will continue to provide support to His Majesty's Government in the management of population although the modality of our support may change in view of the emerging issues in the field of population, such as ageing and the HIV/AIDS scourge. This is not to suggest that Nepal has not made any significant changes in population. Nepal has made significant improvement in socio-economic indicators, including health. The total fertility rate has come down to 4.1 per woman, contraceptive prevalence rate has gone up to 39 percent and utilization of health services is increasing. The government is attempting to formulate comprehensive policies and programs that address gender and sustainable development issues. UNFPA would like to focus its assistance on activities that sharpen these achievements so that Nepal is in a position to fulfil the aspirations of its people for improved quality of life as well as its international commitments.

How do you view UNFPA activities in Nepal?

We are in Nepal on the initiation of the government to assist it in the identification of population problems and their management. UNFPA has assisted the government to fulfil its commitments made in various international conferences and summits such as the International Conference on Population and Development, 1994, the Millennium Development Goals, 2000, and the Sustainable Development Goals, 1992. UNFPA has in the past provided both technical and financial support to His Majesty's Government's efforts in accelerating socio-economic development to improve the quality of life of its people by assisting the government to plan and implement gender-sensitive population and reproductive health policies and programmes.

Have you already signed the new population program with the government? If so, what are the highlights?

First and foremost, the new programme, the Fifth Country Programme, which was formulated in close consultation with the all stakeholders and the government, has been approved by our Governing Board and is waiting to be signed by both the government and UNFPA. Under the 5th Country Programme (2002-2006), we are adopting a two-pronged approach. We will continue to support some of the nation-wide activities that we have been supporting and also focus on selected districts. This will allow us to strengthen national as well as district capacity to formulate, implement, coordinate and monitor population, RH and gender programs. UNFPA is committed to assist His Majesty's Government toward its commitment to fulfil the ICPD and Millennium Development Goals. To this end, improving access to and coverage of quality RH services including family planning and HIV/AIDS, adolescent reproductive health and safer motherhood are some of the activities that are high in our priority list.

How can we ensure effective delivery of services?

For effective delivery and management of these services, capacity building will be an integral component of all our programs with the various organizations and ministries, such as the Ministry of Population and Environment, the Ministry of Women, Children and Social Welfare, the National Planning Commission, the Ministry of Local Development and local governance bodies (district development committees, village development committees, municipalities), non-government organizations and civil society. In short, we are assisting the government to strengthen its capacity to deliver the needed services to its people to realize its goal of reducing poverty and improving the quality of life of people of Nepal. However, allow me to reiterate that UNFPA believes that it is the people of Nepal and their government who have to take the initiative and lead in their own development. Donors are here only for a short time for a specific technical input to speed up the tempo of development. The process has to be initiated and owned by Nepal while donors' technical and financial resources give you a push to attain your development goals. As a part of the UN system in Nepal, UNFPA is working to contribute to your development goals and not the other way round.

Are the current political situation and insurgency affecting your programs?

Good question. But I would like to ask you, Who has not been affected by the current situation? Though UNFPA has not had any acts of disruption directed at it, if the present trend continues, it will definitely slow down our planned activities especially our district focus in those seriously affected districts? I would like to appeal to all concerned to exercise a lot of caution and tolerance bearing in mind that we are here to assist to bring about a better life for all Nepalese and as part of the UN system we have a responsibility to uphold the UN Charter.

What will be the effect of declining fertility on Nepal's population?

After persistence of high fertility in Nepal, empirical evidence is increasingly pointing towards the much-awaited decline in fertility. It should be kept in mind that in the early 1970s, Nepal's TFR was 6.4 children per woman. Today it is estimated around 4.1 children per woman. Despite accelerated decline in the last five years, which is supported by the increased contraceptive prevalence rate, there is no significant impact on population growth as already stated earlier because of the in-built momentum for growth in Nepal's age-sex structure. In addition to its effects on population growth, rapid decline in fertility may also be associated with reduction in the percentage share of young population and increased share of elderly population in Nepal's total population. The observed increases in the elderly population should be a source of concern, especially as further declines are recorded in fertility and mortality. This is more so in resource-poor countries such as Nepal where there is nominal government support for social security. This problem is going to be further accentuated by globalization, commercialization, urbanization and shifts in the traditional family values for elderly care in this country.

What is your impression on the overall health infrastructure in Nepal?

It is a well-developed infrastructure with appropriate tiers of service delivery in Nepal's perspective. The government has tried to address accessibility through the existing infrastructure. However, there is overemphasis on the tertiary sector and the physical aspects of accessibility. There is a need to address the quality of care and other aspects of accessibility through strengthening the capacity of service providers, upgrading of physical facilities with respect to privacy, which in turn will increase service utilization and thereby producing a multiplier effect. Besides the government needs to increase its allocation of the national budget to this important sector.

How do you rate the overall population policy of the government?

As is often the case, there are progressive changes in population policies and programs in the country. One major breakthrough has been in the Approach Paper to the 10th Plan. For the first time, the National Planning Commission has considered population as a crosscutting issue. Population and Health also remain priority areas of concern in the Poverty Reduction Strategy Paper of the government. This is an important development. How it will be integrated in the sectoral policies and programs remains to be seen. Nepal has been attempting to formulate a comprehensive population policy and we will assist the government in the preparation of a Population Perspective Plan as part our support to strengthen government capacity to formulate and implement sustainable development policies and programmes. Nepal still lacks gender-sensitive population and development planning policies. There is no clear policy on youths, elderly, minority ethnic groups, urbanization and spatial distribution while there is almost complete silence on migration. The links between population and development programmes have often been missing, which was largely due to the centralized planning framework of the past. The passage of the Local Self-Governance Act provides opportunities and challenges to change that top-down approach. However, the capacity of local self-governance bodies needs careful attention and strengthening. UNFPA has adopted a two-pronged approach of working both at the national and district level. I hope in the long run, Nepal will be able to formulate and implement a development agenda that expedites its goal of population stabilization and improved quality of life.