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Health Challenges

in the Remote Mountain areas in Nepal

in the context of food insecurity and poor health infrastructure

Krishna Pahari

School of Environmental Management/Pokhara University

and Nepal Development Research Institute

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Outline of presentation

Recent diarrhea outbreak in Nepal

The Mid and Far Western Mountains – a story of deprivation

Food insecurity and malnutrition

Basic infrastructure and services

Issues of sustainability

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Diarrhea outbreak of summer 2009

 

• affected 10 districts in the region• About 400 deaths• more than 100,000 affected

Attracted large media attention

Also became a big political issue

Is it a sudden/unexpected disaster?

Or a result of several underlying causes long in the making?

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Context: Nepal’s ecological and development regions

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The Mid and Far Western Region

The most impoverished region in Nepal

Situation particularly severe in higher hills and mountains in terms of basic infrastructure (roads, communication, health, education, etc)

High prevalence of food insecurity and malnutrition

Mountain ecosystem increasingly fragile due to growing population pressure

Also the region most affected by the past conflict

Problem further aggravated due to impacts of climate change

Heightened expectations after recent political changes

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Number of Poorby district ('000)

0

50

100

150

200

250

300

350

Far WesternDevelopment Region

Mid WesternDevelopment Region

WesternDevelopment Region

CentralDevelopment Region

EasternDevelopment Region

POVERTY MAP based on COST OF BASIC NEEDS (2006)

• National prevalence 31%

• Prevalence in Mid and Far Western region higher than in rest of the country

• These areas largely left out by gains in poverty reduction in 1996-2003

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Malnutrition Maps

Stunting (height-for-age):

• Measures chronic malnutrition

• Nepal 50.4 %

• Mountain and Hills of the Far and Mid-western Dev. Regions have rates as high as 60-70%

Wasting (weight-for-height):

• Measures acute malnutrition

• Nepal 9.6 %

• Most common in Terai (high – to very high)

• Mountain and hills (moderate to low)

Underweight (weight-for-age)

• Reflects chronic and acute malnutrition

• Nepal 45.2 %

• Central Terai, Hills and mountains of Mid and Far-west

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Mid and Far Western Hill/Mountains: also the area most affected by the conflict 1996-2006

Local subsistence farming: situation on the ground

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Irrigated land

Mugu, February 2009

Winter crop production loss in 2009 due to drought

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Hill, ↓25%& Mountain, ↓40%

Bajura, ↓55%

Dolpa, ↓60%

Jumla, ↓51%

Darchula, ↓55%

Terai, ↓10%

With the impact of climate change, droughts and floods/land slides are becoming increasingly common.

Impact of the winter drought on household food security

* mostly from areas moderately to severely impacted by the drought

0%

20%

40%

60%

80%

Experiencingfood shortage

Skipping/reducing

meals

Consumingseed stock

(Hill &Mountain)

Took childrenout of school

Out migrationof a familymember

% of households Households

surveyed as part of the assessment* demonstrated the following traits

Household level drought impact

Access: the Karnali ‘highway’ – opened 2 yrs ago

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Access Constraint – modes of transport: either too expensive or too slow

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Access constraint - topography

Situation background – crop and food insecurity

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The winter crop (wheat and barley) is a critical food source between April to July.

Severe lack of rain and snow seriously impaired winter crops across Nepal.

The expected poor harvest came on top of:

sustained high food prices for over a year;

frequent bandhs/strikes;

poor summer harvest in some areas of Far- and Mid-West.

Situation background – Health and sanitation

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Very poor health facilities – nearest health post could be as far as 1 or 2 days’ walk.

Most health posts without proper staff (no medical doctor/assistant, lack of basic medicines).

Very poor sanitary conditions – open defecation in many areas, even soap could be a luxury!

Severe lack of nutritious food due to crop loss by drought

Lack of awareness

History of epidemic outbreaks

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Health records show that such outbreaks are not new in those regions though they rarely receive much attention

Many times not reported or reported after considerable time due to lack of communications

People now have much expectations, communication is improving, media is getting powerful and various groups are active to raise concerns could be one reason for heightened publicity

Without significant improvements in basic health facilities, sanitation, food security and nutrition such epidemics are likely to occur in the future!

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Many people have no option but to depend on food assistance

Long term solution should be found

Conclusion and issues for discussion

Spatial variation in access to services within a country or region – basic infrastructure essential for all people

Sustainability of settlements in remote areas: modernization vs. attachment to ‘home’ land

Health system should be considered as a part of broader sustainability – particularly in the context of increased vulnerabilities due to climate change

Greater focus should be on adaptation to adverse impacts of climate change in the Himalaya – with implications not only for Nepal for a large population in South Asia: why should the impoverished people in those remote areas suffer from climate change vulnerabilities created by others?

ICT could play a vital role in improving access to services including health in remote areas – using emerging new technologies to the benefit of the rural population

A good surveillance system based on evidence-based grass root information vital for taking timely actions and saving lives