Your SlideShare is downloading. ×
MSNP Nepal , Sanjiv Kumar Rajak
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

MSNP Nepal , Sanjiv Kumar Rajak

442

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
442
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Presented at DDC Achham, 14 June 2012
  • Among the poor, the malnutrition has further increased, therefore those who are malnourished are mostly poor….can be referred from DHS 2011, 56% of children from lowest quintile are stunted versus 26% from highest quintille
  • Grey Matters accounts for intellectuality and cognitive development, less grey matters in malnourished brainsFormation of grey matters almost completes within the age of 2, therefore re-iterates that the under nutrition need to be corrected within the age of 2The loss is irreversible- relate this to GDP and Human Capital
  • The slide is self explanatory. Explains the reviews, consultativeprocess, leadership, focus and implementation
  • Role of each sectors and NPC- with clear strategic objectives for each sectors, with results.Need to explain the zist of the logframe interventions in each sectors just to let them know that what they are exactly supposed to doTailoring and Adaptation at district level
  • Transcript

    • 1. OBJECTIVES • TO UPDATE ON CURRENT UNDER- NUTRITION SITUATION AMONG WOMEN AND CHILDREN OF NEPAL • TO SHARE THE MULTI-SECTOR NUTRITION PLAN AND ITS IMPLEMENTATION ARRANGEMENTS AMONG THE REGIONAL STAKEHOLDERS OF FAR WEST DISTRICTS
    • 2. AN OVERVIEW OF MULTI-SECTOR NUTRITION PLAN Prepared by: National Planning Commission, GON in close consultation with Ministry of Health and Population Ministry of Agriculture Development Ministry of Federal Affairs & Local development Ministry of Urban Development Ministry of Education Lead Technical Support: UNICEF in close collaboration with WB, HKI, WFP and Other Developing Partners Government of Nepal National Planning Commission
    • 3. Nutrition Situation of Women and Children in Nepal
    • 4. NEPAL IS ON TRACK TO REACH MDG4 : REDUCING CHILD MORTALITY 153 118 91 61 54 54 102 79 64 48 46 34 45.9 50 39 33 33 15 0 40 80 120 160 200 1991 1996 2001 2006 2011 2015 MDG U5MR IMR NMR Mortality Trend and MDG Goal (Under 5, Infant and Neonatal) Deaths associated with under-nutrition At - min 35% Diarrhoea 12% Other 29% Pneumonia 20% Malaria 8% Measles 5%HIV/AIDS 4% Perinatal 22% About 35-60% of Child Mortality is associated with undernutrition Sources: EPI/WHO. Black et al, 2008. The Lancet Series on Maternal and Child Under-nutrition. Without Improvement in Nutrition, Further Child Mortality Reduction is less likely
    • 5. Status of Undernutrition in U5 Nepal Source: NDHS 2011 57 49 41 28 43 39 29 27 11 13 11 5 0 10 20 30 40 50 60 NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 2015 Percent Stunting Underweight Wasting
    • 6. 28.3 26.7 24.4 18.2 6.5 8.6 13.5 0 5 10 15 20 25 30 NFHS 1996 NDHS 2001 NDHS 2006 NDHS 2011 Women’s Under-nutrition is Declining But Over-Nutrition is on the Increase Maternal Under-nutrition Maternal Overnutrition
    • 7. Fig 24: Stunting (-2SD) Trend for children between 6-23 months, by Wealth Index 0% 10% 20% 30% 40% 50% 60% 1996 2001 2006 Poorest Poorer M iddle Richer Richest Total Ref: DHS 2001 and 2006. Adapted from Ramu Bishwakarma. Social Inequalities in Child Nutrition in Nepal. August 2009 (Background paper for Nepal Nutrition Assessment and Gap Analysis, November 2009) 65% reduction in richest quintile! 12% increase in poorest quintile! 14% reduction overall MARKED INEQUITY: Wealth Quintiles, Ecology, Ethnicity Nutrition context: trend in stunting prevalence by wealth index High Inequity
    • 8. Percent of children under age 5 who are too short for their age (based on WHO standards) Eastern terai 31% Central terai 41% Western mountain 60% Mid-western terai 44% Far-western hill 58% Eastern hill 46% Central hill 31% Western hill 36% Mid-western hill 52%Far-western terai 32% Western terai 40% Central mountain 46% Eastern mountain 45% Marked Disparity in Stunting Across the Regions > 30%: High Prevalence > 40: Very High Prevalence 41%
    • 9. Percent of children under age 5 who are too thin for their height (based on WHO standards) Eastern terai 10.3% Central terai 10.4% Western mountain 13.2 % Mid-western terai 13.9% Far-western hill 17% Eastern hill 10.5% Central hill 15% Western hill 7.6% Mid-western hill 8%Far-western terai 7.9% Western terai 15.2% Central mountain 7.9% Eastern mountain 8.4% >15%: Serious >10%: Critical Marked Disparity in Wasting Across the Regions 11%
    • 10. IYCF Practices among Under 5 Children Exclusively breastfed 70% Breast milk plus water 10% Breast milk plus other milk 9% Breast milk plus other non-milk liquids <1% Breast milk plus compleme ntary foods 10% Not breastfed 1% Breastfeeding Status Under 6 Months Percent of children 6-23 months Recommended IYCF Practices among 6-23 months children
    • 11. Improvements in Micronutrient malnutrition • Sustained High Vitamin A Supplementation and De- worming to Children Focus on: 6-11 months – below 80 % and Urban below 90% • Household Use of Adequately Iodized Salt (>15 ppm) 80% Nearing Universal Salt Iodization Target Focus on: Mid/Far West Hills- 38%, Eastern Hill - 53.5, • Increased Iron Folic Acid and Deworming Coverage Targeted Towards Anemia Reduction Focus on: Among 6-23 months -68% Adolescent Girls – IFA with de- worming Increasing IFA Compliance among pregnant/lactating 75 23 2 59 52 48 46 0 20 40 60 80 IFA Deworming Anemia 1998 2001 2006 2011 Ref: National Micronutrient Status Survey 1998, DHS 2001 , 2006 and 2011 Anemia trend among children 6- 59 months
    • 12. Anemia Prevalence High in Children: The Problem is serious among 6-23 months children 78 74 72 57 44 38 25 46 0 10 20 30 40 50 60 70 80 90 6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total Age in months Percentofchildrenage6-59monthswith anemia Source: NDHS 2011
    • 13. Mid-Western Terai 56.9 Central Hill 40.2 Mid-Western Mountain 52.7 Eastern Hill 42.3 Western Terai 48.8 Eastern Mountain 51.3 Far-Western Terai 60.4 Central Mountain 33.1 Eastern Terai 49.5 Western Mountain 52.7 Western Hill 43.6 Far-Western Mountain 52.7 Far-Western Hill 40.9 Central Terai 46.7 Mid-Western Hill 36 46% Anaemia Among U5 Children is More than Critical Critical: > 40%, Serious > 20%
    • 14. Consequences of Malnutrition
    • 15. Severe forms of malnutrition Impact of Malnutrition • Are rare - a few percent • Represents the tip of the iceberg • Should not be seen as “the nutritional problem”
    • 16. More than 80% brain development – within 2 years of age
    • 17. Malnourished & ill due to high burden of infections ―Empty Brain‖ – Irreversible Damage Diminished Learning Capacity Reduced Economic Productivity & Income (Diminished Life) Well nourished & healthy Smart Child— Meets Full Potential Enhanced Learning & Performance Increased Productivity & Higher Income (>7% or More) High Social and Economic Burden Human Capacity Resource, Increased Productivity Consequences of Malnutrition Child’s Brain Growth and Development By: Prof. Ascobat Gani
    • 18. 19 Growth and muscle mass Body composition Metabolic Syndrome: programming of metabolism of glucose, lipids, protein Hormone/receptor/gene Brain development Cognitive and educational performance Immunity Work Capacity Diabetes, Obesity Heart Disease High blood pressure Cancer, stroke, and ageing Poor nutrition in uterus and early childhood (STUNTING) Short term Long term Death LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU) (James et al 2000)
    • 19. Stunting is preventable Need to act before the child is 2 years The Critical “Window of Opportunity” 1000 DAYS Pregnancy: 9*30= 270 days 2 years: 365*2=730 days
    • 20. Strategic Shift Needed Priority focus on pregnancy to under 2 years:” 0 3 10 70 Brain’s development potential Age Spending on Health, Education and Welfare Spending vs. Brain Development Total National Budget ‘000s: NRs. 329167675 in F/Y 2069/70-2011/12) Health Budget: NRs. 20124858 (6.11 % of Total National Budget) Nutrition Budget: NRs. 511074 (2.54 % of Total Health Budget) (0.16% of Total National Budget) Nutrition in National Budget
    • 21. Multi-Sector Nutrition Plan Development Process
    • 22. Malnutrition & death Inadequate dietary intake Disease Insufficient food security Inadequate Maternal & Child Care Insufficient health services & unhealthy environment Political, Ideological, Economic structures Resource Control + Organizational structures Root causes Underlying causes Immediate causes Manifestations 7/15/201323
    • 23. Nutrition Assessment and Gap Analysis (2009-2010) Build the National “Nutrition Architecture” (2011-2012): • Identified strengths, weaknesses, and gaps; • Need for a national nutrition architecture; and • A multi-sectoral approach through an agreed nutrition determinants model. • NPC led High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC in place and National Nutrition and Food Security Coordination Committee; • Technical working group to guide multi-sectoral nutrition review, and planning; and • Nutrition and Food Secretariat being established at the NPC – with links to NNC of the MoHP and MoAD
    • 24. Nutrition Multi-Sectoral Reviews: A consultative Process (2011) Costed Multi-sectoral Nutrition Plan of Action • Nutrition reviews by sector: Health; Agriculture, Education, Physical Planning and Works, and Local development • Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors • Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-  Clear leadership: the NPC and actively involving health & other sectors  Focused: the first 1,000 days of life and stunting reduction  Addressing the immediate, underlying and basic factors: • women and children’s access to health and nutrition; • safe water & sanitation; and • education and inequity.  Emphasis on decentralized implementation: initially in selected districts (2012-2014)  Vision to gradually scale up: to all other districts by 2016 (A new approach: learning by
    • 25. Multi-sectoral Nutrition Planning Framework Child growth failure/ death Low Birthweight baby Low weight & height in teenagers Early pregnancy Small adult woman Small adult man The intergenerational transmission of growth failure: When to intervene in the life cycle SO 2. Ministry of Health and Population R 2.1 Maternal Infant Young Child MIYC micronutrient status improved R 2.2 MIYC feeding improved R 2.3 IYC Malnutrition better managed R 2.4 Nutrition related policies, standards and acts updated SO 4. Ministry of Education • R 4.1 Adolescent girl’s awareness and behaviours in relation to protecting foetal, infant and young child growth improved • R 4.2 Parents better informed with regard to avoiding growth faltering • R 4.3 Nutritional status of adolescent girls improved • R 4.4 Primary and secondary school completion rates for girls increased SO 5. Ministry Federal Affairs and Local Development R 5.1 Nutritional content of local development plans better articulated R 5.2 Collaboration between local bodies’ health, agriculture, and education sector strengthened at DDC and VDC level R 5.3 Social transfer programmes corroborated for reducing chronic under nutrition R 5.4 Local resources increasingly mobilized to accelerate the reduction of MCU SO 6. Ministry of Agriculture Development R6.1 Increased availability of animal foods at the household level R 6.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile R 6.3 Increased consumption of animal foods by adolescent girls, young mothers and young children R 6.4 Reduced workload of women and better home and work environment Strategic Objective (SO) 1. National Planning Commission Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased R 1.2. Nutritional information management and data analysis strengthened R 1.3 Nutrition capacity of implementing agencies is strengthened SO 3. Ministry of Urban Development R3.1 All young mothers and adolescent girls use improved sanitation facilities R 3.2 All young mothers and adolescent girls use soap to wash hands R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water
    • 26. Declaration of Commitment for Accelerated Improvement of Maternal and Child Nutrition in Nepal signed by the NPC VC, Secretaries form 7 key Ministries, Representatives of the UN, REACH, NNG, EDPs Health, Civil Society and Private Sector, 17 September 2012 Multi-sector Nutrition Plan for Accelerated Reduction of Maternal and Child Under- nutrition in Nepal, 2013-2017 (2023) launched by HE Prime Minister Rt. Hon Prime Minister Dr. Babu Ram Bhattarai , 20th September 2012
    • 27. HIGHLIGHTS OF MULTI- SECTOR NUTRITION PLAN
    • 28. ax'If]qLo kf]if0f of]hgf p2]Zo dfgj k"FhL / ;du| ;fdflhs cfly{s ljsf;df s'kf]if0f cj/f]wsf] ?kdf g/xg] cj:yf ;'lglZrt ug{sf nflu pNn]vgLo ?kdf bL3{ s'kf]if0f Go"gLs/0f ug]{tkm{ d'n'snfO{ cu|;/ u/fpg' nIo • cfufdL kfFrjif{df dft[ tyf lzz' kf]if0fsf] l:yltdf ;'wf/ / tbg';f/ dft[lzz' tyf afnaflnsfsf] s'kf]if0fnfO{ Go"g u/L cfdfx?sf] zf/Ll/s 3gTj ;"rfÍ (BMI) / aRrfx?sf] k'8sf]kgdf Ps ltxfO{n] sdL Nofpg] • ;dfhsf ;a} :t/df dft[lzz' kf]if0fsf] l:yltdf
    • 29. ax'If]qLo kf]if0f of]hgf tLg d'Vo pknAwLx? • pknAwL g+ !M /fli6«o / :yfgLo:t/df gLlt, of]hgf / ax'If]qLo ;dGjodf ;'wf/ cfPsf] x'g]5 . • pknAwL g+ @M …kf]if0f–nlIftÚ jf …kf]if0fk|lt ;Dj]bgzLnÚ ;]jfx?sf] pRrtd k|of]u ug]{ Jojxf/df ;'wf/ e} cGttM dft[lzz' kf]if0fsf] l:yltdf ;'wf/ x'g]5 . • pknlAw g+ #M cfwf/e"t ;]jfnfO{ ;dfj]zL / ;dtfd"ns 9Ën] k|jfx ug{sf nflu s]Gb|Lo tyf :yfgLo ;/sf/x?sf] kf]if0f;DaGwL Ifdtf ;'b[9 ePsf] x'g]5 .
    • 30. ;g @)!& sf] cGTo;DddfM • kfFr jif{d'lgsf afnaflnsfdWo] k'8sf]kg x'g]sf] k|ltzt @( eGbf sd ePsf] x'g]5 . • kfFr jif{d'lgsf afnaflnsfdWo] sd tf}n x'g]sf] k|ltzt @) eGbf sd ePsf] x'g]5 . • kfFr jif{d'lgsf afnaflnsfdWo] Vofp6]kg x'g]sf] k|ltzt % eGbf sd ePsf] x'g]5 . • dlxnfx?df bL3{ zlQm sdL (Chronic Energy Deficiency) x'g]sf] ;+Vof -BMI sf] ?kdf dfkg x'g]_ !% k|ltzt eGbf tn x'g]5 . • sd tf}n e} hGdg] aRrfsf] -≤@%)) u|fd_ Ü sd ePsf] x'g]5 . • k|fylds tyf cfwf/e't :s"n lzIff k'/fgug]{ afnaflnsf tyf lszf]/ lszf]/Lsf] k|ltzt 36]sf] x'g]5 .
    • 31. cf7 k|ltkmnx? - k|ltkmn g+= !Mkf]if0f nlIft Pj+ ;+j]bglzn ;"rsx? ;dfj]z ug{ /fli6«o tyf :yfgLo:t/sf gLlt tyf of]hgfx?sf] k"g/fjnf]sg e} cBfjlws ul/Psf] x'g]5 . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L /fli6«o of]hgf cfof]u tyf If]qut dGqfnox? -:yfgLo ljsf;, :jf:Yo, lzIff, s[lif, ef}lQs of]hgf tyf lgdf{0f_ of] k|ltkmn xfl;n ug{ lhDd]jf/ x'g]5g . !=! If]qut dGqfnox?sf kf]if0f;DaGwL e"ldsfdf clea[l4 ug]{ . !=@ kf]if0fsf] ljifonfO{ cfkmgf] of]hgfdf k|fyldstf lbg / kf]if0f nlIft Pj+ ;+j]bglzn d'Vo d'Vo ;"rsx?nfO{ ;dfj]z ug{ dGqfnox?df k}/jL ug]{ . !=# ax'If]qLo kf]if0f of]hgf cg'?k /fli6«o kf]if0f gLlt tyf /0fgLltnfO{ cBfjlws ug]{ / cg'udg tyf d"NofÍgsf] k|f?k cBfjlws ug]{ .
    • 32. k|ltkmn g+= @M /fli6«o / :yfgLo txdf ax'If]qLo ;dGjo ;+oGqx? ls|ofzLn ePsf x'g]5g . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L /fli6«o of]hgf cfof]u / :yfgLo lgsfox? of] k|ltkmn k|flKtsf nflu lhDd]jf/ x'g]5g @=! kf]if0f / vfB ;'/Iff;DaGwL ls|ofsnfkx?nfO{ 6]jf k'¥ofpgsf nflu /fli6«o of]hgf cfof]udf Ps ;lrjfnosf] :yfkgf÷;'b[9 agfpg] . @=@ ;dGjodf ;'wf/ Nofpg k|efjsf/L ;+rf/ k|0ffnL :yfkgf ug]{ .
    • 33. k|ltkmn g+= #M ljz]if u/L ;dfhsf ljkGg / kx'Fr jflx/ /x]sf ;d'bfodf dft[lzz' kf]if0fsf ;]jfx? pkof]usf] l:yltdf ;'wf/ cfPsf] x'g]5 . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L of] k|ltkmn xfl;n ug{ :jf:Yo If]q lhDd]jf/ x'g]5 . #=! Jofks b[li6sf]0f cjnDag u/L dft[lzz' tyf afnaflnsfsf] kf]if0fsf] sfo{s|d sfof{Gjog / la:tf/ ug]{ . #=@ ljz]if u/L kx'Frjflx/ /x]sf ;d'bfox? tyf s'kf]if0faf6 a9L k|efljt lhNnfx?df hf]8 lbO{ cfdf, lzz' tyf afnaflnsfx?sf] ;"Idkf]if0fsf] l:yltdf ;'wf/ Nofpg] sfo{s|dx?nfO{ lg/Gt/tf lbg] / la:tf/ ug]{ . #=# vf;u/L a9L c;/ k/]sf lhNnfx?df lzz' tyf afnaflnsfx?df /x]sf] clt Pj+ dWod s8f s'kf]if0f
    • 34. k|ltkmn g+= $M lszf]/Lx?sf] dftflktfx?sf] lzIff, hLjgofkgsf ;Lkx? / kf]if0fsf] l:yltdf clea[l4 ePsf] x'g]5 . b]xfosf ls|ofsnfkx? sfof{Gjog u/L of] k|ltkmn xfl;n u $=! ljz]if u/L cfdfx? / afnaflnsfx?sf] kf]if0fdf ;'wf/ / bL3{ s'kf]if0fnfO{ Go"gLs/0f ug]{ s'/fdf hf]8 lb+b} lszf]/Lx?nfO{ k|bfg ul/g] hLjgofkgsf ;Lkx?df kf]if0fsf] ljifonfO{ PsLs[t ug{ ;xof]u ug]{ $=@ lszf]/Lx?df bL3{ s'kf]if0fnfO{ Go"gLs/0f ug]{ 1fg / l;ksf] clea[l4 ug]{ . $=# cfdf tyf afnaflnsfx?sf] x]/rfx / vfglkg;DaGwL Jojxf/df ;'wf/ Nofpg cleefjsx?sf] lzIffsf nflu ;|f]t ;fdu|Lx? tof/cBfjlws ug]{ . $=$ cfdf / afnaflnsfx?sf] x]/rfx / vfglkg;DaGwL Jojxf/sf ljifodf cleefjsx?sf] 1fgdf clea[l4 ug{ sfo{s|dx? cfof]hgf ug]{ .
    • 35. k|ltkmn g+= %M sd pd]/sf cfdfx?, lszf]/Lx?, lzz'x? / afnaflnsfx?df emf8f kvfnf / ARI sf 36gfx?df sdL cfPsf] x'g]5 . of] k|ltkmn k|flKtsf nflu ef}lts of]hgf tyf lgdf{0f If]q lhDd]jf/ x'g]5 . %=! ljz]if u/L lszf]/lszf]/Lx?, afnaflnsfx? / ;–;fgf aRrfsf cfdfx?nfO{ hf]8 lb+b} vf; vf; ;dodf ;fj'gn] xftw'g] afgL a;fpg k|a4{gfTds cleofgx? cfof]hgf ug]{ . %=@ a9L k|efljt lhNnfx?nfO{ ljz]if hf]8
    • 36. k|ltkmn g+= ^M pko'Qm ef]hgsf] pknAwtf tyf pkef]udf - u'0f:t/, k/Ldf0f, vfgf vfg] k6s / ;'/Iffsf b[li6n]_ a[l4 Pj+ dlxnfx?sf] sfo{af]emdf sdL cfPsf] x'g]5 . b]xfosf ls|ofsnfkx?sf] sfof{Gjog u/L o; k|ltkmnsf] k|flKtsf nflu s[lif, tyf :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g . ^=! 3/kl/jf/ / ;d'bfosf] txdf h}ljs ;|f]tdf cfwfl/t vfgf nufot ;"Id kf]ifstTjo'Qm ef]hg pknAw u/fpg] ^=@ ;"Id kf]ifstTjo'Qm :yfgLo afnLx?sf] ;'q ljsf; / k|a4{g ug]{ ^=# sd cfo;d"xsf lszf]/Lx?, ue{jlt dlxnfx? / # jif{eGbf sd pd]/sf aRrfx?nfO{ :tgkfg u/fpg] cfdfx?df ;"Id kf]ifstTjo'Qm ef]hg tyf cfodf a[l4 ug{ ljleGg sfo{s|dx?jLr ;x;DaGw :yfkgf
    • 37. k|ltkmn g+= &M s]Gb|, lhNnf, gu/ tyf uflj; txx?df cfdf / aRrfx?sf] kf]if0fdf ;'wf/ Nofpg pko'Qm ;xof]u pknAw u/fpg] Ifdtfdf clea[l4 ePsf] x'g]5 . of] k|ltkmn xfl;n ug{sf nflu /fli6«o of]hgf cfof]u, :jf:Yo, lzIff, ef}lts of]hgf tyf lgdf{0f, s[lif / :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g . &=! s]Gb| / :yfgLo txdf hgzlQmsf] ax'If]qLo kf]if0f Ifdtf ljsf; ug]{ u/fpg] &=@ ;+u7gfTds ;'b[9Ls/0fsf nflu ;Da4 If]qx?sf] ;+u7g tyf Joj:yfkg;DaGwL n]vfhf]vf ug]{ . &=# Ps} lsl;dsf] tyf glthfd'vL k|ltj]bg k|0ffnLsf] :yfkgf ug]{ . &=$ ax'If]qLo kf]if0f of]hgfsf k|d'v ;"rsx?nfO{ ;dflji6 ug{ ul/jL cg'udg tyf ljZn]if0f k|0ffnL (PMAS) / lhNnf ul/jL cg'udg tyf ljZn]if0f k|0ffnL (DPMAS) sf ;"rsx?sf] k'g/fjnf]sg ug]{ .
    • 38. k|ltkmn g+= *M /fli6«o tyf :yfgLo txx?df ax'If]qLo kf]if0f ;"rgf k|0ffnLsf] ljsf; e} k/:k/ cfj4 / cBfjlws ul/Psf] x'g]5 . of] k|ltkmnsf] k|flKtsf nflu /fli6«o of]hgf cfof]u, :jf:Yo, lzIff, ef}lts of]hgf tyf lgdf{0f, s[lif / :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g *=! k|d'v ;/f]sf/jfnfx?nfO{ ;dflji6 u/L - :Jff:Yo Joj:yfkg ;"rgf k|0ffnL, lzIff Joj:yfkg ;"rgf k|0ffnL, vfg]kfgL tyf ;/;kmfO{, s[lif tyf :yfgLo ljsf;sf_ s]Gb|:t/df ax'If]qLo kf]if0f;DaGwL ;"rgf ul/jL cg'udg tyf ljZn]if0f k|0ffnL ;Fu k/:k/ cfj4 / cBfjlws ug]{ .
    • 39. sfo{of]hgf – :jf:Yo pknlAw != dft[lzz' tyf afnaflnsfx?sf] cfxf/df ;'wf/ x'g]5 .k|ltkmn !=)M ue{jtLsf] cfxf/ Jojxf/df ;'wf/ x'g]5 . !=! :jf:Yo :jo+;]ljsfx? dfkm{t ue{jtLsf] a]n}df klxrfg u/L btf{ ug]{ !=@ ue{jtL tyf kl/jf/sf ;b:ox?nfO{ ay{ lk|Ko/8g]z Kofs]h cg';f/ h}ljs ;|f]tsf] vfgf pkef]u ug{ k}/jL ug]{ !=# ue{jtLsf] cfxf/ Jojxf/df ;'wf/ ug{ kf]if0fsf] nflu ;~rf/ /0fgLltsf] c+usf] ?kdf Jojxf/ kl/jt{g ;~rf/ sfo{qmd ug]{ k|ltkmn @=)M hGdg]lalQs} :tgkfg u/fpg] tyf k"0f{ :tgkfg - cfdfsf] b"wdfq_ u/fpg kxn ;'? ePsf] x'g]5 @=! ;fd'bflos :jf:Yo sfo{stf{ tyf :jo+;]jsx?nfO{ lzz' tyf s]6fs]6Lsf] cfxf/ ;DaGwL tflnd k|bfg ug]{ @=@ cfdf, gjhft lzz', afn:jf:Yo tyf ljsf;;DaGwL tflnddf IYCF Kofs]h cfTd;ft ug]{ @=# k|ltkmn ! sf] !=# lqmofsnfk k|ltkmn #=)M 5 b]lv @# dlxgf;Ddsf afnaflnsfsf] k"/s cfxf/ pknAwtfdf ;'wf/ x'g]5 .
    • 40. sfo{of]hgf – :jf:Yo pknlAw @=)M dft[lzz' tyf afnaflnsfsf] ;"Id kf]if0fsf] l:yltdf ;'wf/ x'g]5 .k|ltkmn $=) ue{jtL tyf k|;"ltkZrft cfdfx?aLr cfO/g / h'sf lgoGq0f rSsLsf] vkt a9L x'g]5 . $=! :jf:YosdL{ tyf dlxnf :jf:Yo :jo+;]ljsfx?nfO{ cfO/g tTj ld;fpg] ;DaGwdf k"gtf{huL tflnd k|bfg ug]{ $=@ k|lt dlxgf dlxnf :jf:Yo :jo+;]ljsfx? dfkm{t #) rSsL cfO/g kmf]lns Pl;8 afF8g nufpg] tyf cfdfx?nfO{ vfg] ug{ pTk|]l/t ug]{, ;Demfpg] $=# :jf:Yo sfo{stf{x? dfkm{t cfO/g kmf]lns Pl;8 -uef{j:yfdf !*) rSsL / uef{j:yfkl5 :tgkfg u/fpFbf $% rSsL_ tyf ! h'sf lgoGq0f rSsL - uef{j:yfdf_ afF8g nufpg] $=$ ue{jtL tyf cfdfx?n] cfO/g kmf]lns Pl;8 tyf ! h'sf lgoGq0f rSsL vfg'kg]{ ;DjGwdf ue{jtL dlxnf tyf cGo kl/jf/sf ;b:onfO{ k}/jL ug]{ $=$=! ;"Id kf]ifstTj ;e]{If0f ug]{ k|ltkmn %=) cfO/g tTj ld;fPsf] vfg]s'/fsf] pkef]u a9g]5 %=! 3/kl/jf/n] cfO/g tTj ld;fPsf] cGgsf] pkef]u a9fpg] ljifodf cleofg ;~rfng ug]{ %=@ ;do ;dodf lk;fgL ldnx?sf] cg'udg u/L vfg]s'/fdf cfO/g tTj pko'Qm lsl;dn] ld;fPsf] ;'lglZrt ug]{
    • 41. sfo{of]hgf – :jf:Yo pknlAw @=)M dft[lzz' tyf afnaflnsfsf] ;"Id kf]if0fsf] l:yltdf ;'wf/ x'g]5 .k|ltkmn &=) 5 b]lv t]O; dlxgfsf lzz'aLr ;"Idkf]ifstTj o'Qm kfp8/sf] pkof]u a9]sf] x'g]5 . &=! ;"Idkf]ifstTj kfp8/ &% lhNnfdf lj:tf/ ug{] &=@ 5 b]lv t]O; dlxgfsf lzz'x?nfO{ ;"Idkf]ifstTj o'Qm kfp8/ v'jfpg'kg]{ ljifodf :jf:YosdL{ tyf dlxnf :jf:Yo :jo+;]ljsfdfkm{t cfdf Pj+ kl/jf/sf cGo ;b:onfO{ ;/;Nnfx ;]jf k|bfg ug]{ k|ltkmn *=) dft[lzz' tyf s]6fs]6Lx?df x'g] ;+qmd0f 36]sf] x'g]5 *=@ IMCI k"gtf{huL tflnd dfkm{t dft[lzz' tyf s]6fs]6Lx?df x'g] ;ªqmd0fsf ljifodf hf]8 lbg] *=@ CB-NCP&% lhNnfdf lj:tf/ ubf{ dft[, lzz' tyf s]6fs]6Ldf x'g] ;+qmd0f ljifodf hf]8 lbg] *=# ue{jtL, lszf]/lszf]/L tyf afnaflnsfsf lglDt cfjZos ;+Vofdf LLIN sf] kof{Kt ljt/0f ug]{ *=$ lgoldt bfb'/fsf] vf]ksf] ;+Vof a9fpg ;~rf/ dfWodsf] pkof]u j[l4 ug]{
    • 42. sfo{of]hgf – :jf:Yo pknlAw #=) lzz' tyf afnaflnsfx?df /x]sf] s'kf]if0fsf] kof{Kt Joj:yfkg ePsf] x'g]5.k|ltkmn !)=) ) b]lv #^ dlxgf;Ddsf afnaflnsfsf] kf]if0fsf] l:ylt cg'udg u/L clws s'kf]if0f klxrfg ug]{ !)=! PHC/ORC k'gM lqmofzLn ubf{ s'kf]if0f ePsf afnaflnsfsf] klxrfg tyf kf]if0f :t/ cg'udg ;'b[9 ug]{ !)=@ ljZj :jf:Yo ;+u7g j[l4 u'0f:t/ cg';f/ ;d'bfodf cfwfl/t j[l4 cg'udg sfof{Gjog x'g]5 . k|ltkmn !!=) kfFr jif{d'lgsf ;a} afnaflnsfsf] clts8f s'kf]if0f 36g]5 . !!=! ;d'bfodf cfwfl/t s8f s'kf]if0f Joj:yfkg sfo{qmd w]/} clt s8f s'kf]lift afnaflnsf ePsf #% lhNnfdf lj:tf/ ug{] !!=@ w]/} clts8f s'kf]lift afnaflnsf ePsf #% lhNnfdf kf]if0f k'gM:yfkg u[x lj:tf/ ug]{ k|ltkmn !@=) kfFr jif{d'lgsf ;a} afnaflnsfsf] dWod s'kf]if0f 36g]5
    • 43. sfo{of]hgf – :jf:Yo pknlAw $M :jf:Yo If]qsf kf]if0f;DaGwL P]g, lgod, gLlt, /0fgLlt / dfkb08x?nfO{ cBfjlws ul/Psf] x'g]5 .k|ltkmn !#=) /fli6«o kf]if0f gLlt tyf /0fgLlt ;+zf]wg tyf cBfjlws ul/Psf] x'g]5 . !#=! ;/sf/L tyf u}/ ;/sf/L ;/f]sf/jfnfx?sf] ;xof]udf ljBdfg /fli6«o kf]if0f gLlt tyf /0fgLlt ;+zf]wg ug]{ . !#=@ kf]if0fsf] ;~rf/ /0fgLlt th'{df ug]{ . !#=# ;+zf]lwt /fli6«o kf]if0f gLltcg'?k :jf:Yo If]qsf] nufgL;lxtsf] ax'jifL{o kf]if0f of]hgf th'{df ug]{ . k|ltkmn !$=) kf]if0f;DaGwL a[xb tflnd Kofs]hx? tof/ ul/g]5 . !$=! ljBdfg ljleGg kf]if0f;DaGwL tflnd ;fdu|L k'g/fjnf]sg u/L ;+zf]wg ug]{ .
    • 44. sfo{of]hgf – :jf:Yo pknlAw %M ax'If]qLo kf]if0f of]hgfdf :jf:Yo If]qsf] :jf:Yo If]qsf] ;'wf/fTds of]ubfgsf] nflu ;+:yfut ;'b[9Ls/0f tyf Ifdtf ljsf; ePsf] x'g]5 .k|ltkmn !^=) ax'If]qLo kf]if0f of]hgfsf] k|f?k cg'?k ;a} txdf ;+:yfut Joj:yf k'g/fjnf]sg ug]{, :jf:Yo tyf hg;+Vof dGqfnocGtu{t /fli6«o kf]if0f s]Gb| :yfkgf;lxt !^=! ;+u7g tyf Joj:yfkg l8hfOg tyf n]vfhf]vf ug]{ Ifdtf ljsf; cfjZostf;lxt !^=@ /fli6«o kf]if0f s]Gb|sf] ;+u7gfTds ;+/rgf tof/ u/L :jLs[t ug]{ !^=# ;+u7g tyf Joj:yfkg n]vfhf]vf tyf /fli6«o kf]if0f s]Gb|sf] ;+u7gfTds ;+/rgf cg';f/ Ifdtf ljsf; of]hgf th'{df ug]{ !^=$ :jLs[t ;+u7gfTds ;+/rgfsf] b/jGbL cg';f/ kbk"lt{ ug]{ k|ltkmn !&=) ;a} txdf :jf:YosdL{x?sf] -dlxnf ;fd'bflos :jf:Yo sfo{stf{;lxt_ kf]if0f;DaGwL Ifdtf ljsf; ug]{ !&=! a[xb kf]if0f tflnd Kofs]h cg';f/sf tflnd sfo{qmd ;~rfng ug]{ k|ltkmn !*=) dft[lzz' s'kf]if0f 36fpg :jf:Yosf hgzlQmn] cGo If]q;Fu ;dGjo u/L of]ubfg ug]{
    • 45. glt hf z[+v nf ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx? nIo k'8sf]kg 36fpg hf]8 lbg] ax'If]qLo k|of;df lzIff dGqfnosf] of]ubfgdf clej[l4 x'g]5 . @)!^ sf] cGTo;Dddf lhjgofkgsf ;Lkdf cfwfl/t kf]if0f sfo{qmd;DaGwL tflnd k|fKtug]{ lzIfsx?, ;|f]t JolQmx? tyf afn Snasf ;b:ox?sf] ;+Vof a9]sf] x'g]5 . p2]] Zo lszf]/Lx?sf] lzIff, lhjgofkgsf ;g @)!& sf] cGTo;DddfM @)!^ sf] cGTo;DddfM lszf]/Lx?dWo] sIffdf xflh/L tyf sIff sfo{of]hgf –lzIff If]q
    • 46. sfo{of]hgf – lzIff If]q pknlAw !=) ue{ tyf lzz' tyf afnaflnsfsf] j[l4 ;DaGwdf lszf]/Lx?sf] hfu/0f / Jojxf/df ;'wf/ cfPsf] x'g]5 k|ltkmn !=! bL3{sfnLg s'kf]if0f Go"gLs/0f ug]{ ljifo lszf]/Lx?nfO{ k|bfg ul/g] hLjgofkg;DaGwL lzIffdf a9L eGbf a9L ;dfj]z ul/Psf] x'g]5 -;an jftfj/0fsf] l;h{gf ug]{_ . k|ltkmn !=@ lszf]/Lx?df bL3{sfnLg s'kf]if0fnfO{ Go"gLs/0f ug]{ 1fg / ;Lksf] clej[l4 x'g]5 . pknlAw @=) ;–;fgf afnaflnsfsf] x]/rfx / cfxf/ Jojxf/df ;'wf/ u/L j[l4 ljkmntfsf] km}nfj6 /f]Sg ;lsg] ljifodf cleefjsx? -dlxnf_ /fd|/L ;';"lrt ePsf x'g]5g . k|ltkmn @=! afnaflnsf x]/rfx tyf cfxf/ Jojxf/sf
    • 47. sfo{of]hgf – lzIff If]q pknlAw # lszf]/L 5fqfx?sf] kf]if0f:t/df ;'wf/ x'g]5 k|ltkmn #=! ECD afnaflnsf tyf lszf]/L 5fqfx?n] - * sIff ;Dd_ lbjfvfhf k|fKt ug]{5g . k|ltkmn #=@ cfwf/e"t lzIffdf -sIff !–*_ lszf]/L 5fqfx?sf] z}lIfs ;xeflutf tyf pknlAwdf ;'wf/ x'g]5 . pknlAw $ ax'If]qLo k|of;df of]ubfg of]ubfg k'¥ofpg lzIff If]qsf] Ifdtf cleaj[l4 ePsf] x'g]5 k|ltkmn $=! kf]if0f lglb{i6 lzIff cWofkg ug{ lzIff dGqfnosf k|lzIfs Pj+ lzIfsx? -k"j{ ;]jfsfnLg tyf ;]jfsfnLg_ k"0f{?kdf tof/ ul/Psf] x'g]5 . k|ltkmn $=@ k'8sf]kg 36fpg] ljifodf lzIf dGqfno
    • 48. glth f z[+v nf ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx? nIo k'8sf]kg 36fpg] sfo{df ltj|tf lbg] ax'If]qLo k|of;df zx/L ljsf; dGqfnosf] of]ubfg x'g]5 . zx/L ljsf; dGqfnosf] jflif{s tyf ax'jflif{s of]hgfdf vfg]kfgL tyf ;/;kmfO sfo{qmdx? dfkm{t s'kf]if0f 36fpg of]ubfg k'Ug] nIf k|ltlalDat ul/g]5 p2]] l56f] aRrfkfpg] ;g @)!& sf] cGTo;DddfM sfo{of]hgf –vfg]kfgL tyf ;/;kmfO -zx/L ljsf;_
    • 49. pknlA w ! ;fa'g kfgLn] xftw'g] cEof; a9]sf] x'g]5 . pknlA w @ ;a} nlIft ljBfno, uflj; Pj+ gu/kflnsf v'Nnf lb;fd'Qm If]q x'g]5g . pknlA w # hn ;'/Iff If]q 3f]if0f ePsf] x'g]5 pknlA w $ ;+o'Qm sfo{ of]hgf tyf cg'udg k|0ffnL :yfkgf ePsf] x'g]5 pknlA w % s]Gb|Lo tyf :yfgLo:t/df hgzlQm ljsf; x'g]5 . k|ltkm n ! ;a} l56f] aRrf kfpg] cfdfx? tyf lszf]/Lx?sf] xftw'g] ;'ljwfx?df kx'Fr e} xftw'gsf] nflu ;fa'g k|of]u u/]sf x'g]5g . k|ltkm n @ ;a} l56f] aRrfkfpg] cfdfx? tyf lszf]/Lx?n] ;'wfl/Psf] ;/;kmfO ;'ljwf tyf :jR5s/ Jojxf/ k|of]u u/]sf x'g]5g . k|ltkm n # ;a} ue{jtL Pj+ :tgkfg u/fpg] cfdfx?sf ;fy;fy} @ jif{d'lgsf afnaflnsfn] ;kmf kfgL k|of]u u/]sf x'g]5g .
    • 50. glthf z[+vnf ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx? nIf bL3{sfnLg s'kf]if0f 36fpg] sfo{df tLj|tf lbg] ax'If]qLo k|of;df s[lif tyf ;xsf/L dGqfnosf] of]ubfgdf clej[l4 x'g]5 . s[lif sfo{qmd kf]if0f ;+j]bgzLn x'g]5 . p2]Zo sd cfo ePsf lszf]/lszf]/Lx? / sd pd]/df ue{jlt x'g]] cfdfx? tyf afnaflnsfx?aLr lalawtfk"0f{ vfgf ;"Id kf]if0fo'Qm vfgfsf] pkef]u %)Ü n] a9]sf] x'g]5 . k|f0fLhGo ;|f]tsf] vfgfsf] k|of]u sfo{of]hgf – s[lif If]q
    • 51. k|ltkm nx? k|ltkm n !=) 3/kl/jf/ / ;d'bfosf] txdf vf;u/L ;"Id kf]ifstTjo'Qm ef]hg h:t} h}ljs ;|f]tdf cfwfl/t vfgf, xl/of ;fukft / kmnkm"n, Rofp, bfn cflb ljljwtfk"0f{ vfgfsf] pknAwtf 3/kl/jf/ / ;d'bfo :t/df j[l4 x'g]5 . cfufdL % jif{df 3/kl/jf/ / ;d'bfodf:t/df ;"Id kf]ifstTjo'Qm vfgfsf] pTkfbg %)Ü a9g]5 k|ltkm n @=) sd cfoePsf kl/jf/sf] cfo j[l4 e} o;df sd pd]/df ue{jlt x'g]] cfdfx? / lszf]/lszf]/Lx?sf] o:tf] cfodf kx'r tyf lgoGq0f cfufdL % jif{df nlIft 3/kl/jf/sf] cfodf @)Ü a'l4 sfo{of]hgf – s[lif If]q
    • 52. glth f z[+v nf ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx? nIf kf]if0f k|a4{g sfo{df ltj|tf lbg] ax'If]qLo k|of;df :ygLo ;'zf;g Pj+ ;fdflhs ;'/Iffsf] of]ubfgdf clej[l4 x'g]5 . lhNnf:t/df kf]if0f ;"rgfsf] kx'Frdf clej[l4 e} kf]if0f ;]jfx?df ;'wf/ x'g]5 . p2]Z o kf]if0f k|a4{g sfo{df ltj|tf lbg] k|of;df ;xof]u k'¥ofpg :yfgLo ;g @)!@ b]lv :yfgLo ;'zf;g gLlt tyf sfo{qmddf l8hfOg tyf th'{dfdf kf]if0f k|ltlalDat x'g]5 . sfo{of]hgf – :yfgLo ;'zf;g
    • 53. k|ltkmn !M :yfgLo lgsfosf of]gfdf kf]if0f :ki6?kdf /flvg]5 ;g @)!# b]lv lhNnf tyf gu/ ljsf; cfjlws of]hgf / oL ;+:yfsf] jflif{s of]hgfdf kf]if0f ljifo k|ltljlDjt x'g]5 . ;g @)!# b]lv :yfgLo lgsfo cg'bfg lgb]{lzsfdf nlIft ljsf; sfo{qmdsf] k|a4{gfTds nufgL If]qcGtu{t ;dflxt ug{;Sg] u/L kf]if0f ;dfj]z ul/Psf] x'g]5 . k|ltkmn @M k'8sf]kg tLj|t/?kdf Go"g ug{ :yfgLo ;|f]t kl/rfng qmlds ?kdf a9b} uPsf] x'g]5 . ;g @)!$ b]lv 5gf]6 ul/Psf uflj;x?df ==Ü uflj;:tl/o ;fd'bflos ;+:yfx? kf]if0f;DaGwL k}/jLdf ;+nUg x'g]5g . ;g @)!# b]lv ;fdflhs k/LIf0f tyf ;fj{hlgs ;'g'jfO d~rx?sf 5nkmndf kf]if0fnfO{ :yfg lbFb} ;f] ljifo logsf k|ltj]bg tyf sfo{ of]hgfdf /flvPsf] pknlAw ! :yfgLo ;'zf;g /0fgLlt tyf sfo{qmd l8hfOg ubf{ kf]if0f b[li6uf]r/ ul/g]5
    • 54. pknlA w @ :yfgLo ;/sf/sf] th'{df ul/Psf] of]hgfsf] k|ltkm Pj+ ljleGg If]qaLr ax'If]qLo ;dGjo ug]{ Ifdtf ljsf; ePsf] x'g]5 . k|ltk mn $ lhlj; Pj+ uflj;:t/df :yfgLo lgsfo, :jf:Yo, s[lif / lzIff If]qaLr ;xof]u ;'b[9 ePsf] x'g]5 . ;g @)!@ sf] cGTo;Dddf lhlj;, gu/kflnsf / uflj;:t/df kf]if0f tyf vfB ;'/Iff lgb]{zd ;ldlt lqmofzLn x'g]5 . ;g @)!# b]lv lhNnfdf sfof{Gjog x'g] kf]if0f;DaGwL sfo{qmd :jLs[t ug{ Pj+ k|ult ;dLIff ;DalGwt If]qaf6 u/fO{ bL3{sfnLg s'kf]if0f 36fpg cfjZos lqmofsnfkx? l;kmfl/; ug{ ;ldltsf] a}7s q}dflzs ?kdf a;]sf x'g]5g . k|ltk mn % ax'If]qLo k|of;df of]ubfg k'¥ofpg sd{rf/Lsf] Ifdtf ljsf; ul/g]5 . ;g @)!# b]lv :yfgLo lgsfosf ;Dks{ ;+:yfx?n] kf]if0f sfof{Gjog / cGo ;+:yfx?;Fu ;dGjo, cfˆgf] sfo{ ljj/0f cGtu{tsf] sfdsf] ?kdf, u/]sf x'g]5g . ;g @)!# b]lv :yfgLo lgsfosf ;Da4 sd{rf/LnfO{ kf]if0f;DaGwL sfo{ut lhDd]jf/L lbOPsf] x'g]5 . ;g @)!$ sf] cGTo;Dddf :yfljd+ tyf :yfgLo lgsfosf tf]lsPsf d'Vo sd{rf/LaLr kf]if0f;DaGwL 1fg a9]sf] x'g]5 . k|ltk lhNnf ul/aL cg'udg ;g @)!# b]lv kf]if0f;DaGwL k|ult -lnË,
    • 55. NEPALFar-Western Region Mid-Western Region Western Region Central Region Eastern Region Initial MSNP Roll-out Districts DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWAL PARASI KAPIL- BASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHANUSA MAHO- TARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI TANAHU PALPA SYANGJA PARBAT ARGHAK HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR DHAN- KUTA TAPLEJUNG OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUK- HUMBU DOLAKHA SANKHUWA- SABA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUT- HAN ROLPASALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG SIX INITIAL MOEL DISTRICTS (Bajura, Jumla, Kapilvastu, Nawalparashi, Parsa and Jumla) PROPOSED BASED ON 14 INDICATORS Criteria/Indicators for selection 1. Average of 1 to 4 quarters food security phase 2. Net Enrolment Rate (NER) Basic Education 3. Working Children 10-14 years 4. Sanitation coverage 5. Per Capita Development Budget Expenditure 6. DPT 3 immunization under 1 year of age 7. Expected frequencies of diarrheal outbreaks 8. Ratio of girls to boys in secondary education 9. Proportion of severely underweight children less than 5 years 10. Minimum Conditions and Performance Measures (MCPMs) of Local Bodies of Nepal 11. Proportion of births attended by Skilled Birth Attendant as % of expected pregnancies: 12. Stunting Prevalence 13. Access 14. Similar MSNP actions by on-going programs/partners Central Region MSNP implementation period (First Phase): 2013-2017
    • 56. ;+u7gfTds tyf Joj:yfksLo ;+/rgf
    • 57. /fli6«o txM pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt dfggLo pkfWoIf, /fli6«o of]hgf cfof]u, cWoIf /fli6«o of]hgf cfof]usf dfggLo ;b:ox? -:jf:Yo, s[lif tyf jfl0fHoIf]q x]g]{ ;b:o ;lrj, s[lif tyf ;xsf/L dGqfno ;b:o ;lrj, :jf:Yo tyf hg;+Vof dGqfno ;b:o ;lrj, :yfgLo ljsf; dGqfno ;b:o ;lrj, jfl0fHo tyf cfk"lt{ dGqfno ;b:o ;lrj, cy{ dGqfno ;b:o ;lrj, lzIff dGqfno ;b:o ;lrj, ef}lts of]hgf tyf lgdf{0f dGqfno ;b:o ;lrj, dlxnf, afnaflnsf tyf ;dfhsNof0f dGqfno – ;b:o $ hgf lj1x? -kf]if0f, vfB ;'/Iff, jfl0fHo tyf cfk"lt{;DaGwL_ ;b:o ;b:o ;lrj, /fli6«o of]hgf cfof]u ;b:o ;lrj ;x;lrj, ;fdflhs ljsf; dxfzfvf, /fli6«o of]hgf cfof]usf] ;lrjfno ;x–;b:o ;lrj
    • 58. gLltut dfu{bz{g / cg'udgsf ;fy} pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt lgDg sfo{x?sf nflu klg lhDd]jf/ x'g]5 M • ax'If]qLo kf]if0f / vfB ;'/Iff;DaGwL a[xt gLltx? th'{df ug]{Ù • cfGtl/s tyf afXo ;|f]tx? ;'lglZrt ug]{Ù • /fli6«o tyf cGt/f{li6«o txdf kIfkf]if0f ug]{ / k|lta4tfx? JoQm ug]{Ù • sfo{qmd sfof{Gjog l:yltsf] ;dLIff tyf d"Nofªsg ug]{Ù /
    • 59. pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldltsf] ;xof]usf nflu Ps ;lrjfno /xg]5 hf] lgDg sfo{x?sf nflu lhDd]jf/ x'g]5 M • ;"rgf Joj:yfkgM ul/aL cg'udg tyf ljZn]if0f k|0ffnL, lhNnf ul/aL lgjf/0f tyf ljZn]if0f k|0ffnL, :jf:Yo Joj:yfkg ;"rgf k|0ffnL, lzIff Joj:yfkg ;"rgf k|0ffnLnufot;Fu ;DaGw :yflkt ug]{ . • ;"rgf ;Dk|]if0f÷kIfkf]if0f ug]{ . • Ifdtf ljsf;sf nflu ;xof]u ug]{ .
    • 60. df=;b:o -:jf:Yo tyf kf]if0f If]q_, /fli6«o of]hgf cfof]u –;+of]hs df=;b:o -s[lif If]q_, /fli6«o of]hgf cfof]u –;x–;+of]hs ;x–;lrj, gLlt of]hgf tyf a}=;= dxfzfvf, :jf:Yo tyf hg;+Vof dGqfno –;b:o ;x–;lrj, vfg]kfgL dxfzfvf, ef}lts of]hgf tyf lgdf{0f dGqfno –;b:o ;x–;lrj, ah]6 tyf sfo{qmd dxfzfvf, cy{ dGqfno –;b:o ;x–;lrj, k|zf;g, ;+:yfg tyf cfk"lt{ dxfzfvf, jfl0fHo tyf cfk"lt{ dGqfno –;b:o ;x–;lrj, of]hgf tyf j}b]lzs ;xof]u ;dGjo dxfzfvf, :yflgo ljsf; dGqfno –;b:o ;x–;lrj, of]hgf dxfzfvf, s[lif tyf ;xsf/L dGqfno –;b:o dxflgb]{zs, s[lif ljefu – ;b:o dxflgb]{zs, kz';]jf ljefu – ;b:o dxflgb]{zs, vfB k|ljlw tyf u'0f lgoGq0f ljefu –;b:o dxflgb]{zs, l;+rfO ljefu – ;b:o /fli6«o kf]if0f tyf vfB ;'/Iff ;dGjo ;ldlt
    • 61. kf]if0f tyf vfB ;'/Iff If]lqo ;dGjo ;ldlt ax'If]lqo kf]if0f of]hgfsf] sfof{Gjogdf ;xof]u / ;dGjo ug{ tyf sfof{lGjt sfo{qmdsf] ;'kl/j]If0f / cg'udgsf nflu If]lqo:t/df cfjZostf cg';f/ If]lqo k|zf;ssf] ;+of]hsTjdf ;Dj4 ljifout lgsfox? / ;/f]sf/jfnfx? ;d]t ePsf] kf]if0f tyf vfB ;'/Iff If]lqo ;dGjo ;ldlt u7g ug{ ;lsg]5 .
    • 62. lhNnf:t/M kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt lhlj; ;efklt, cWoIf lhNnf :jf:Yo÷hg:jf:Yo clws[t ;x– cWoIf :yfgLo ljsf; clwsf/L ;b:o nfOg Ph]G;Lsf k|d'vx? -s[lif, kz' ;]jf, lzIff, vfg]kfgL_ ;b:ox? dlxnf ljsf; clws[t ;b:o sfo{sf/L clws[t, gu/kflnsf ;b:o cWoIf, lhNnf pBf]u jfl0fHo ;+3 ;b:o cWoIf, lhNnf u}/;/sf/L dxf;+3 ;b:o k|ltlglw, lhNnf:t/df sfdug]{ ljsf; ;fem]bf/÷-c_u};;x?
    • 63. ;fªs]lts?kdf pQm lgb]{zs ;ldltsf] sfof{b]z lgDgfg';f/ x'g]5 M • lhNnfdf sfof{Gjog x'g] kf]if0f;DaGwL sfo{qmdx?sf] ljZn]if0f, ;dLIff, cg'df]bg ug]{ / ax'If]qLo kf]if0f of]hgfsf] dd{cg'?k lhNnf kl/ifbdf :jLs[ltsf nflu l;kmfl/; ug]{ . • lhNnfsf] cfjlws / jflif{s of]hgfx?df kf]if0fsf ;"rsx? ;dfj]z ug]{ . • nfOg Ph]G;Lx? / lhNnf ul/aL cg'udg tyf ljZn]if0f k|0ffnLsf] k|ult ;dLIff ug]{ .
    • 64. gu/kflnsf :t/ M kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt d]o/, gu/kflnsf cWoIf lhNnf :jf:Yo÷hg:jf:Yo clws[t ;x cWoIf sfo{sf/L clws[t, gu/kflnsf ;b:o k|d'v, nfOg Ph]G;Lx? -s[lif,kz' ;]jf, lzIff, vfg]kfgL_ ;b:ox? of]hgf clws[t, lhlj; ;b:o k|d'v, gu/ :Jff:Yo s]Gb|, gu/kflnsf-ljBdfg eP_ ;b:o
    • 65. uflj;:t/M kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt cWoIf, uflj; cWoIf k|ltlglw, s[lif ;]jf s]Gb|, kz' ;]jf s]Gb| / :jf:Yo rf}ls jf s]Gb| ;b:ox? k|ltlglw, :jf:Yo ;]jf Joj:yfkg ;ldlt ;b:o cWoIf, ljBfno Joj:yfkg ;ldlt w]/} eP 5flgPsf] !_ ;b:o k|ltlglw, jf8{ l;l6hg kmf]/d,
    • 66. ;fªs]lts?kdf pQm lgb]{zs ;ldltsf] sfof{b]z lgDgfg';f/ x'g]5M • lhNnfdf cjnDag ul/Psf] ax'If]qLo kf]if0f of]hgf cg'?k x'g] u/L uflj;sf jflif{s of]hgfx?df kf]if0fsf sfo{qmdx? ljZn]if0f ug]{ / ;dflxt ug]{ . • kf]if0f sfo{qmdx?sf] sfof{Gjogsf] k|ult ;dLIff ug]{ . • uflj;df bL3{ Go"gkf]if0f 36fpgsf nflu ax'If]qLo ;dGjo ug]{ .
    • 67. ah]6 af+8kmf+8 tyf sfof{Gjog

    ×