ANALYZE THE PROGRESS TOWARDS ACHIEVING MDGs IN NEPAL-PDF

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  • 1. ‘‘ANALYZE THE PROGRESS TOWARDS ACHIEVING MDGs IN NEPAL’’A Term paper submitted to fulfill the partial requirement of BPH second semester [Public Health PBH 111.3] SUBMITTED TO: DEPARTMENT OF PUBLIC HEALTH, LA GRANDEE INTERNATIONAL COLLEGE, SIMALCHAUR-8, POKHARA 2011 SUBMITTED BY: SAMJHANA GURUNG ‘A’ SAMJHANA GURUNG ‘B’ SABITA TIMILSINA SARALA KUMAL SAGUN PAUDEL
  • 2. 1. AcknowledgementThe students of Bachelor of Public Health 2 nd semester of 2nd year like to express our humblythanks to all those who have supported and helped us in accomplishing this term paper in thetopic ‘‘ANALYZE THE PROGRESS TOWARDS ACHIEVING MDGs IN NEPAL’’.We would like to convey our heartfelt thanks to all those who were directly or indirectlyconcerned with this and to all our well wishers.First of all we would like to thank our respected subject teacher Mr. Diphendra Kumar yadav forgiving us opportunity to prepare this term paper. We are fully indebted to our coordinator Mr.Dilip Yadav for expert guidance, regular supervision, untiring encouragement, inspiration andvaluable suggestion and full support during preparation of term paper.This term paper is written in simple language, with every bit of necessary information related tothe topic so that studying independently also would not find any difficulties. We think that thiseffort will help every individual to understand about the information of the related topic. ii
  • 3. 2. ACRONYMSADB : Asian Development BankAIDS : Acquired Immune Deficiency SyndromeBMI : Body Mass IndexCBOs : Community Based OrganizationsCMR : Child Mortality RateDALYs : Disability Adjusted Life YearsDOHS : Department of Health ServicesDOTS : Directly Observed Treatment Short CourseEHCS : Essential Health Care ServicesFAO : Food and Agriculture OrganizationFCHVs : Female Community Health VolunteersFY : Fiscal YearGDP : Gross Domestic ProductGNP : Gross National ProductHDR : Human Development Report/UNDPILO : International Labour OrganizationIMCI : Integrated Management of Childhood IllnessIMF : International Monetary FundIMR : Infant Mortality RateINGOs : International Non-Governmental OrganizationsMCHW : Maternal and Child Health WorkerMDGs : Millennium Development GoalsMMR : Maternal Mortality RateMOHP : Ministry of Health and Population/NepalMTEF : Medium Term Expenditure FrameworkNGOs : Non-Governmental OrganizationsNLSS : National Living Standard Survey/NepalNMR : Neonatal Mortality RateNPC : National Planning Commission/NepalNRB : Nepal Rastra BankPCE : Per Capita ExpenditurePEM : Protein Energy MalnutrationPGR : Poverty Gap RatioPPP : Purchasing Power ParityPRGF : Poverty Reduction and Growth Facility/IMFPRSP : Poverty Reduction Strategy PaperRs. : Rupees/NepaleseSLTHP : Second Long Term Health PlanSTD : Sexually Transmitted DiseaseUN : United NationsUNAIDS : United Nations Program on HIV/AIDSUNDP : United Nations Development ProgramUNESCO : United Nations Education and Social CouncilUNFPA : United Nations Fund for Population Activities iii
  • 4. UNICEF : United Nations Childrens FundVDC : Village Development Committee/NepalWB : World BankWDR : World Development Report/WBWFP : World Food ProgramWHO : World Health OrganizationWTO : World Trade organization iv
  • 5. 3. Table of contents1. Acknowledgement ...................................................................................................................................... ii2. ACRONYMS ................................................................................................................................................. iii3. Table of contents ........................................................................................................................................ v4. Introduction ................................................................................................................................................. 15. Goals............................................................................................................................................................. 1 Goal 1: Eradicate extreme poverty and hunger ............................................................................................ 1 Goal 2: Achieve universal primary education................................................................................................ 2 Goal 3: Promote gender equality and empower women............................................................................. 2 Goal 4: Reduce Child Mortality Rate .............................................................................................................. 2 Goal 5: Improve Maternal Health .................................................................................................................. 3 Goal 6: Combat HIV/ AIDS, malaria, and other diseases .............................................................................. 3 Goal 7: Ensure Environmental Sustainability ................................................................................................ 4 Goal 8: Develop a global partnership for development ............................................................................... 56. Objective:..................................................................................................................................................... 5 6.1. General Objectives:.................................................................................................................................. 5 6.2. Specific Objectives: ............................................................................................................................. 57. The MDGs and Nepal .................................................................................................................................. 68. Key Strategies of Nepal ............................................................................................................................... 69. Findings ........................................................................................................................................................ 9 9.1. Progress toward the Millennium Development Goals and Targets ..................................................... 910. Discussion ..............................................................................................................................................1111. Conclusion .............................................................................................................................................1112. References .............................................................................................................................................12 v
  • 6. 4. IntroductionThe UN global conferences of the 1990s drew up a number of different key global Developmentgoals and targets to focus equalize and harmonize the needs and status of the people all over theworld. These goals and targets were known as the International Development targets. Again in2000, the representatives of 189 nations, including 147 heads of state and Government adoptedthe Millennium Declaration during the Millennium Development Summit (September 6-8, 2000)of the United Nations. The Millennium Declaration focused on peace, security and developmentconcerns comprising environment, human rights and good governance. In this connection, theDeclaration tried to mainstream a set of interconnected and mutually reinforcing developmentgoals into a global agenda. The international development targets and the development goalswere merged together and renamed as the Millennium Development Goals (MDGs).1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development.These goals had been decided and fixed earlier in many international forums and conventions.What is new about the MDGs is setting of targets under each goal, a joint meeting of UNSecretariat, and specialized UN agencies, the World Bank, IMF and OECD.The Millennium Development Goals were developed out of the eight chapters of the UnitedNations Millennium Declaration, signed in September 2000.There are eight goals with 21 targets,and a series of measurable indicators for each target. 5. GoalsGoal 1: Eradicate extreme poverty and hunger Target 1:  Halve between 1990 and 2015, the proportion of people whose income is less than $1 per day. Indicator:  Proportion of population below $1 (1993 PPP) per day (World Bank) Poverty gap ratio (incidence * depth of poverty) (World Bank) 1
  • 7. Target 2:  Halve, between 1990 and 2015, the proportion of people who suffer from hunger. Indicator:  Prevalence of underweight children under five years of age (UNICEF-WHO)  Proportion of population below minimum level of dietary energy consumptionGoal 2: Achieve universal primary educationTarget 3:  Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling.Indicator:  Net enrollment ratio in primary education (UNICEF-WHO)  Proportion of population starting grade 1 who reach grade 5(UNESCO)  Literacy rate of 15-24 years old (UNESCO)Goal 3: Promote gender equality and empower womenTarget 4:  Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015. Indicator:  Ratio of girls to boys in primary, secondary and tertiary education (UNESCO)  Ratio of literate women to men, 15-24 years old (UNESCO)Goal 4: Reduce Child Mortality RateTarget 5:  Reduce by two thirds, between 1990 and 2015, the Under five mortality rate. 2
  • 8. Indicator:  Under-five mortality rate (UNICEF-WHO)  Infant mortality rate (UNICEF-WHO)  Proportion of eye year children immunized against measles.Goal 5: Improve Maternal HealthTarget 6:  Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.Indicator:  Maternal mortality ratio (UNICEF-WHO)  Proportion of births attended by skilled health personnel (UNICEF-WHO)Goal 6: Combat HIV/ AIDS, malaria, and other diseases Target 7:  Have halted by 2015 and begun to reverse the spread of HIV / AIDS. Indicator:  HIV prevalence among pregnant women aged 15-24 years (UNAIDS-WHI-UNICEF)  Condom use rate of contraceptive prevalence rate (UN Population Division)  Condom use at last high- risk sex (UNICEF –WHO)  Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV / AIDS (UNICEF-WHO)  Contraceptive prevalence rate (UN Population Division)  Ratio of school attendance of orphans to school attendance of non orphans aged 10- 14 years (UNICEF-UNAIDS-WHO) Target 8:  Have halted by 2015 and began to reverse the incidence of malaria and other major diseases. Indicator: 3
  • 9.  Prevalence and death rates associated with malaria (WHO)  Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures (UNICEF-WHO)  Prevalence and death rate associated with tuberculosis (WHO)  Proportion of tuberculosis cases detected and cured under DOTS (internationally recommended TB control strategy)Goal 7: Ensure Environmental SustainabilityTarget 9:  Integrate the principles of sustainable development into country policies and programme; reverse loss of environmental resources Indicator:  Proportion of land area covered by forest (FAO)  Ratio of area protected to maintain biological diversity to surface area (UNEP- WCMC)  Energy use (kg oil equivalent) per $1 GDP (PPP) (IEA, WORLD BANK)  Carbon dioxide emission per capita (UNFCCC, UNSD) and consumption of ozone- depleting CFCs (ODP tons) (UNEP-Ozone secretariat)  Proportion of population using solid fuels (WHO) Target 10:  Halve, by 2015,the proportion of people without sustainable access to safe drinking water and basic sanitation( for more information see the entry on water supply) Indicator:  Proportion of population with sustainable access to an improved water source, urban and rural (UNICEF-WHO)  Proportion of population with access to improved sanitation, urban and rural (UNICEF-WHO) Target 11:  By 2020, to have achieved a significance improvement in the lives of at least 100 million slum-dwellers. Indicator: 4
  • 10.  Proportion of households with access to secure tenure (UN-HABITAT)Goal 8: Develop a global partnership for developmentTarget 12-18:  Develop further an open, rule –based, predictable, non-discriminatory trading and financial system. Address the Special Needs of the Least Developed Countries (LDC). Address the special needs of landlocked developing countries and Small Island developing States.  Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term. In co-operation with pharmaceutical companies, provide access to affordable, drugs in developing countries.  In co-operation with the private sector, make available the benefits of new technologies, especially information and communications.Indicator:  Net ODA as percentage of Development Assistance Committee (DAC) donor’s Gross National Income (GNI)  Unemployment rate of young people aged 15-24 years, each sex and total (ILO)  Proportion of population with access to affordable essential drugs on a sustainable basis (WHO) 6. Objective: 6.1. General Objectives:  To analyze the progress towards achieving MDGS in Nepal. 6.2. Specific Objectives:To compare the various indicators such as;  % of population below $1 per day (PPP value)  Employment-to-population ratio  % of the population below the minimum level of dietary energy consumption  % of underweight children under 5 5
  • 11.  Share of women in wage employment in the Non agricultural sector (%)  Net enrollment rate in primary education (%)  Proportion of pupils starting grade 1 and reaching grade 5 (%)  Ratio of women to men at tertiary level  Literacy rate of people 15–24 years old (%)  Infant mortality rate (per 1,000 live births)  Under-5 mortality rate (per 1,000 live births)  % of 1 year-old children immunized against measles  Maternal mortality ratio (per 100,000 live births)  Proportion of births attended by skilled birth attendant  Contraceptive prevalence rate (%)  HIV prevalence among people 15–49 years old  (number of cases per 1000 of the population)  Proportion of the population with sustainable access to improved sanitation (%) etc. 7. The MDGs and NepalNepal has set up its long-term development targets in line with the MDGs. The MDG programsare linked with the programs of the ongoing 10th Plan (2002-2007). The achievements attainedby the end of the final year of the 12th Plan (2016/17) will be assessed with the achievements ofthe MDGs (NPC, 2002). If the objectives and targets of the 12th Plan are not fulfilled, the targetsof MDGs will also become futile and incomplete.Global Monitoring Report of 2004 lays emphasis on high and broad based economic growth,empowerment and investment increment for the achievement of the MDGs. In order to empowerthe people, services designed for the targeted people should be rendered timely with quality,quantity and participatory approach. Nepal faces problems pertaining to project design,implementation and attainment of the targeted results. At times, policy ambiguity becomes anacute barrier. Still, the implementing pitfalls and rampant corruption have been primarilyresponsible for the failure of the projects. This reality calls for an awareness right from thedesigning phase of the project to the end of implementation. 8. Key Strategies of NepalWhile the Nepal Government is committed to achieving the MDGs by putting the right policiesin place, improving efficiency and effectiveness of the interventions that contribute to reachingthe goals, and pursuing the required policy and institutional reforms, Poverty Reduction StrategyPaper (PRSP) should serve as a medium-term roadmap to get to the longer-term goals set out bythe MDGs, and thus needs to be fully aligned with the MDGs and backed up by resources. Alldevelopment activities must be strategically geared towards attainment of the Goals, which calls 6
  • 12. for enhanced coordination and harmonization among development actors. This, in turn, requiresa comprehensive development framework which(i) prioritizes MDG based programs, and sufficient resources allocated to such programs and(ii) Addresses the gender, caste, ethnicity, and spatial dimensions of poverty.The next cycle of PRSP/ 11th Plan is the crucial instrument for the operationalization of MDGsthrough the PRSP process. The followings would be the milestones for the government fullyintegrate MDGs in the PRSP process: (i) preparing the national planners to devising approach paper of the Plan towards attaining MDGs, (ii) revising MDG Needs Assessment (MDG NA) and making it as the entry point for building the PRSP so that each activity in each sector of the PRSP/ 11th Plan is tied up with the goals, targets and indicators of MDGs, (iii) initiating the consultation process at the central and local level, supporting key Ministries to develop MDG based sectoral business plans and programs in the process of PRSP preparation, (iv) engaging in dialogue with other stakeholders, and (v) Streamlining all donor programs towards the attainment of MDGs and coordinating aid programs to focus them towards this direction.The current MDG NA covers only agriculture, education, gender, health and rural infrastructuresector. In order to achieve all the Goals, the needs assessment needs to incorporate otherremaining MDGs related sectors such as energy, forestry, slum and global partnership. Based onthe findings of MDG NA and MDG Progress Report 2005 and the review of PRSP, the existinginstitutional arrangements need to be assessed, and recommendations and findings thereof needto be implemented. Capacity building for achieving MDGs requires covering;(i) Government and local bodies,(ii) Community workers and other volunteers.(iii) Civil Society Organizations (CSOs) including national non-governmental organizations and CBOs,(iv) private sector,(v) political activists, and(vi) Media.This need to be done by the preparation of CSO strategies, capacity building for utilizing CSOstrategies for moving towards MDGs, awareness creation to the private sector, and mobilizationof teachers, students, political activists, health workers and social volunteers.The government has introduced MTEF since 2002/03 for linking annual budget with PRSP,prioritizing the programs and projects, ensuring full budget release for the priority one projectseven in a situation of resource shortfalls, and linking resource allocation with intended output/outcome. This is critical step in translating MDG based development strategy into annual budgetprograms. Internalization of MDGs in the relevant Ministries through the business plan and 7
  • 13. MTEF requires training to the officials involved in planning and monitoring, MTEF, and MDGoperationalization.The existing MTEF Working Committees in all the line ministries have to be involved in thepreparation of MDG based annual program/budget, business plan, and monitoring and evaluationof sectoral programs. The committees should include planning and accounting officials inaddition to technical staff of the concerned ministries/departments and be trained in MDG basedPRSP, business plan and MTEF preparation, poverty monitoring and evaluation, and humandevelopment oriented approach to policy formulation and implementation. A Trainers’ TrainingMDG, PRSP and MTEF preparation should be provided to a wide range of staff of lineministries and their local agencies.Business Plans for major sectors like education, health, drinking water, agriculture and irrigation,and rural infrastructure (road and electricity) have been prepared. Making these business plansMDG based or at least MDG friendly is extremely necessary; as futurePRSP and MTEF process will build on these business plans.District Periodic Plans (DPPs) are instrumental in linking MDGs to annual developmentprograms of the districts. Currently, 52 districts have periodic plans prepared under the guidelineprovided by NPC. These Plans suffer from various shortcomings. First, plans are ambitious andprograms are not prioritized. Second, resource estimation is ad hoc and financing of theprograms is not sufficient. Third, they are developed with limited participation and focusdisproportionately on infrastructure (mostly road), often at the cost of pro-poor social, and MDGrelated programs. Localizing MDGs would require that DPP are MDG driven and sufficientlybacked with resources, which is not the case so far.Now, as midterm review of the DPPs is on unveiled, and as the remaining districts also need toprepare their DPPs if they are to be linked with the national PRSP, support in DPP strengtheningand up-scaling exercise is necessary. For localization of MDGs, there is huge area for mobilizing the local bodies including theVillage Development Committees and Municipalities. The current MDG Project has started toprepare the District MDG Progress report in some districts. But, given the remaining time for thedeadline, this process needs to be substantially expanded to other districts. The importance ofthis program would be: (i) awareness generation to general public at the district level; (ii) getting commitment and ownership on the MDGs by local government bodies – particularly from the district level policy makers, planners and bureaucrats, external development partners, non-governmental sectors including the private sectors; and (iii) Mobilization of all these stakeholders for preparing their MDG based time bound action plan.The process of devolution should not end at the district level. VDCs and municipalities are to betaken as the next stage of devolution. For MDG based resource allocation, VDCs need a visionand capacity to formulate plans and programs with priority on MDG and pro-poor areas. So far,the resource allocation pattern is ad hoc, based on who can garner pressure on the decision 8
  • 14. makers, resources are thinly distributed and in the absence of prioritization criterion, judgment ofthe key officials prevails in programming activities and financing them. For MDG basedprogramming at the village and municipal level, these bodies also need to have their perspectiveplans, prioritize them in line with the MDGs based PRSP, and sequencing activities as per thepriority so that resource could be optimally allocated to prioritized projects. There is a need thatNPC, DDCs, and donors pilot VDC plan preparation in selected villages and municipalities insome districts (preferably with the fully devolved districts). 9. Findings9.1. Progress toward the Millennium Development Goals and Targets Goals and Targets Current Status, against 2015 TargetGoal 1:Eradicate Extreme Poverty and Item 1990 Latest 2015Hunger % of population below $1 per day 33.5 24.1 (2005) 17 (PPP value)Target 1.A: Poverty gap ratio at $1.25 a day - 6.1 (2008) - Halve, between 1990 and 2015, (PPP) (%)the proportion of people whoseincome is less than $1 a day. Item 1990 Latest 2015 Employment-to-population ratio - 81.7 (2008) - Proportion of own-account and - 81.9 (2010) -Target 1.B: contributing family workers in totalAchieve full and productive employmentEmployment and decent workfor all, including women and Item 1990 Latest 2015young people. % of the population below the 49 22.5 (2006) 25 minimum level of dietary energy consumptionTarget 1.C: % of underweight children under 5 57 38.6 (2006) 29 Halve, between 1990 and 2015,the proportion of people whosuffer from hunger.Goal 2:Achieve Universal Primary Item 1990 Latest 2015Education Net enrollment rate in primary 64 93.7 (2009) 100 education (%)Target 2.A: Proportion of pupils starting grade 1 38 77.9 (2009) 100 Ensure that, by 2015, children and reaching grade 5 (%)everywhere, boys and girls Literacy rate of people 15–24 years 49.6 86.5 (2008) 100alike, will be able to complete a old (%)full course of primaryschooling. 9
  • 15. Goal 3:Promote Gender Equality and Item 1990 Latest 2015Empower Women Ratio of girls to boys at primary level 0.56 1.0 (2009) 1.0 Ratio of girls to boys at secondary 0.43 0.93 (2009) 1.0 levelTarget 3.A: Ratio of women to men at tertiary 0.32 0.63 (2007) 1.0Eliminate gender disparity in levelprimary and secondary Share of women in wage 18.9 19.9 (2009) -education, preferably by 2005, employment in the Non agriculturaland in all levels of education no sector (%)later than 2015. Proportion of seats held by women in 3.4 32.8 (2010) - Parliament (%) Item 1990 Latest 2015Goal 4: Infant mortality rate (per 1,000 live 108 41 (2010) 34Reduce Child Mortality births) Under-5 mortality rate (per 1,000 live 162 50 (2010) 54Target 4.A: births)Reduce by two thirds, between % of 1 year-old children immunized 42 85.6 (2009) >901990 and 2015, the under-5 against measlesmortality rate.Goal 5:Improve Maternal Health Item 1990 Latest 2015 Maternal mortality ratio (per 100,000 850 229 (2009) 213 live births)Target 5.A: Proportion of births attended by 7 28.8 (2009) 60Reduce by three-quarters, skilled birth attendantbetween 1990 and 2015, thematernal mortality ratio. Item 1990 Latest 2015 Contraceptive prevalence rate (%) 24 45 (2010) 67 Unmet need for family planning - 26.3 (2010) -Target 5.B: Contraceptive prevalence rate (%) 24 45 (2010) -Achieve, 2015, universal accessto reproductive health.Goal 6: Combat HIV/AIDS,Malaria, and Other Diseases Item 1990 Latest 2015 HIV prevalence among people 15–49 NA 0.5 (2009) - years oldTarget 6.A: Have halted by (%)2015, and begun to reverse, thespread of HIV/AIDS. Item 1990 Latest 2015 Prevalence rate associated with malaria 1.96 0.16 (2009) - (number of cases per 1000 of theTarget 6.C: Have halted by population)2015, and begun to reverse, the Prevalence associated with tuberculosis 460 280 (2005) -incidence ofmalaria and other majordiseases. 10
  • 16. Goal 7:Ensure Environmental Item 1990 Latest 2015Sustainability CO2 emission (tons per capita) - 0.2 (2005) -Target 7.A: Item 1990 Latest 2015Integrate the principles of Proportion of land area covered by 37 29 (2009) -sustainable development into forestcountry policies and programs (%)and reverse the loss of Proportion of terrestrial areas - 19.7 (2009) -environmental resources. protected (%) CO2 emissions, total (million tons) - 3 (2004) -Target 7.B: Reduce biodiversity loss, Item 1990 Latest 2015achieving, by 2010, a significant Proportion of the population with 46 80 (2010) 73reduction in the rate of loss. sustainable access to improved water sources (%) Rural 43 78 (2010) 72Target 7.C: Urban 90 94 (2010 95Halve, by 2015, the proportion Proportion of the population with 6 43 (2010) 53of people without sustainable sustainable access to improvedaccess to safe drinking water. sanitation (%) Rural 3 37 (2010) 52 Urban 34 78 (2010) 67 10. Discussion 11. ConclusionThe development area covers all aspects of changes needed to make human life easier. Manyinternational forums tried to bring all human needs & challenges focusing, synchronizing andbringing into a common plate form to resolve. But, there is still feeble consolidation andintegration to each other regardless the developed or developing. However, a global concern hasbeen started. 11
  • 17. 12. References A report on ‘‘Achieving the Health Millennium Development Goals in Asia and the Pacific Policies and Actions within Health Systems and Beyond’’ by Asia-Pacific MDG Study Series. A statistical data published by ‘‘The World Bank Group’’ ‘‘Achieving Millennium Development Goals: Challenges For Nepal’’ by Research Department, International Finance Division, Nepal Rastra Bank http://www.undp.org Nepal MDGs Progress Reports 2010. ‘‘Nepal’s progress towards Millennium Development Goals’’ by Asian Development Bank. THANKYOU www.facebook.com/sagun.paudel http://www.upload-slides.blogspot.com/ mail4sagun@gmail.com 12