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. Acknowledgement
The students of Bachelor of Public Health 2 nd semester of 2nd year like to express our humbly
thanks to all those who have supported and helped us in accomplishing this term paper in the
topic ‘‘ANALYZE THE PROGRESS TOWARDS ACHIEVING MDGs IN NEPAL’’.
We would like to convey our heartfelt thanks to all those who were directly or indirectly
concerned with this and to all our well wishers.
First of all we would like to thank our respected subject teacher Mr. Diphendra Kumar yadav for
giving 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 and
valuable suggestion and full support during preparation of term paper.
This term paper is written in simple language, with every bit of necessary information related to
the topic so that studying independently also would not find any difficulties. We think that this
effort will help every individual to understand about the information of the related topic.
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3. 2. ACRONYMS
ADB : Asian Development Bank
AIDS : Acquired Immune Deficiency Syndrome
BMI : Body Mass Index
CBOs : Community Based Organizations
CMR : Child Mortality Rate
DALYs : Disability Adjusted Life Years
DOHS : Department of Health Services
DOTS : Directly Observed Treatment Short Course
EHCS : Essential Health Care Services
FAO : Food and Agriculture Organization
FCHVs : Female Community Health Volunteers
FY : Fiscal Year
GDP : Gross Domestic Product
GNP : Gross National Product
HDR : Human Development Report/UNDP
ILO : International Labour Organization
IMCI : Integrated Management of Childhood Illness
IMF : International Monetary Fund
IMR : Infant Mortality Rate
INGOs : International Non-Governmental Organizations
MCHW : Maternal and Child Health Worker
MDGs : Millennium Development Goals
MMR : Maternal Mortality Rate
MOHP : Ministry of Health and Population/Nepal
MTEF : Medium Term Expenditure Framework
NGOs : Non-Governmental Organizations
NLSS : National Living Standard Survey/Nepal
NMR : Neonatal Mortality Rate
NPC : National Planning Commission/Nepal
NRB : Nepal Rastra Bank
PCE : Per Capita Expenditure
PEM : Protein Energy Malnutration
PGR : Poverty Gap Ratio
PPP : Purchasing Power Parity
PRGF : Poverty Reduction and Growth Facility/IMF
PRSP : Poverty Reduction Strategy Paper
Rs. : Rupees/Nepalese
SLTHP : Second Long Term Health Plan
STD : Sexually Transmitted Disease
UN : United Nations
UNAIDS : United Nations Program on HIV/AIDS
UNDP : United Nations Development Program
UNESCO : United Nations Education and Social Council
UNFPA : United Nations Fund for Population Activities
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4. UNICEF : United Nations Children's Fund
VDC : Village Development Committee/Nepal
WB : World Bank
WDR : World Development Report/WB
WFP : World Food Program
WHO : World Health Organization
WTO : World Trade organization
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5. 3. Table of contents
1. Acknowledgement ...................................................................................................................................... ii
2. ACRONYMS ................................................................................................................................................. iii
3. Table of contents ........................................................................................................................................ v
4. Introduction ................................................................................................................................................. 1
5. 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 ............................................................................... 5
6. Objective:..................................................................................................................................................... 5
6.1. General Objectives:.................................................................................................................................. 5
6.2. Specific Objectives: ............................................................................................................................. 5
7. The MDGs and Nepal .................................................................................................................................. 6
8. Key Strategies of Nepal ............................................................................................................................... 6
9. Findings ........................................................................................................................................................ 9
9.1. Progress toward the Millennium Development Goals and Targets ..................................................... 9
10. Discussion ..............................................................................................................................................11
11. Conclusion .............................................................................................................................................11
12. References .............................................................................................................................................12
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6. 4. Introduction
The UN global conferences of the 1990s drew up a number of different key global Development
goals and targets to focus equalize and harmonize the needs and status of the people all over the
world. These goals and targets were known as the International Development targets. Again in
2000, the representatives of 189 nations, including 147 heads of state and Government adopted
the Millennium Declaration during the Millennium Development Summit (September 6-8, 2000)
of the United Nations. The Millennium Declaration focused on peace, security and development
concerns comprising environment, human rights and good governance. In this connection, the
Declaration tried to mainstream a set of interconnected and mutually reinforcing development
goals into a global agenda. The international development targets and the development goals
were merged together and renamed as the Millennium Development Goals (MDGs).
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. 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 UN
Secretariat, and specialized UN agencies, the World Bank, IMF and OECD.
The Millennium Development Goals were developed out of the eight chapters of the United
Nations Millennium Declaration, signed in September 2000.There are eight goals with 21 targets,
and a series of measurable indicators for each target.
5. Goals
Goal 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)
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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 consumption
Goal 2: Achieve universal primary education
Target 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 women
Target 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 Rate
Target 5:
 Reduce by two thirds, between 1990 and 2015, the Under five mortality rate.
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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 Health
Target 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:
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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 Sustainability
Target 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:
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10.  Proportion of households with access to secure tenure (UN-HABITAT)
Goal 8: Develop a global partnership for development
Target 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
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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 Nepal
Nepal has set up its long-term development targets in line with the MDGs. The MDG programs
are linked with the programs of the ongoing 10th Plan (2002-2007). The achievements attained
by the end of the final year of the 12th Plan (2016/17) will be assessed with the achievements of
the MDGs (NPC, 2002). If the objectives and targets of the 12th Plan are not fulfilled, the targets
of 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 empower
the 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 an
acute barrier. Still, the implementing pitfalls and rampant corruption have been primarily
responsible for the failure of the projects. This reality calls for an awareness right from the
designing phase of the project to the end of implementation.
8. Key Strategies of Nepal
While the Nepal Government is committed to achieving the MDGs by putting the right policies
in place, improving efficiency and effectiveness of the interventions that contribute to reaching
the goals, and pursuing the required policy and institutional reforms, Poverty Reduction Strategy
Paper (PRSP) should serve as a medium-term roadmap to get to the longer-term goals set out by
the MDGs, and thus needs to be fully aligned with the MDGs and backed up by resources. All
development activities must be strategically geared towards attainment of the Goals, which calls
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12. for enhanced coordination and harmonization among development actors. This, in turn, requires
a 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 MDGs
through the PRSP process. The followings would be the milestones for the government fully
integrate 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 infrastructure
sector. In order to achieve all the Goals, the needs assessment needs to incorporate other
remaining MDGs related sectors such as energy, forestry, slum and global partnership. Based on
the findings of MDG NA and MDG Progress Report 2005 and the review of PRSP, the existing
institutional arrangements need to be assessed, and recommendations and findings thereof need
to 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 CSO
strategies for moving towards MDGs, awareness creation to the private sector, and mobilization
of 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 projects
even 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 budget
programs. Internalization of MDGs in the relevant Ministries through the business plan and
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13. MTEF requires training to the officials involved in planning and monitoring, MTEF, and MDG
operationalization.
The existing MTEF Working Committees in all the line ministries have to be involved in the
preparation of MDG based annual program/budget, business plan, and monitoring and evaluation
of sectoral programs. The committees should include planning and accounting officials in
addition to technical staff of the concerned ministries/departments and be trained in MDG based
PRSP, business plan and MTEF preparation, poverty monitoring and evaluation, and human
development oriented approach to policy formulation and implementation. A Trainers’ Training
MDG, PRSP and MTEF preparation should be provided to a wide range of staff of line
ministries 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 plans
MDG based or at least MDG friendly is extremely necessary; as future
PRSP and MTEF process will build on these business plans.
District Periodic Plans (DPPs) are instrumental in linking MDGs to annual development
programs of the districts. Currently, 52 districts have periodic plans prepared under the guideline
provided by NPC. These Plans suffer from various shortcomings. First, plans are ambitious and
programs are not prioritized. Second, resource estimation is ad hoc and financing of the
programs is not sufficient. Third, they are developed with limited participation and focus
disproportionately on infrastructure (mostly road), often at the cost of pro-poor social, and MDG
related programs. Localizing MDGs would require that DPP are MDG driven and sufficiently
backed 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 to
prepare their DPPs if they are to be linked with the national PRSP, support in DPP strengthening
and up-scaling exercise is necessary.
For localization of MDGs, there is huge area for mobilizing the local bodies including the
Village Development Committees and Municipalities. The current MDG Project has started to
prepare the District MDG Progress report in some districts. But, given the remaining time for the
deadline, this process needs to be substantially expanded to other districts. The importance of
this 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 be
taken as the next stage of devolution. For MDG based resource allocation, VDCs need a vision
and 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
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14. makers, resources are thinly distributed and in the absence of prioritization criterion, judgment of
the key officials prevails in programming activities and financing them. For MDG based
programming at the village and municipal level, these bodies also need to have their perspective
plans, prioritize them in line with the MDGs based PRSP, and sequencing activities as per the
priority so that resource could be optimally allocated to prioritized projects. There is a need that
NPC, DDCs, and donors pilot VDC plan preparation in selected villages and municipalities in
some districts (preferably with the fully devolved districts).
9. Findings
9.1. Progress toward the Millennium Development Goals and Targets
Goals and Targets Current Status, against 2015 Target
Goal 1:
Eradicate Extreme Poverty and
Item 1990 Latest 2015
Hunger % 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 whose
income 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 total
Achieve full and productive employment
Employment and decent work
for all, including women and Item 1990 Latest 2015
young people.
% of the population below the 49 22.5 (2006) 25
minimum level of dietary energy
consumption
Target 1.C: % of underweight children under 5 57 38.6 (2006) 29
Halve, between 1990 and 2015,
the proportion of people who
suffer from hunger.
Goal 2:
Achieve Universal Primary
Item 1990 Latest 2015
Education 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) 100
alike, will be able to complete a
old (%)
full course of primary
schooling.
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15. Goal 3:
Promote Gender Equality and
Item 1990 Latest 2015
Empower 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
level
Target 3.A: Ratio of women to men at tertiary 0.32 0.63 (2007) 1.0
Eliminate gender disparity in level
primary and secondary Share of women in wage 18.9 19.9 (2009) -
education, preferably by 2005, employment in the Non agricultural
and 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 2015
Goal 4: Infant mortality rate (per 1,000 live 108 41 (2010) 34
Reduce Child Mortality births)
Under-5 mortality rate (per 1,000 live 162 50 (2010) 54
Target 4.A: births)
Reduce by two thirds, between % of 1 year-old children immunized 42 85.6 (2009) >90
1990 and 2015, the under-5 against measles
mortality 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) 60
Reduce by three-quarters, skilled birth attendant
between 1990 and 2015, the
maternal 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 access
to 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 old
Target 6.A: Have halted by (%)
2015, and begun to reverse, the
spread of HIV/AIDS. Item 1990 Latest 2015
Prevalence rate associated with malaria 1.96 0.16 (2009) -
(number of cases per 1000 of the
Target 6.C: Have halted by population)
2015, and begun to reverse, the
Prevalence associated with tuberculosis 460 280 (2005) -
incidence of
malaria and other major
diseases.
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16. Goal 7:
Ensure Environmental
Item 1990 Latest 2015
Sustainability CO2 emission (tons per capita) - 0.2 (2005) -
Target 7.A: Item 1990 Latest 2015
Integrate the principles of Proportion of land area covered by 37 29 (2009) -
sustainable development into forest
country 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 2015
achieving, by 2010, a significant Proportion of the population with 46 80 (2010) 73
reduction in the rate of loss. sustainable access to improved
water sources (%)
Rural 43 78 (2010) 72
Target 7.C: Urban 90 94 (2010 95
Halve, by 2015, the proportion Proportion of the population with 6 43 (2010) 53
of people without sustainable sustainable access to improved
access to safe drinking water. sanitation (%)
Rural 3 37 (2010) 52
Urban 34 78 (2010) 67
10. Discussion
11. Conclusion
The development area covers all aspects of changes needed to make human life easier. Many
international forums tried to bring all human needs & challenges focusing, synchronizing and
bringing into a common plate form to resolve. But, there is still feeble consolidation and
integration to each other regardless the developed or developing. However, a global concern has
been started.
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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.
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