Unfortunately, even as the end of the third fiscal year since the commencement of the fortified flour distribution program nears, under-two babies in Karnali remain practically deprived of dietary nutrition. Last year, under-two babies were provided fortified flour only for three months. [break]
As per the government’s plan, announced by then finance minister SurendraPandey in a budget speech, under-two babies were to be given fortified flour every month. However, due to the lengthy procurement process, budget crunch and lack of coordination between the Child Health Division (CHD) and the Logistics Management Division (LMD) or between District Public Health Offices (DPHOs) and health posts, the fortified flour distribution drive has failed to make any impact so far.
“Last year, much of the fortified flour meant for under-two babies was consumed by their parents,” says LalBahadurShahi, in-charge of a health post in Raralihi village in Jumla. “We warned them we would stop the flour distribution if they did not feed their babies properly. But, they did not listen.” Shahi says the flour distribution is useless if the distribution is not regular. “As long as children are not fed the fortified flour regularly every month, they will remain undernourished,” he says.
Children suffer
KapureBishwakarma, a 25-year-old Dalit from Daha VDC-1 of Kalikot district, inherited a patch of semi-arid land from his father when he decided to live apart with his newly-wed wife four years ago.
What motivated Kapure -- who looks strikingly lean and older than his actual age possibly because of lack of nutritious -- to break away from a large joint family was a normal father’s natural aspiration for the good health of his offspring. He wanted to feed his children adequately -- something impossible as long as he lived in a joint family.
However, despite opting for a nuclear family, Kapure failed to feed his two little daughters properly. Last season, excessive rainfall badly damaged his crop, which in any case was not good in the previous two years also due to lack of proper irrigation. Faced with severe food shortage, Kapure, like other locals, went to India.
“The crop does not last more than three months,” Kapure says. “Every year, I need to work either in the village or in India to feed my family for the remaining nine months.” In Kalikot, he occasionally earns a few kilos of rice under the World Food Program (WWF)’s food-for-work scheme, but this is sufficient only for a couple of weeks.
Early this month, when a Republica correspondent reached Kapure’s house, his wife Mandara, 22, was baking roti inside a smoke-filled room. “This is our lunch,” she said, putting her infant daughter Nirmala to sleep on a cot. Her first daughter, three-year-old Rita, is underweight. She weighs barely 11 kg. She would have weighed at least 15 kg by now had she been fed adequately.
“We give our children roti in the morning and rice-curry in the evening,” she says. “We have nothing else to feed them during the day.”
The story of Kapure and Mandara is not unique in Karnali. The lack of irrigation, modern agricultural techniques or proper road connection, among several other things, have made it difficult for people there to eke out a living. So most of their children, and especially those below five, are undernourished.
Percentages of stunted, wasted and underweight children -- the three forms of malnourishment -- are stunningly high in Karnali compared to the national averages. Last March, when SulochanaShahi, a village facilitator of UNICEF’s Decentralized Action for Children and Women (DACAW) program, weighed 21 under-three children in the Motelaneighborhood of Daha village, nine of them were found to be underweight.
If Motela is anything to go by, the percentage of those underweight is far higher than the national average of 29 percent.
“In this village, underweight children can be found in almost every other house,” says Shahi. Only a month ago, DhannameBishwakarma, 48, and his wife Bhugi, 40, had twin boys who were also underweight. “Today, unlike in the past, mothers do not waste their colostrums. They are aware about children’s health. But the incidence of malnourishment is still far higher in our villages.”
Only for six months
The government’s fortified flour distribution program in Karnali was meant for children like Kapure and Mandara’s under-weight daughter. But the program has evidently failed to protect children vulnerable to malnourishment.
This year also, the Department of Health Services (DoHS)’s CHD is planning to distribute fortified flour for under-weight babies for only for six months due to the lack of adequate budget. According to Raj Kumar Pokharel, Chief of Nutrition Section at CHD, only Rs 30 million has been allocated for distributing fortified flour in Karnali. “This is enough only for six months,” says Pokharel.
Last year, according to Pokharel, only Rs 10 million was allocated, which bought enough flour for only three months. “The government announced the plan but did not allocate the budget,” he says. “At least Rs 90 millions is necessary for feeding under-two babies every day year round.”
Though the program is implemented by CHD, the DoHS’s LMD is responsible for purchasing and supplying fortified flour to all five district headquarters in Karnali. The CHD has asked the LMD to supply all the flour for Karnali within the first three months of manufacture of the flour. However, it now appears only a few months of shelf life remains for the flour when it reaches Karnali.
The LMD had supplied only 1,800 cartons containing one kg packets of flour and 700 cartons containing 500 gram packets to Jumla by the second week of April. The flour was manufactured by an Indian agro-food company based in Orissa in December. This means the first three months of shelf life have already elapsed. But, the LMD is yet to supply more cartons of the fortified flour to Jumla.
According to RoshanlalChaudhari, chief of District Public Health Office (DPHO) in Jumla, 2,500 cartons containing one kg flour packets and 1,500 cartons containing 500 gram packets are required just for three months. “We also lack the budget for delivering flour to all the villages,” he says. “We have no money for distributing flour to every village every month. We can give them the flour just once.”
Tackling malnourishment is key to achieving the MDG-4 of reducing infant mortality and under-five mortality to 36 and 54 percent respectively by 2015-end. And, the government has realized that malnourishment cannot be done away with unless children in Karnali are better nourished. However, the government’s first significant intervention in protecting children in Karnali has turned out to be like any other government program.
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