Marty Logan

KATHMANDU, Oct 11 2006 (IPS) – Nine years ago Nepal s health ministry set up two health posts in remote Dhugesadh village, where the nearest hospital is a three to four day walk away. Till today, no doctors have arrived to staff them.
A doctor held one of the jobs for six months two years ago, but since then the posts have been vacant. Even at the district s Taplejung Hospital, only one of two doctor positions is ever filled at one time. If that doctor goes out for some work, there is no doctor at all, hospital chief Shree Ram Shah told Gorkhapatra newspaper.

Delivery of government services like health care must improve if Nepal is to achieve the United Nations Millennium Development Goals (MDGs) by the 2015 deadline, Shankar Sharma, former vice-chairman of the country s National Planning Commission, told IPS prior to an MDG meeting that started here Wednesday. There s no substitute for improved governance sending workers to the districts and keeping them in place, he added.

The MDGs are eight goals set by world leaders in 2000 for tackling extreme poverty and hunger and boosting development. Politicians, civil society activists, academics and private sector representatives from South Asia have gathered in Kathmandu to brainstorm how the region can move more quickly toward those goals.

A 2005 progress report concluded that progress in South Asia was erratic, both within countries and amongst nations. For example while India was on track to cut by half the number of people living on less than a dollar a day, its big challenge is child mortality and maternal mortality , according to Kim Hak-Su, UN under-secretary-general.

In South Asia, there is sufficient grain but for some reason the distribution is not good so you find hunger pockets and malnutrition , Kim, who is also executive secretary of the UN Economic and Social Commission for Asia and the Pacific (UNESCAP), told IPS Tuesday.
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We addressed this in our 2005 report. There is something wrong with service delivery across South Asia; the other side of the coin is institutional weakness, added Kim.

According to the report, A Future Within Reach, one of the most direct ways in which governments can address poverty and meet the MDGs is by ensuring adequate basic services for the poor, either by providing these services directly or by mobilising the private sector and civil society .

Sharma pointed out that while the number of health centres in Nepal skyrocketed by 400 percent from 1990 to 2005, the number of doctors rose by only 30 percent. Despite that, the country is on track to meet most of its MDG goals for health and education, thanks largely to a coordinated response from the government and donors of foreign aid. (Foreign loans and grants make up about 28 percent of revenues in Nepal s 2006-2007 budget.)

But a 100-percent increase in aid will be needed if Nepal is to meet its MDG goals, he predicted.

Another persistent South Asian problem is inequality. For instance, a Nepal government report released in September found that in 52 of the country s 75 districts the poverty rate was 35 percent, despite the national rate having declined from 42 to 31 percent in the period 1996-2004. In 25 remote districts, 45 to 60 percent of people were living in poverty.

To address such poverty pockets , development in two areas is essential, said Sharma: accessibility, so family farms can grow profitable cash crops instead of engaging only in subsistence agriculture; and education. This means that government has to do more to identify these areas and have very specific programmes for them. For example, it s one thing to say that primary schools will be a priority but where exactly will they go? he added.

According to Kim, such inequality is one outcome of the jobless growth seen throughout South Asia, where the vast majority of people already labour in the informal sector. Each country needs to find its own economic niche, he suggested. In my opinion Nepal can survive much better specialising in tourism, added Kim.

Sharma suggested that Nepal follow the lead of countries like Cambodia, which have adopted what they call MDG-Plus . The South-east Asian nation has taken on the eight millennium goals but added another to deal with one of its major concerns: clearing the millions of deadly landmines planted during the Khmer Rouge regime.

Nepal could include roads and electrification. For (landlocked) countries like Nepal, Bhutan and Laos, these are very important, said Sharma, who added that he was optimistic about making progress on the MDGs.

This peace process has given some hope. In the last 15 years there have been improvements in roads, education, etc. I m optimistic that probably 50 to 60 percent of the goals can be achieved.