Impossible goals to acheive in MDGs

Nepal government has pledged to the Millennium Development Goals (MDG), eight broad goals to be achieved by 2015. Among these, two sectors, basic health and primary education, are considered key to human development. Nepal’s performance in these seems far short of the mark, which will have prolonged negative impact on the country. However, these are also two areas in which the government is claiming great success. Even if we rely on the government statistics such as the Economic Survey 2013, the gap between what we have achieved and what we planned to is wide. Moreover, some recent incidents indicate that these government statistics could be misleading. With little more than two years remaining, the achievement of MDG seems impossible, though it is heavily funded by donor agencies (mainly UNDP) and given high priority by the government.

One of the crucial health indicators of MDG is the maternal mortality rate. The target was to reduce it to 134 deaths per 100,000 live births by the end of 2015. The Economic Survey 2013 states that there have been 250 deaths per 100,000 live births in the current fiscal year. Only 29 percent of the deliveries are made by skilled midwifes. Recently we heard of Lachima Budha of Mugu who died after she had to carry a dead fetus inside her for several days in the absence of a hospital or doctor. Then there was Kristina Gurung of Gorkha who had to spend Rs 60,000 to stay for a month at a hotel in the district headquarters because there was no birthing center in her locality. Sources at Gorkha hospital reported that each month, about 100 pregnant women avail of their facilities, among whom 30 stay in hotels. These case stories depict the gloomy reality behind government statistics. About 85 percent Nepalis live in rural areas where skilled midwifes, doctors or medicine are seldom available. One recent report by the Ministry of Health was an eye-opener. Deepak Dahal in Nagarik (Aug 19, 2013) reports a serious malpractice at Sushma Koirala Memorial Trust. The Trust has initiated a campaign against uterus prolapse in Surkhet. During inspection by MoH, it was found that this campaign has violated basic WHO norms for safe handling. For example, two doctors made 30 operations in a day, when WHO restricts more than six operation a day. More seriously, they amputated the uterus of many women when they could have given medicines or alternative treatment. In the MoH report, several cases reported as uterus operation were merely medical checkups. Such records have produced overestimated figures in government statistics. The Sushma Trust, which has no hospital of its own, has conducted such campaigns in more than a dozen locations including Kathmandu, Mahottari, Dailekh, Kalikot, Surkhet and Rukum. Agencies that conduct such operations are given government subsidy of Rs 1,200 per operation in Tarai, Rs. 1300 per operation in hills and Rs. 1,500 per operation in mountains. However, Sushama Trust is not the first to misuse such subsidies. In its inspection report, MoH identified several such cases. Modern family planning methods are considered important for reducing population growth, abortion, infant mortality, and maternal mortality. MDG had set a target of raising the number of users of such methods to 67 percent by 2015. As per the Economic Survey, in 2012-13 only 48 percent women of fertile age were using these techniques. In contrast, 27 percent of the women of reproductive age lack access to family planning tools, resulting in 200,000 unwanted pregnancies. Technically, we can call it ‘unmet demand’, that is, these women desire some family planning tools, but do not have access to it. A news in Nagarik (August 28, 2013) mentions Srijana BiKa of Gorkha, who says her fourth pregnancy is an unwanted one, as family planning tools are unavailable at the rural primary health centers. This despite the fact the government spends about Rs 300 to 350 million each year on Family Planning programs. The second most acclaimed area of government reform is education. Despite the fact that government budget for education sector has more than doubled in the last five years—going from Rs 27 billion to Rs 63.91 billion—SLC results, a major indicator of education, have been consistently discouraging. Meanwhile, performance gap between private and public schools is widening. The SLC result of 2012 shows that only one in four students of public schools have passed SLC, whereas nine in ten students from private schools passed. School Sector Reform Program, which was intended to improve the quality of education in government schools, has apparently failed. This five-year long donor supported project, implemented in some pilot districts, is ending in December 2013. However, the performance of public schools was miserable in all these districts, a waste of Rs 257 billion funds poured into the program. There have been news about officially registered schools that got government funds, but had no physical existence. Such virtual schools were reported to be in hundreds, especially in Tarai districts of Mahottari, Rautahat, Parsa and Dhanusha. This indicates a nearly absent inspection and monitoring by the government. Such virtual schools naturally bloat the statistics of students and teachers as well as number of literates. One of the MDG goals was 100 percent Net Enrollment Rate in primary education and no Drop-outs up to class five. Reportedly, we achieved 95 and 84 percent of these goals respectively. But in fact, several government schools are going to be closed or merged due too many students dropping out. Department of Education has just announced merging of 30 schools in Nuwakot and 10 schools in Kathmandu. Public schools have been suffering from incompetent and politically-motivated teachers. The absence of local elected bodies and the void at the center; political turmoil, donor-driven mentality and bureaucratic negligence are impeding our development. The two sectors discussed here, health and education, are just examples. Other sectors where the government has not claimed high achievement are in similar or worse conditions, with any optimistic data a big suspect.