This week I had the great pleasure of working with a distinguished international civil servant, public policy expert and peace advocate: Kul Gautam. A man with a long career in international development having served as the Deputy Executive Director of UNICEF and Assistant Secretary-General of the United Nations.
Kul joined us this week for our Nutrition Advocacy Tour. Over the last few days our guests, Kul Gautam and Walter Nyika, have met with various MPs, representatives from the media and RESULTS UK’s dedicated grassroots groups with the aim of raising the profile of nutrition ahead of the Prime Ministers Hunger Summit ‘Nutrition For Growth’ in June.
I had the opportunity to sit down with Kul and find our more about nutrition in Nepal.
A country of contrast
“This is a land of contrast.” Kul is talking about Nepal. The country where he grew up and now resides with his family. “[It] is a country with one of the highest burdens of malnutrition. It is one of the least developed countries, with very low per capita income. It is a country that has been in war, civil war, for 10 years… but surprisingly Nepal is making pretty good progress.”
In fact Nepal is on target to reach many of the Millennium Development Goals (MDGs), particularly MDG 4 – to reduce child mortality rates.
“If you look at stunting Nepal is one of the few success stories. Stunting has gone down from 57%, ten years ago, to 41%. Forty-one percent is still too high. But it is going down and that is significant for a country that has been in a period of flux, transition and civil war.”
“And you might ask ‘how could that happen?’ When poverty is so high, when there is political instability and when economic growth is very poor.” Kul credits Nepal’s success in this area to 50,000 female community health volunteers (FCHV). Recognising the that for many people care happens in the home by family or community based caregiver, Nepal has focused on teaching health workers the importance of things such as breastfeeding, micronutrient supplementation and anti-natal check ups, and then having them spread the word throughout their communities. These community health workers, the majority of them volunteers, are fundamental in build partnerships and linkages with sometimes overburdened health services.
“Today in Nepal, if you look at vitamin A coverage it is as high as 95%, consistently for a decade… Nepal’s [vitamin A] coverage is one of the highest in the world, largely thank to these female community health workers and their outreach. They do amazing things.”
A micronutrient masterpiece
Nepal’s micronutrient success is not exclusive to their Vitamin A coverage.
“When I was a child, in my village and wherever I went, I always saw lot of people with this big goitre; this huge bulge on their neck. And that was so common that we took it for granted that, yes, you get this thing and okay it’s a little inconvenient, it’s ugly, but it’s the way it is. [But] today, you don’t see any.”
“We have made tremendous progress to ensure all the salt consumed in Nepal is iodized." This is very interesting considering Nepal is a landlocked country. "We don’t have access to the sea and we don’t produce any salt... [In fact] all the salt in Nepal comes from India. Yet, Nepal has a higher rate of converge of iodized salt than India." Kul credits the this success to the progressive action of the countries health leaders.
“We used to think, as a child, that it was just an ugly bulge, but is has far more repercussions on the intellectual development on children. It is the world’s most widespread cause on mental disability, lower IQ and lower ability to learn in school. So once we solved that problem, many other problems have been solved. Not only in health and nutrition, but in education.”