Attending the 'discharge' ceremony (Credit: UNMIN / Chandra Shekhar Karki)

It’s been a while since I’ve blogged, but lots has been happening here in Nepal. If I’d written before Christmas, I think that my blog would have been pretty downbeat. Up until almost the very end of the year there was very little progress on the peace process and it was getting harder to be optimistic (as I generally like to be!) about the way things were going.  Parliament was still being blocked, there were still strikes (bandhs) which meant total shut down throughout the Kathmandu Valley – no motorised vehicles of any kind, the drafting of the constitution was well behind schedule and it seemed that the key players didn’t really want to talk to each other.

With a new year, comes – potentially – a new beginning. Now I don’t want to sound naïve, but there has been positive progress in the last few weeks. To name just a few, just before Christmas the Maoist Party stopped blocking parliament, so for the first time in months Nepal has a fully functioning parliament. The long awaited High Level Political Mechanism – which is supposed to resolve the really knotty peace process issues such as the future of the 19,600 ex-Maoist fighters – has been formed with the participation of the three largest political parties, and they are talking (always a good thing!). And lastly – and I think potentially most heartening – the discharge of the so-called “disqualified” combatants from the camps has been completed peacefully.

Disqualified Maoists queueing for the discharge process at MCS 6 Surkhet (Credit: UNMIN / Chandra Shekhar Karki)

There are about 4,000 “disqualified” – really a strange term to use – of which around 3,000 were under age when they joined the Maoist army (they were child soldiers during the war, even though many are now over 18), and about 1,000 were late recruits to the Maoist army (they joined after the fighting was officially over). I went to the far west of Nepal last week, to a place near Surkhet, to witness one of the discharge ceremonies. It was very interesting and really quite moving. Quite a few of the “disqualified” had already left the camps, but there were still over 600 in this camp alone who were to be discharged.

All the “disqualified” were registered with the UN monitors (see the photo) and given an identity card, which certifies them as an ex-combatant. The card also has a telephone number on it which these young people can call any time in the next year and get advice on what to do next. There are four “packages” available to them to help them reintegrate back into civilian life: vocational training; training as a health worker; setting up their own business or going back to school. The UK has helped fund these packages, which are offered by the UN and its partners on behalf of the government.

Ex-Maoist combatants prepared to leave (Credit: UNMIN / Chandra Shekhar Karki)

At the ceremony, there were some speeches (you can see me on the podium with the UN and Maoist commanders) by the Maoist Commandant of the camp, the Deputy Commander of the Maoist Army, and the Head of the UN in Nepal. They were then each given a tikka (red mark on their foreheads) and a garland of marigolds, and sent towards the buses which would take them to the nearest town from which they start their way home and to a new life.

I watched the faces of these young people. There is some anger amongst them that they fought for what they believed in and now they are being discharged and sent home and being told that they are “disqualified” – the term in Nepali is apparently even more negative, meaning almost “unfit”. Some of the young men had been drinking, causing a bit of trouble and breaking chairs to vent their frustration and anger the morning we arrived for the ceremony. The ceremony however passed peacefully and the looks on most of these young faces as they passed me to go to the bus was sad, lost, many tearful, some defiant, some clearly very apprehensive. Understandable when you consider that most of their adult lives had been fighting for or living in a camp under the control of the Maoist army. They probably had little idea what was waiting for them outside the camp. My heart really went out to them, especially the young girls, with young babies, of whom there were quite a few. Take a look at this excellent photo essay from UNICEF which brilliantly captures the process.

Ready to load (Credit UNMIN / Chandra Shekhar Karki)

The discharge of the “disqualified” is now over. We can’t really say if it was successful or not yet, as that will depend on how these young people are welcomed back to their villages and hopefully reintegrated into civilian life. I really hope that they all manage to forge for themselves a more peaceful existence in a peaceful Nepal.

This is one important step forward, but a huge challenge awaits, which is to resolve the future of the remaining 19,600 ex-Maoist fighters still in the camps, and to help them move on to a new life.......

Geri and the Prime Minister at the launch

As you may have seen from the press, Geri Halliwell (ex-Spice Girl) was here a few weeks back as a UNFPA Ambassador to help raise awareness of women’s issues in Nepal. While here, Geri helped launch a Violence Against Women campaign together with the Prime Minister of Nepal, visited a number of programmes run by the UN to provide support and protection to abused women, and she also met Sapana Malla, a member of the Constituent Assembly (an MP) and also a powerful and impressive advocate for women’s rights in Nepal.

Violence against women is an incredibly important issue here and it was good to have a celebrity such as Geri to help create awareness both here and abroad about the awful situation that many women in Nepal face, often in their own homes. In fact the more I get to learn about the position of women here in Nepal, the more shocked I become. I recently learned that the number one cause of death for women of reproductive age is suicide. That’s a truly dreadful statistic and we don’t know enough about what lies behind this, but one can assume that these women must have suffered pretty appallingly before they resort to suicide. And unfortunately much of the time victims of abuse or violence, or the victims’ families, have nowhere to turn for help, safety or support.

Let me tell you a very tragic, true story that happened just the other week, very close to home.

A colleague of mine was approached by her housekeeper whose sister had come to her very upset because a neighbour’s 12-year-old daughter had been found raped and murdered earlier that day. The girl was from a poor family, and the family believed the perpetrator was their wealthy landlord’s son because he had abducted her a few days earlier. The family were trying to contact the landlord to talk to him about the abduction, but had not been successful.

It is important here to emphasise how rich and powerful landlords in Nepal can be and how poor and powerless the tenants. After the girl had been missing for 3 days her parents found her body in nearby woodland. They went to the police to file a report, but the police initially refused. Then they changed their minds and agreed, but only if the family paid them a large amount of money (which they did not have). It was at this point that the housekeeper went to my colleague and asked for help.

Sapana Malla the MP and women's advocate

My colleague called Sapana Malla, the MP and women’s advocate I mentioned earlier, and asked for help. They went early the next morning to the police station. Once confronted by Sapana and her team, the police then filed a report with no payment from the family. The next day, the suspect (and a friend) were arrested and the police were saying that they would not be allowed bail as the charge was so serious.

In this case, Sapana and her team will continue to provide support to the victim’s family. Obviously it will not bring the little girl back, or undo the dreadful crime, but it does mean that the family have a chance at some form of justice, which it looks unlikely they would otherwise have had.

It is women like Sapana and her team who we in DFID want to support more, so that they can help more families like this, and try to remove the sense of impunity that exists. We are looking at how we can increase local level support, maybe through training to police stations, maybe through support to local level legal centres, where people can go in cases such as these. Poor people otherwise have very few options and, if it hadn’t been for the housekeeper’s plea for help, in this case also the family may have had nowhere to turn.

Diseased crops in Mustang. Credit: Sunil Pant

It seems that everywhere I look at the moment I am hearing stories about how climate change is affecting people’s lives here – in really tangible ways. The Nepali Constituent Assembly Member, Sunil Pant, recently led a cross party mission of MPs to the district of Mustang, in Nepal’s Himalayan region. There the MPs saw and heard evidence that the communities were finding hard to manage changing weather patterns, growing incidence of extreme weather events such as frequent droughts and floods, break out of crop diseases, livestock diseases and conflicts over sharing scarce water. A lot of people are now aware that the glaciers are melting, but for example, the apple farms in Mustang are being devastated as warmer and drier winters and high temperatures have meant that the quantity and quality of apple productivity has gone down; the houses are made with clay roofs, which should be able to withstand snowfall, but are not designed to withstand the heavy rains the villagers are now experiencing; and goats and some traditional crops are dying due to new kinds of diseases (see photo) that the farmers haven’t seen before and are attributing to the changing seasons.

More landslides are being triggered by the changing weather, destroying routes

But it’s not just in Mustang that climate change is being felt – it’s all over Nepal. Pasang Tamang, has spent 50 years of his life in Ward Number 4 of Bhorle Village in the Rasuwa District. According to Pasang, the temperature has definitely increased. Papaya never used to grow in his yard but now it bears fruit. A local flower, Aaru, used to bloom in March but now it blooms much earlier, starting in December/January, similarly, another local plant, the Shorea robusta (I don’t know the Nepali name) has started shedding leaves much earlier than before. Pasang is also worried because landslides have already destroyed 13 of the 15 water mills in the Ghatte River, the river that borders ward 1 and 4 of Bhorle. And again, stories of increased instances of diseases, this time in people – according to Pasang diseases such as jaundice, which were unknown to him and his folks in the village until a few years ago, now seem to be spreading rapidly. 

Communities have had to take shelter in stone caves because of the changes and impacts of landslides

Now I’m no expert, but something bad is going on – directly affecting people’s lives - and climate change seems the most likely reason. It must be pretty scary when seasons and patterns that you have lived with all your life (and for generations before you) suddenly start changing in a few short years. This is why we are trying to do what we can in Nepal to help people adapt to climate change, so that they can at best live with, and perhaps even benefit from, these strange changes that are happening in their villages.

 

This blog features as part of Blog Action Day and the Act on Copenhagen campaign

Sarah Ferguson meets Prime Minister Madhav Kumar Nepal

The Duchess of York, Sarah Ferguson, was here last weekend to see the work that Nepal is doing on health care provision for mothers and babies. The Duchess, who – for those that don’t know, used to be married to the Queen’s son, Prince Andrew – was here primarily with the White Ribbon Alliance which promotes safe motherhood, but I am pleased to say that she also had the opportunity to find out about what we, DFID, are doing here.

The Duchess met the Prime Minister of Nepal, (also called Madhav Kumar Nepal – see the photo) and congratulated him on the progress that has been made in making childbirth safer in Nepal and improving the chances of babies surviving to their fifth birthdays.

Duchess of York Sarah Ferguson with women and children at Bungamati

And indeed, despite all the challenges in this country, there has been really good progress on this issue and the numbers of women dying in childbirth has fallen by nearly half.  But still, every four hours in Nepal a woman dies due to pregnancy and/or childbirth complications, and 6 in 100 children will not see their fifth birthdays. Still too many by far. In the UK it is just under 1 maternal deaths per week and 6 deaths of under five children per 1000 live births.

The Duchess of York at the maternity hospital

The Duchess visited a maternity hospital in Kathmandu. Here you can see us both talking to Laxmi who had given birth 4 hours earlier. No wonder she looks exhausted! Laxmi and all the other women in the hospital had received excellent care. Most women in Nepal are not so lucky.

Just this week the papers have been full of reports of how the Prime Minister himself saved a woman who would otherwise have died in childbirth.  Kamala, it is reported, was bleeding profusely during her labour and her chances of survival were slim. The PM somehow got to hear of Kamala's situation and diverted his helicopter from an official visit to her small town in remote Rukum district. The PM's action meant that Kamala was quickly brought to Kathmandu, and actually to the same maternity hospital where Laxmi had received her care.  I'm pleased to say that reports are that Kamala is doing well, though her baby, sadly, was stillborn.

Before this story hit the headlines, the Duchess's visit helped to highlight that maternal health is a huge issue here in Nepal and that lots more needs to be done. The Duchess vowed to carry this message to the UN General Assembly in New York in September and to keep up the pressure on donors like the UK to continue the work we are doing. 

Few women will be as lucky as Kamala and be rescued by a passing helicopter, so we need to ensure that good quality medical care is near their homes, where they need it.  DFID has provided £71.5 million to health care in Nepal over the past 6 years, of which £23 million is specifically directed towards maternal health. We plan and hope to do even more so that for women like Laxmi and Kamala good care for them and their babies is not a game of chance.

A typical paddy field (Credit: Chris Martin)

A while ago I wrote about how Nepal was waiting for the monsoon rains to come. Well, they’re here now, but unfortunately things are still not good. The rains that have come are not “good” rains. Firstly, they are late – the normal monsoon should start on 10 June (yes it is that precise!), but this year didn’t start until June 23rd. And when the rains did come, it was very low precipitation – the rainfall was only 66% of normal rainfall. And this was during paddy planting season. The photo above shows what the paddy should look like.

A dried out paddy field (Credit: Chris Martin)

The Ministry of Agriculture reckon that all 75 districts are affected by a drought and that planting couldn’t take place in about 10 – 15% of paddy. And where it was planted, some of it has dried. This photo, left, was taken in Rudrapur in Rupendehi District about 10 days ago, at what should have been the height of the monsoon, and you can see from the picture that what should be squelchy wet paddy is dried out.

This is after a winter where there was also less rain than normal, so wheat and barley production are down by about 15%.  All in all the food situation in Nepal is looking pretty serious.  The estimated total deficit in food production is about 400,000 metric tonnes. 

The government has already proposed a number of programmes to provide people with food, and also to provide winter crop seeds and fertilizer to try to help people get back on their feet. Last year we gave £5.4 million to the World Food Programme for emergency food supply. We’ll need to watch the impact of the failed rains closely to see whether more support will be required this year.

Washed away road in Ramche, Rasuwa District (credit: Storyline Associates)

And just to complete the picture, in some areas where there have been rains, they have fallen hard and fast, resulting in floods and deadly landslides. Landslides don’t only wash away homes, they also wash away roads, which as I’ve said before are vitally important in connecting people to markets and basic services. Here is a picture of a group of people in Ramche, Rasuwa District, where the community were rebuilding the road after a heavy downpour so that transport, buses etc could start moving again....you can see the water is still gushing through. Our roads programme will help to rebuild some of these roads, and we collaborate with the Asian Development Bank and World Bank to support the government to maintain and construct rural roads. As climate change will make these downpours more likely in future we have reviewed the design of our roads and increased drainage and landslide proofing measures – this kind of adaptation to climate change will be needed across all sectors, from roads to agriculture to health, and is part of the work we are doing with government and others on climate change.

Me with Joanna Lumley at the British Embassy

Just in case you’ve missed it - Joanna Lumley is in Nepal this week! She’s been called a “Goddess of Nepal”, and has arrived for the first time to meet Gurkhas and their families, for whom she has campaigned so successfully. I met her earlier this week and she’s lovely – down to earth and charming!

Here’s a photo of us at the British Embassy. Anyway, celeb-fever aside, while she’s here, we also took the opportunity to show her a little of what DFID is doing here to improve the lives of poor people. As her main interest on this trip is specifically the welfare of Gurkhas and their communities, we showed her some of the work we have been doing for the past 20 years in support of the Gurkha Welfare Scheme (GWS).

Water tap under construction in Chaura village

Joanna (I take the liberty to be on first name terms) went to see the Chaura water project near Pokhara in central Nepal. Here she is by a temporary tap with Captain Bhakta Bahadur Rai, the GWS Programme Director. DFID has invested around £14 million in projects such as these, building over 800 rural water and sanitation schemes, which we estimate will have benefited more than 160,000 people.  We are working on nearly 160 new schemes, which we hope will reach an additional 33,000 people in rural areas. Water is of course important not only as a safe source of drinking water, but also to improve hygiene and prevent disease. It also saves time, as it is often women and children who have to spend sometimes several hours a day going back and forth up and down mountains to fetch water. That time can now be spent more productively going to school or working in agriculture or small-scale businesses to increase their income. So the benefits are significant.

School latrine for girls and boys

The Gurkha Welfare Scheme also helps renovate and build schools and bridges. Joanna got to visit the newly-built school toilets with our Infrastructure Advisor, Chandra Shrestha, on the right of the photo. Clean and safe toilets make a huge difference to girls’ attendance in school. The Scheme also provides medical care to remote areas - about 14,500 people received medical assistance through the scheme in last year. And when we say remote, we mean remote. The doctors and medical staff that provide this service sometimes need to walk for days to reach the communities they are serving. 

Of course, Gurkhas do not live in tightly defined, ring-fenced communities, so our programmes will also of course benefit the wider rural community. And support we have provided to rural communities in Nepal, will also have benefited Gurkha communities as well. So facilities such as over 200 health posts and 20,000 toilets in remote areas, 2,500 schools or community centres and safe drinking water for around 75,000 households which we have built through our Community Support Programme will also have benefited Gurkha communities. As does our support to health and education across all of Nepal. The fact that there is peace in the country also makes a huge difference to people’s lives, and the UK is supporting the peace process, both politically and where we can, financially (for instance, through our support of the 2008 elections).

This trip for Joanna is quite rightly very focussed on the Gurkhas. But we would like to invite Joanna to come back to Nepal to see more of the country and to see what the UK, through DFID, is doing to help people here. It would be a huge boost for development in Nepal – she is not only a Goddess for Gurkhas, but for the whole of Nepal.  So here’s hoping we can make that happen!

Looking down on Dobilla Bridge, Parbat

Last week I went to see how suspension bridge technology is being used in Nepal to increase access for poor people to roads and services such as schools and health centres. I went to Dobilla in Parbat District, near Pokhara, to see a bridge which DFID had helped construct. Bridges are very much needed in Nepal, as there are many gorges and rivers – about 6,000 rivers and streams! - and much of the country is still far from accessible. It’s estimated that 70% of the population is not accessible by road, and there are parts of the country where it can still take someone 13 days to walk to the nearest road! So while in many other countries DFID no longer builds roads and bridges, here in Nepal we do and it’s making a big difference.

Talking with the engineers

The technology used for this bridge costs approximately half in comparison to the previously used technology and, like the Clifton Suspension Bridge in its time, is testing the boundaries of what can be achieved. The engineer I’m talking to here explained that they learned a lot while building this bridge, using all Nepali materials (except cables, which came from India) and primarily local labour.

Dobilla Bridge - a large scale Meccano model?

I was also told that the suspension bridge is most suitable for the hilly areas. Such bridges connect up to 150 metre wide rivers without any support in the middle and carry up to a 20 ton load. Harsh, glacial-fed river hydrology and unfavourable river bed materials make building multi-span bridges exceptionally difficult. (If you look closely, you can see it looks like a giant Meccano model, which can be relatively simply put together with minimum skill.) If they can demonstrate that this is replicable, it will mean that we can build more bridges more easily and cheaply across Nepal.

One of the bridge labourers

Work on the bridge generated about 18,000 person days of employment – with about 20 % of the workforce female. The woman pictured on the left worked on the bridge and was paid 180 Nepali rupees a day (about £1.40). I know this doesn’t sound like a lot, but the average labourer’s wage here is less than half of that – 75 Nepali rupees a day. I asked what the bridge would mean to her and she said that it meant she could now get to the nearest hospital in 15 minutes as opposed to 3 hours as previously. It also means that people are closer to markets and can get more money for their local produce than if they have to sell only locally. So in principle, the bridge should help boost the local economy too. An estimated 50,000 people will benefit from this bridge if you count the numbers of people in communities on both sides now connected by the road and bridge.

These kinds of bridges and trail bridges are dotted all over Nepal, particularly in the hill areas, and after a couple of months here, they are to me as part and parcel of Nepal as the Clifton Suspension Bridge is to Bristol.

It has been very hot and humid in Kathmandu for the past few weeks and the monsoon is showing no signs of arriving. I was in a meeting earlier this week, and half way through the meeting, it started to rain heavily. The temperature immediately cooled and the meeting participants looked at one another and smiled - it's raining! Usually in the UK, people complain when it rains. Here, it is seen as a good thing - not only because it cools the air, but because the rains are absolutely vital for the 20 million people in Nepal who rely on rain to grow food.

With the monsoon about two weeks late, and just a weak surge on 23^rd June in some districts in the east of the country, farmers are left worrying that the long dry spell will badly affect the upcoming maize harvest and the paddy plantation. At this time of the year, paddy plantation should have been at its peak all over the country here!

Women in the paddy fields. Credit: Sangeeta Shrestha, DFID Nepal

80% of the population in Nepal and 95% of the poor rely on agriculture for all or part of their livelihoods. Land is relatively scarce (as a lot of the country is mountainous) and only 20 % of the total area can be used for agriculture. Irrigation, which in other countries has helped to significantly increase production, is not well developed here. Nepal is only slightly smaller than Bangladesh, but only 36% of the land possible is covered by irrigation, compared with 56% in Bangladesh.

Nepal also has the lowest agricultural productivity in South Asia and is a food importer, importing anything from 0% to 20% of its food needs, depending on the amount of rain received in the previous growing season. So good rains really are critical.

We had a water shortage in the office this week, so had to temporarily close several bathrooms due to a lack of water. Because the monsoon is late, farmers were refusing to release water to the water tankers which normally deliver water to the office (and some homes) as they were saving this for their own paddy fields. Good rains dictate whether there is a good harvest or not, and a good harvest can make all the difference between being able to feed your family, or not.

Unfortunately the rains which came during my meeting had stopped by the time the meeting finished, so we are still left waiting for the monsoon which has become more erratic in past years, as predicted by climate change experts. So I am left with the very un-British sentiment of hoping it will rain again soon!!

School inauguration

It was a fascinating visit, but from a raft of impressions from the visit, what I wanted to write about was the women I met. When I went to open the new primary school that DFID had helped the community to build, the whole local community was there, about 200 people. Among these were about 70 women, mostly mothers of the children at the school. They had been involved in the school building, and were also involved in local credit schemes. Take a look at the Community Support Programme website to find out more.

There were three groups of women, all in matching saris depending on which group they belonged to: Red, pink or green. There was a sense of pride and solidarity in their "uniforms" and they stuck together in their groups throughout the whole inauguration ceremony and afterwards.

I wanted to know more about their credit groups. They were very organised. Only married women can belong, as they did not want an unmarried woman joining, taking out a loan, and then moving away because she had married and would go to live with her husband's family (possibly in another district) as is the custom here. They each contributed 61 Nepalese Rupees (NRs) a month to the kitty - this is about 50p. I asked why 61, not 60 and was told that 60 goes into the kitty and the 1 rupee goes towards stationary and running costs of the group. Very organised!

Most of the time the loans are between NRs 10-40,000 (£80 - £325), and are used to open small shops or to grow vegetables (to buy seeds and implements etc). We asked if they ever took loans to pay for a wedding or a dowry and they were shocked at such frivolous ideas! We asked what they did with the extra money the shops or vegetables brought in, but they were quite reticent about telling us. Studies of such credit groups show that additional income is usually used to supplement the food of the family, primarily the children, or to help pay for schooling. Perhaps if there is a little spare, they may buy a new sari, but they were not going to say that in front of the men of the community who were watching and listening closely! 

Talking to the credit group

And then something happened which has really stuck in my mind: I asked about safety, as the Terai can be a very dangerous place with criminal gangs controlling some areas. One group admitted they had once been robbed on the way to deposit money in the bank, so I suggested they should ask the men to accompany them, to provide additional security. They laughed at this idea and one woman explained that the men were not interested and did not support the women in what they were doing (even though at least indirectly they would also be getting the benefit of the increased income). At this, an older man stepped forward and shouted at the women - how dare they say such things, and how dare they say such things to foreigners! The effect was instantaneous and from a group of proud, confident women, they were suddenly more cowed, much more cautious. The discussion finished shortly afterwards.

The incident really underlined again for me the position that many women have in society here.  Despite great progress in some areas, many women in Nepal, particularly rural women, still have a rough deal.  Land is generally inherited from the father to the son, so women have much greater economic insecurity than men. A recent study showed that only 11 % of households had any land in female ownership, and only 7 % reported ownership of livestock. Somewhat surprising given that 72 % of women work in agriculture (compared to 48 % of men), and earn considerably less doing so - an average daily wage of NRs 47 (38p) per day compared to the male average of NRs 63 (51p).  This has an impact on the whole family, in Nepal around 50% of children are malnourished, and over 40% of adult women are too. Women eat last, eat the least and eat the worst food. It means their children are born malnourished and their future is permanently blighted. The low status of women is a key part of this problem.

But things are changing. I work in an office which has a good number of strong, dynamic Nepalese women, who are clearly the equal of their male counterparts.  33% of seats in the Nepalese Parliament are occupied by women - the highest number of women parliamentarians in South Asia. This compares favourably to the UK which stands at 19% or the US at just under 17%. And these women are beginning to make their mark. But these are educated and mostly urban women, and the impact of these favourable changes need to be felt more among poorer women too. That's why the programmes that we have on health, education, skills development and empowerment are so very important not only for the women I met last week, but for the next generation of women, girls and boys here in Nepal.

Young children in the hills (Credit: DFID Nepal)

So both my children were ill this week, and I took them to a local baby clinic here in Kathmandu where both received good care and medicines. And in the way that healthy children do, both bounced back to health quickly. But they are definitely the lucky ones.  Each day in Nepal 200 children under 5 years old die. Acute respiratory infections, diarrhoea, and measles account for most deaths: underlying many of these deaths is malnutrition which is a chronic challenge in Nepal. Here, 61 out of 1,000 children die before reaching 5 years old (i.e. a tragic 1 in 16 children), compared to 6 out of 1,000 in the UK.

Healthcare in Nepal, for anyone, not just children, is not a given. Health care provision has greatly expanded: over the last decade, the number of health care institutions quadrupled particularly at village level. These facilities are largely staffed by Nepal’s valiant female community health volunteers. The services they provide are a major factor in Nepal halving child death levels over this period.

However, impressive (and inspiring) as this is, it is not enough. Although the commute time has continued to decline with the improvement in roads and the increased number of facilities, in some remote areas it takes 4 days to walk to a hospital. Additionally, although the number of doctors has increased significantly, there are only 2 doctors per 10,000 compared to 23 per 10,000 in the UK. 

A healthy mother and baby (Credit: Nabin Baral)

I had a briefing from our Safer Motherhood programme today, which again brought home to me the disparities which exist and how difficult and dangerous life is for poor people here in Nepal. Although women dying in childbirth decreased significantly – at last by one third - between 1996 and 2006, there are still 281 deaths per 100,000 live births. That’s the same as one woman dying every four hours. I find that a dreadful statistic, particularly as so many of these deaths can be prevented. Although in the same period the use of doctors, nurses and midwives at births doubled from 9 to nearly 19%, this still means that over 80% of women in Nepal deliver without any help from a trained health worker.

A rural health post (Credit: DFID Nepal)

DFID is working to improve health conditions for poor people in Nepal. Over the last decade we have been at the forefront of the challenge to reduce maternal mortality. We are central to new policies: such as the one launched this year enabling all women to have free delivery care nationwide.  We help to train doctors and nurses, build, renovate and equip health facilities, build roads and bridges to improve access to these health facilities. Furthermore we work with communities to ensure everyone knows the value of antenatal and delivery care and where and when to get the services. We continue to support the reduction of child mortality: for example supporting the introduction of a new vaccine and supporting education, particularly for women, whose understanding and use of child health care and health services rises with education level.

None of this is rocket science - it’s simple and practical and is making a difference. So while I feel incredibly lucky that my family and I have access to good medical care here in Kathmandu, I’m also proud to be part of something that is trying to provide a better level of care to poor people all over this beautiful country.