OBJECTIVES• TO UPDATE ON CURRENT UNDER-

NUTRITION SITUATION AMONG WOMEN AND CHILDREN OF NEPAL

• TO SHARE THE MULTI-SECTOR NUTRITION PLAN AND ITS IMPLEMENTATION ARRANGEMENTS AMONG THE REGIONAL STAKEHOLDERS OF FAR WEST DISTRICTS

AN OVERVIEW OF

MULTI-SECTOR NUTRITION PLAN

Prepared by: National Planning Commission, GON in close consultation with

Ministry of Health and PopulationMinistry of Agriculture Development

Ministry of Federal Affairs & Local developmentMinistry of Urban Development

Ministry of Education

Lead Technical Support: UNICEF in close collaboration with WB, HKI, WFP and Other Developing Partners

Government of NepalNational Planning Commission

Nutrition Situation of Women and Children in Nepal

NEPAL IS ON TRACK TO REACH MDG4 : REDUCING CHILD MORTALITY

153

118

91

61 54 54

102

7964

48 4634

45.9 5039 33 33

150

40

80

120

160

200

1991 1996 2001 2006 2011 2015MDG

U5MR IMR NMR

Mortality Trend and MDG Goal(Under 5, Infant and Neonatal)

Deaths associated with under-nutrition

At - min 35%

Diarrhoea12%

Other29%

Pneumonia20%

Malaria8%

Measles5%HIV/AIDS

4%

Perinatal22%

About 35-60% of Child Mortality is associated

with undernutrition

Sources:EPI/WHO. Black et al, 2008. The Lancet Series on Maternal and Child Under-nutrition.

Without Improvement in Nutrition, Further Child Mortality Reduction is less likely

Status of Undernutrition in U5 Nepal

Source: NDHS 2011

NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 2015

0

10

20

30

40

50

60 57

49

41

28

4339

29

27

1113

11

5

Stunting Underweight Wasting

Pe

rce

nt

NFHS 1996 NDHS 2001 NDHS 2006 NDHS 20110

5

10

15

20

25

30

28.3

26.7

24.4

18.2

6.5 8.6

13.5

Women’s Under-nutrition is Declining But Over-Nutrition is on the Increase

Maternal Under-nutrition Maternal Overnutrition

Fig 24: Stunting (-2SD) Trend for children between 6-23 months, by Wealth Index

0%

10%

20%

30%

40%

50%

60%

1996 2001 2006

P oorest

P oorer

Middle

Richer

Richest

Total

Ref: DHS 2001 and 2006. Adapted from Ramu Bishwakarma. Social Inequalities in Child Nutrition in Nepal. August 2009 (Background paper for Nepal Nutrition Assessment and Gap Analysis, November 2009)

65% reduction in richest quintile!

12% increase in poorest quintile!

14% reduction overall

MARKED INEQUITY: Wealth Quintiles, Ecology, Ethnicity

Nutrition context: trend in stunting prevalence by wealth index

High Inequity

Percent of children under age 5 who are too short for their age

(based on WHO standards)

Eastern terai31%

Central terai41%

Western mountain 60%

Mid-western terai 44%

Far-westernhill 58%

Eastern hill 46%

Centralhill 31%

Western hill 36%

Mid-western hill 52%Far-western terai

32%

Western terai 40%

Central mountain 46%

Eastern mountain 45%

Marked Disparity in Stunting Across the Regions

> 30%: High Prevalence > 40: Very High Prevalence

41%

Percent of children under age 5 who are too thin for their height

(based on WHO standards)

Eastern terai10.3%

Central terai10.4%

Western mountain 13.2 %

Mid-western terai13.9%

Far-westernhill 17%

Eastern hill 10.5%

Centralhill 15%

Western hill 7.6%

Mid-western hill 8%Far-western terai

7.9%

Western terai 15.2%

Central mountain 7.9% Eastern mountain

8.4%

>15%: Serious>10%: Critical

Marked Disparity in Wasting Across the Regions

11%

IYCF Practices among Under 5 Children

Exclusively breastfed

70%

Breast milk plus water

10%

Breast milk plus other

milk9%

Breast milk plus other non-milk

liquids<1%

Breast milk plus

complementary foods

10%

Not breastfed

1%

Breastfeeding Status Under 6 Months

Percent of children 6-23 months

Recommended IYCF Practices among 6-23 months children

Improvements in Micronutrient malnutrition

• Sustained High Vitamin A Supplementation and De-worming to ChildrenFocus on: 6-11 months – below 80 % and Urban below 90%

• Household Use of Adequately Iodized Salt (>15 ppm) 80% Nearing Universal Salt Iodization TargetFocus on: Mid/Far West Hills- 38%, Eastern Hill - 53.5,

• Increased Iron Folic Acid and Deworming Coverage Targeted Towards Anemia Reduction Focus on: Among 6-23 months -68%Adolescent Girls – IFA with de-wormingIncreasing IFA Compliance among pregnant/lactating

IFA Deworming Anemia0

1020304050607080

23

2

5952 48

75

461998

2001

2006

2011

Ref: National Micronutrient Status Survey 1998, DHS 2001 , 2006 and 2011

Anemia trend among children 6-

59 months

Anemia Prevalence High in Children: The Problem is serious among 6-23 months children

6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total0

102030405060708090

78 74 72

57

4438

25

46

Age in months

Perc

ent o

f chi

ldre

n ag

e 6-

59 m

onth

s w

ith

anem

ia

Source: NDHS 2011

Total 5 - 1920 - 3940 - 61Missing Value

Mid-Western Terai

56.9

Central Hill

40.2

Mid-Western Mountain52.7

Eastern Hill

42.3

Western Terai48.8

Eastern Mountain

51.3

Far-Western Terai

60.4

Central Mountain

33.1

Eastern Terai

49.5

Western Mountain52.7

Western Hill

43.6

Far-Western Mountain

52.7

Far-Western Hill

40.9

Central Terai

46.7

Mid-Western Hill

36

46%

Anaemia Among U5 Children is More than Critical

Critical: > 40%, Serious > 20%

Consequences of Malnutrition

Severe forms of malnutrition

Impact of Malnutrition

• Are rare - a few percent

• Represents the tip of the iceberg

• Should not be seen as “the nutritional problem”

More than 80% brain development – within 2 years of age

Malnourished & ill due to high

burden of infections

“Empty Brain” – Irreversible Damage Diminished Learning

Capacity

“Empty Brain” – Irreversible Damage Diminished Learning

Capacity

Reduced Economic Productivity & Income

(Diminished Life)

Reduced Economic Productivity & Income

(Diminished Life)

Well nourished & healthy

Smart Child— Meets Full Potential

Enhanced Learning & Performance

Smart Child— Meets Full Potential

Enhanced Learning & Performance

Increased Productivity & Higher Income (>7% or

More)

Increased Productivity & Higher Income (>7% or

More)

High Social and Economic Burden

Human Capacity Resource, Increased Productivity

Consequences of Malnutrition Child’s Brain Growth and Development

By: Prof. Ascobat Gani

19

Growth and muscle massBody composition

Metabolic Syndrome:programming of metabolism

of glucose, lipids, protein Hormone/receptor/gene

Brain development

Cognitive andeducational performance

ImmunityWork Capacity

Diabetes, ObesityHeart DiseaseHigh blood pressureCancer, stroke, and ageing

Poor nutrition in uterus and early childhood

(STUNTING)

Short term Long term

Death

LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU)

(James et al 2000)

Stunting is preventableNeed to act before the child is 2 years

The Critical “Window of Opportunity”

1000 DAYSPregnancy: 9*30= 270 days

2 years: 365*2=730 days

Strategic Shift NeededPriority focus on pregnancy to under 2 years:”

0 3 10 70

Brain’s development potential

Age

Spending on Health,Education and Welfare

Spending vs. Brain Development

Total National Budget ‘000s: NRs. 329167675 in F/Y 2069/70-2011/12)

Health Budget: NRs. 20124858 (6.11 % of Total National Budget)

Nutrition Budget: NRs. 511074 (2.54 % of Total Health Budget) (0.16% of Total National Budget)

Nutrition in National Budget

Multi-Sector Nutrition Plan Development Process

Malnutrition &death

Inadequate dietaryintake

Disease

Insufficient food security

Inadequate Maternal & Child Care

Insufficient health services& unhealthy environment

Political, Ideological,Economic structures

Resource Control+

Organizational structuresRoot

causesRoot

causes

Underlyingcauses

Underlyingcauses

Immediatecauses

Immediatecauses

ManifestationsManifestations

04/12/2023 23

Nutrition Assessment and Gap Analysis (2009-2010)

Build the National “Nutrition Architecture”

(2011-2012):

• Identified strengths, weaknesses, and gaps;

• Need for a national nutrition architecture; and

• A multi-sectoral approach through an agreed nutrition determinants model.

• NPC led High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC in place and National Nutrition and Food Security Coordination Committee;

• Technical working group to guide multi-sectoral nutrition review, and planning; and

• Nutrition and Food Secretariat being established at the NPC – with links to NNC of the MoHP and MoAD

Nutrition Multi-Sectoral Reviews: A consultative

Process (2011)

Costed Multi-sectoral Nutrition Plan of Action

• Nutrition reviews by sector: Health; Agriculture, Education, Physical Planning and Works, and Local development

• Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors

• Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-sectoral linkages

Clear leadership: the NPC and actively involving health & other sectors

Focused: the first 1,000 days of life and stunting reduction

Addressing the immediate, underlying and basic factors:

• women and children’s access to health and nutrition;

• safe water & sanitation; and • education and inequity.

Emphasis on decentralized implementation: initially in selected districts (2012-2014)

Vision to gradually scale up: to all other districts by 2016 (A new approach: learning by doing)

Multi-sectoral Nutrition Planning Framework

Child growthfailure/ death

Low Birthweightbaby

Low weight & height in teenagers

Early pregnancy

Small adultwoman

Small adult man

The intergenerational transmission of growth failure: When to intervene in the life cycle

SO 2. Ministry of Health and PopulationR 2.1 Maternal Infant Young Child MIYC micronutrient status improved

R 2.2 MIYC feeding improved

R 2.3 IYC Malnutrition better managed

R 2.4 Nutrition related policies, standards and acts updated

SO 4. Ministry of Education• R 4.1 Adolescent girl’s

awareness and behaviours in relation to protecting foetal, infant and young child growth improved

• R 4.2 Parents better informed with regard to avoiding growth faltering

• R 4.3 Nutritional status of adolescent girls improved

• R 4.4 Primary and secondary school completion rates for girls increased

SO 5. Ministry Federal Affairs and Local Development R 5.1 Nutritional content of local development plans better articulated

R 5.2 Collaboration between local bodies’ health, agriculture, and education sector strengthened at DDC and VDC level

R 5.3 Social transfer programmes corroborated for reducing chronic under nutrition

R 5.4 Local resources increasingly mobilized to accelerate the reduction of MCU

SO 6. Ministry of Agriculture DevelopmentR6.1 Increased availability of animal foods at the household level

R 6.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile

R 6.3 Increased consumption of animal foods by adolescent girls, young mothers and young children

R 6.4 Reduced workload of women and better home and work environment

Strategic Objective (SO) 1. National Planning Commission

Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased

R 1.2. Nutritional information management and data analysis strengthened

R 1.3 Nutrition capacity of implementing agencies is strengthened

SO 3. Ministry of Urban DevelopmentR3.1 All young mothers and adolescent girls use improved sanitation facilities

R 3.2 All young mothers and adolescent girls use soap to wash hands

R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water

Declaration of Commitment for Accelerated Improvement of Maternal and Child Nutrition in Nepal signed by the NPC VC, Secretaries form 7 key Ministries, Representatives of the UN, REACH, NNG, EDPs Health, Civil Society and Private Sector, 17 September 2012

Multi-sector Nutrition Plan for Accelerated Reduction of Maternal and Child Under-nutrition in Nepal, 2013-2017 (2023) launched by HE Prime Minister Rt. Hon Prime Minister Dr. Babu Ram Bhattarai , 20th September 2012

HIGHLIGHTS OF MULTI-SECTOR NUTRITION PLAN

ax'If]qLo kf]if0f of]hgfp2]Zodfgj k"FhL / ;du| ;fdflhs cfly{s ljsf;df s'kf]if0f cj/f]wsf] ?kdf g/xg] cj:yf ;'lglZrt ug{sf nflu pNn]vgLo ?kdf bL3{ s'kf]if0f Go"gLs/0f ug]{tkm{ d'n'snfO{ cu|;/ u/fpg' nIo• cfufdL kfFrjif{df dft[ tyf lzz' kf]if0fsf] l:yltdf ;'wf/ /

tbg';f/ dft[lzz' tyf afnaflnsfsf] s'kf]if0fnfO{ Go"g u/L cfdfx?sf] zf/Ll/s 3gTj ;"rfÍ (BMI) / aRrfx?sf] k'8\sf]kgdf Ps ltxfO{n] sdL Nofpg]

• ;dfhsf ;a} :t/df dft[lzz' kf]if0fsf] l:yltdf ;'wf/ Nofpg, /fli6«o of]hgf cfof]u tyf ;Da4 k|d'v If]qut dGqfnox?sf] Ifdtf ;'b[9 u/L jx'If]qLo kf]if0f sfo{s|dx?sf] k|a4{g / ;+rfng ug{ ;dy{ agfpg'

ax'If]qLo kf]if0f of]hgftLg d'Vo pknAwLx?

• pknAwL g+ !M /fli6«o / :yfgLo:t/df gLlt, of]hgf / ax'If]qLo ;dGjodf ;'wf/ cfPsf] x'g]5 .

• pknAwL g+ @M …kf]if0f–nlIftÚ jf …kf]if0fk|lt ;Dj]bgzLnÚ ;]jfx?sf] pRrtd k|of]u ug]{ Jojxf/df ;'wf/ e} cGttM dft[lzz' kf]if0fsf] l:yltdf ;'wf/ x'g]5 .

• pknlAw g+ #M cfwf/e"t ;]jfnfO{ ;dfj]zL / ;dtfd"ns 9Ën] k|jfx ug{sf nflu s]Gb|Lo tyf :yfgLo ;/sf/x?sf] kf]if0f;DaGwL Ifdtf ;'b[9 ePsf] x'g]5 .

cTofjZos sfo{s|dx?sf] Ps Kofs]hsf ;fy of] of]hgf …cj;/sf] em\ofn… (Window of Opportunity) – lhjgsf klxnf] ;'gf}nf !))) lbgdf s]lGb|t /xg]5 .

;g @)!& sf] cGTo;DddfM

• kfFr jif{d'lgsf afnaflnsfdWo] k'8\sf]kg x'g]sf] k|ltzt @( eGbf sd ePsf] x'g]5 .

•  kfFr jif{d'lgsf afnaflnsfdWo] sd tf}n x'g]sf] k|ltzt @) eGbf sd ePsf] x'g]5 .

•  kfFr jif{d'lgsf afnaflnsfdWo] Vofp6]kg x'g]sf] k|ltzt % eGbf sd ePsf] x'g]5 .

• dlxnfx?df bL3{ zlQm sdL (Chronic Energy Deficiency) x'g]sf] ;+Vof -BMI sf] ?kdf dfkg x'g]_ !% k|ltzt eGbf tn x'g]5 .

• sd tf}n e} hGdg] aRrfsf] -≤@%)) u|fd_ Ü sd ePsf] x'g]5 .

• k|fylds tyf cfwf/e't :s"n lzIff k'/fgug]{ afnaflnsf tyf lszf]/ lszf]/Lsf] k|ltzt 36]sf] x'g]5 .

cf7 k|ltkmnx? - k|ltkmn g+= !M kf]if0f nlIft Pj+ ;+j]bglzn ;"rsx? ;dfj]z ug{ /fli6«o tyf :yfgLo:t/sf gLlt tyf of]hgfx?sf] k"g/fjnf]sg e} cBfjlws ul/Psf] x'g]5 . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L /fli6«o of]hgf cfof]u tyf If]qut dGqfnox? -:yfgLo ljsf;, :jf:Yo, lzIff, s[lif, ef}lQs of]hgf tyf lgdf{0f_ of] k|ltkmn xfl;n ug{ lhDd]jf/ x'g]5g\ .!=! If]qut dGqfnox?sf kf]if0f;DaGwL e"ldsfdf clea[l4 ug]{ .

!=@ kf]if0fsf] ljifonfO{ cfkm\gf] of]hgfdf k|fyldstf lbg / kf]if0f nlIft Pj+ ;+j]bglzn d'Vo d'Vo ;"rsx?nfO{ ;dfj]z ug{ dGqfnox?df k}/jL ug]{ .

!=# ax'If]qLo kf]if0f of]hgf cg'?k /fli6«o kf]if0f gLlt tyf /0fgLltnfO{ cBfjlws ug]{ / cg'udg tyf d"NofÍgsf] k|f?k cBfjlws ug]{ .

!=$ If]qut /fli6«o of]hgfdf kf]if0f ;dfa]z ug]{, kf]if0f nlIft Pj+ ;+j]bglzn cg'udg tyf d"NofÍgsf] k|f?k ;lxt .

!=% kf]if0f nlIft cg'udg tyf d"NofÍgsf] k|f?k;lxt :yfgLo of]hgf th'{df k|ls|of / of]hgfx?df kf]if0fnfO{ ;dflxt ug]{ .

k|ltkmn g+= @M/fli6«o / :yfgLo txdf ax'If]qLo ;dGjo ;+oGqx? ls|ofzLn ePsf x'g]5g\ . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L /fli6«o of]hgf cfof]u / :yfgLo lgsfox? of] k|ltkmn k|flKtsf nflu lhDd]jf/ x'g]5g\ @=!kf]if0f / vfB ;'/Iff;DaGwL ls|ofsnfkx?nfO{ 6]jf k'¥ofpgsf nflu /fli6«o of]hgf cfof]udf Ps ;lrjfnosf] :yfkgf÷;'b[9 agfpg] .@=@ ;dGjodf ;'wf/ Nofpg k|efjsf/L ;+rf/ k|0ffnL :yfkgf ug]{ .@=# /fli6«o kf]if0f ?k/]vf cg';f/ :yfgLo txdf ax'If]qLo ;dGjo ;ldltx? u7g ug{] .

k|ltkmn g+= #Mljz]if u/L ;dfhsf ljkGg / kx'Fr jflx/ /x]sf ;d'bfodf dft[lzz' kf]if0fsf ;]jfx? pkof]usf] l:yltdf ;'wf/ cfPsf] x'g]5 . b]xfosf ;fÍ]lts ls|ofsnfkx? sfof{Gjog u/L of] k|ltkmn xfl;n ug{ :jf:Yo If]q lhDd]jf/ x'g]5 .#=! Jofks b[li6sf]0f cjnDag u/L dft[lzz' tyf afnaflnsfsf] kf]if0fsf] sfo{s|d sfof{Gjog / la:tf/ ug]{ .#=@ ljz]if u/L kx'Frjflx/ /x]sf ;d'bfox? tyf s'kf]if0faf6 a9L k|efljt lhNnfx?df hf]8 lbO{ cfdf, lzz' tyf afnaflnsfx?sf] ;"Idkf]if0fsf] l:yltdf ;'wf/ Nofpg] sfo{s|dx?nfO{ lg/Gt/tf lbg] / la:tf/ ug]{ .#=# vf;u/L a9L c;/ k/]sf lhNnfx?df lzz' tyf afnaflnsfx?df /x]sf] clt Pj+ dWod s8f s'kf]if0f Go'gLs/0f;DaGwL ls|ofsnfknfO{ la:tf/ / Joj:yfkg ug]{ .#=$ :jf:Yo If]qsf kf]if0f;DaGwL P]g, lgod, /0fgLlt / dfkb08x?nfO{ cBfjlws ug]{ .#=% :jf:Yo If]qsf] ;+:yfut ;'b[9Ls/0f ug{ ;xof]u ug]{ .

k|ltkmn g+= $Mlszf]/Lx?sf] dftflktfx?sf] lzIff, hLjgofkgsf ;Lkx? / kf]if0fsf] l:yltdf clea[l4 ePsf] x'g]5 . b]xfosf ls|ofsnfkx? sfof{Gjog u/L of] k|ltkmn xfl;n u$=! ljz]if u/L cfdfx? / afnaflnsfx?sf] kf]if0fdf ;'wf/ / bL3{ s'kf]if0fnfO{ Go"gLs/0f ug]{ s'/fdf hf]8 lb+b} lszf]/Lx?nfO{ k|bfg ul/g] hLjgofkgsf ;Lkx?df kf]if0fsf] ljifonfO{ PsLs[t ug{ ;xof]u ug]{ $=@ lszf]/Lx?df bL3{ s'kf]if0fnfO{ Go"gLs/0f ug]{ 1fg / l;ksf] clea[l4 ug]{ .$=# cfdf tyf afnaflnsfx?sf] x]/rfx / vfglkg;DaGwL Jojxf/df ;'wf/

Nofpg cleefjsx?sf] lzIffsf nflu ;|f]t ;fdu|Lx? tof/\cBfjlws ug]{ .$=$cfdf / afnaflnsfx?sf] x]/rfx / vfglkg;DaGwL Jojxf/sf ljifodf cleefjsx?sf] 1fgdf clea[l4 ug{ sfo{s|dx? cfof]hgf ug]{ .$=% vf;u/L clt vfBfGg Go"g / lk5l8Psf lhNnfx?df sIff % b]lv * ;Ddsf lszf]/Lx?sf nflu lbjf vfhfsf] Joj:yf ug]{ .$=^ nlIft If]qdf sIff % b]lv * ;Ddsf lszf]/Lx?sf] z}lIfs ;xeflutf /

pknlAwdf ;'wf/ ug{ cfO/g, kmf]lns Pl;8, h'sf lgoGq0f tyf lbjf vfhf ug{sf nflu lzIff If]q lhDd]jf/ x'g]5 .

k|ltkmn g+= %Msd pd]/sf cfdfx?, lszf]/Lx?, lzz'x? / afnaflnsfx?df emf8f kvfnf / ARI sf 36gfx?df sdL cfPsf] x'g]5 . of] k|ltkmn k|flKtsf nflu ef}lts of]hgf tyf lgdf{0f If]q lhDd]jf/ x'g]5 .%=!ljz]if u/L lszf]/lszf]/Lx?, afnaflnsfx? / ;–;fgf aRrfsf cfdfx?nfO{ hf]8 lb+b} vf; vf; ;dodf ;fj'gn] xftw'g] afgL a;fpg k|a4{gfTds cleofgx? cfof]hgf ug]{ .%=@ a9L k|efljt lhNnfx?nfO{ ljz]if hf]8 lb+b} v'nf lb;flk;fj d'Qm If]q cleofg ;+rfng ug]{ .%=# a9L k|efljt If]qx?nfO{ ljz]if hf]8 lb+b} hn ;'/Iff of]hgf / pkof]u ljGb'df ;'/lIft kfgLsf] k|of]u af/] ;r]tgf a[l4 ug]{ .

k|ltkmn g+= ^Mpko'Qm ef]hgsf] pknAwtf tyf pkef]udf -u'0f:t/, k/Ldf0f, vfgf vfg] k6s / ;'/Iffsf b[li6n]_ a[l4 Pj+ dlxnfx?sf] sfo{af]emdf sdL cfPsf] x'g]5 . b]xfosf ls|ofsnfkx?sf] sfof{Gjog u/L o; k|ltkmnsf] k|flKtsf nflu s[lif, tyf :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g\ .^=! 3/kl/jf/ / ;d'bfosf] txdf h}ljs ;|f]tdf cfwfl/t vfgf nufot ;"Id

kf]ifstTjo'Qm ef]hg pknAw u/fpg] ^=@ ;"Id kf]ifstTjo'Qm :yfgLo afnLx?sf] ;'q ljsf; / k|a4{g ug]{^=# sd cfo;d"xsf lszf]/Lx?, ue{jlt dlxnfx? / # jif{eGbf sd pd]/sf aRrfx?nfO{ :tgkfg u/fpg] cfdfx?df ;"Id kf]ifstTjo'Qm ef]hg tyf cfodf a[l4 ug{ ljleGg sfo{s|dx?jLr ;x;DaGw :yfkgf ug]{ .^=$ dlxnfx?sf] sfo{af]emdf sdL Nofpg :j:Yo / ;'ky d"Nosf] phf{sf nflu ;xof]u pknAw u/fpg] .^=% afn gub cg'bfgsf] ;+oGq k'g/fjnf]sg u/L ue{fj:yfb]lv b'O{aif{ d'lgsf afnaflnsfnfO{ pknAw u/fpg] .

k|ltkmn g+= &Ms]Gb|, lhNnf, gu/ tyf uflj; txx?df cfdf / aRrfx?sf] kf]if0fdf ;'wf/ Nofpg pko'Qm ;xof]u pknAw u/fpg] Ifdtfdf clea[l4 ePsf] x'g]5 . of] k|ltkmn xfl;n ug{sf nflu /fli6«o of]hgf cfof]u, :jf:Yo, lzIff, ef}lts of]hgf tyf lgdf{0f, s[lif / :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g\ .&=! s]Gb| / :yfgLo txdf hgzlQmsf] ax'If]qLo kf]if0f Ifdtf ljsf; ug]{ u/fpg]&=@ ;+u7gfTds ;'b[9Ls/0fsf nflu ;Da4 If]qx?sf] ;+u7g tyf Joj:yfkg;DaGwL n]vfhf]vf ug]{ .&=# Ps} lsl;dsf] tyf glthfd'vL k|ltj]bg k|0ffnLsf] :yfkgf ug]{ .&=$ ax'If]qLo kf]if0f of]hgfsf k|d'v ;"rsx?nfO{ ;dflji6 ug{ ul/jL cg'udg tyf ljZn]if0f k|0ffnL (PMAS) / lhNnf ul/jL cg'udg tyf ljZn]if0f

k|0ffnL (DPMAS) sf ;"rsx?sf] k'g/fjnf]sg ug]{ .&=% sfof{Gjog k|ls|ofsf] lgoldt / ax'If]qLo ;+o'Qm cg'udg ug]{ .&=^ lhNnf ljsf; ;ldlt tyf cGo :yfgLo:t/sf nfOg Ph]G;Lx?df cg'udg tyf d"NofÍgsf nflu k|f?k / ;+oGq :yfkgf ug]{ .&=& ;a} txx?df kf]if0fsf nflu ;+:yfut lhDd]jf/L jfF8kmfF8 ug]{ .

k|ltkmn g+= *M/fli6«o tyf :yfgLo txx?df ax'If]qLo kf]if0f ;"rgf k|0ffnLsf] ljsf; e} k/:k/ cfj4 / cBfjlws ul/Psf] x'g]5 . of] k|ltkmnsf] k|flKtsf nflu /fli6«o of]hgf cfof]u, :jf:Yo, lzIff, ef}lts of]hgf tyf lgdf{0f, s[lif / :yfgLo ljsf; If]qx? lhDd]jf/ x'g]5g\*=! k|d'v ;/f]sf/jfnfx?nfO{ ;dflji6 u/L -:Jff:Yo Joj:yfkg

;"rgf k|0ffnL, lzIff Joj:yfkg ;"rgf k|0ffnL, vfg]kfgL tyf ;/;kmfO{, s[lif tyf :yfgLo ljsf;sf_ s]Gb|:t/df ax'If]qLo kf]if0f;DaGwL ;"rgf ul/jL cg'udg tyf ljZn]if0f k|0ffnL ;Fu k/:k/ cfj4 / cBfjlws ug]{ .*=@ :yfgLo:t/df :jf:Yo, lzIff, vfg]kfgL / ;/;kmfO{, s[lif tyf u}/;/sf/L If]qsf kf]if0f;DaGwL ;"rgf ;dfj]z u/L lhNnf ul/jL cg'udg tyf ljZn]if0f k|0ffnLdf cfj4 / cBfjlws ug]{ .

sfo{of]hgf – :jf:YopknlAw != dft[lzz' tyf afnaflnsfx?sf] cfxf/df ;'wf/ x'g]5 .k|ltkmn !=)M ue{jtLsf] cfxf/ Jojxf/df ;'wf/ x'g]5 .

!=! :jf:Yo :jo+;]ljsfx? dfkm{t ue{jtLsf] a]n}df klxrfg u/L btf{ ug]{!=@ ue{jtL tyf kl/jf/sf ;b:ox?nfO{ ay{ lk|Ko/8\g]z Kofs]h cg';f/ h}ljs ;|f]tsf] vfgf pkef]u ug{ k}/jL ug]{!=# ue{jtLsf] cfxf/ Jojxf/df ;'wf/ ug{ kf]if0fsf] nflu ;~rf/ /0fgLltsf] c+usf] ?kdf Jojxf/ kl/jt{g ;~rf/ sfo{qmd ug]{

k|ltkmn @=)M hGdg]lalQs} :tgkfg u/fpg] tyf k"0f{ :tgkfg -cfdfsf] b"wdfq_ u/fpg kxn ;'? ePsf] x'g]5@=! ;fd'bflos :jf:Yo sfo{stf{ tyf :jo+;]jsx?nfO{ lzz' tyf s]6fs]6Lsf] cfxf/ ;DaGwL tflnd k|bfg ug]{@=@ cfdf, gjhft lzz', afn:jf:Yo tyf ljsf;;DaGwL tflnddf IYCF Kofs]h cfTd;ft ug]{@=# k|ltkmn ! sf] !=# lqmofsnfk

k|ltkmn #=)M 5 b]lv @# dlxgf;Ddsf afnaflnsfsf] k"/s cfxf/ pknAwtfdf ;'wf/ x'g]5 .#=! 5 b]lv cf7 dlxgf;Ddsf lzz'nfO{ x/]s lbg @ b]lv # k6s;Dd ≥ $ vfgf ;d"xsf] k"/s vfgf k|fKt u/fpg ;xof]u ug]{#=@ gf} b]lv @# dlxgf;Ddsf lzz'nfO{ x/]s lbg @ b]lv # k6s;Dd ≥ $ vfgf ;d"xsf] k"/svfgf k|fKt u/fpg ;xof]u ug]{

sfo{of]hgf – :jf:YopknlAw @=)M dft[lzz' tyf afnaflnsfsf] ;"Id kf]if0fsf] l:yltdf ;'wf/ x'g]5 .k|ltkmn $=) ue{jtL tyf k|;"ltkZrft\ cfdfx?aLr cfO/g / h'sf

lgoGq0f rSsLsf] vkt a9L x'g]5 . $=! :jf:YosdL{ tyf dlxnf :jf:Yo :jo+;]ljsfx?nfO{ cfO/g tTj ld;fpg] ;DaGwdf k"gtf{huL tflnd k|bfg ug]{$=@ k|lt dlxgf dlxnf :jf:Yo :jo+;]ljsfx? dfkm{t #) rSsL cfO/g kmf]lns Pl;8 afF8\g nufpg] tyf cfdfx?nfO{ vfg] ug{ pTk|]l/t ug]{, ;Demfpg]$=# :jf:Yo sfo{stf{x? dfkm{t cfO/g kmf]lns Pl;8 -uef{j:yfdf !*) rSsL / uef{j:yfkl5 :tgkfg u/fpFbf $% rSsL_ tyf ! h'sf lgoGq0f rSsL -uef{j:yfdf_ afF8\g nufpg] $=$ ue{jtL tyf cfdfx?n] cfO/g kmf]lns Pl;8 tyf ! h'sf lgoGq0f rSsL vfg'kg]{ ;DjGwdf ue{jtL dlxnf tyf cGo kl/jf/sf ;b:onfO{ k}/jL ug]{$=$=! ;"Id kf]ifstTj ;e]{If0f ug]{

k|ltkmn %=) cfO/g tTj ld;fPsf] vfg]s'/fsf] pkef]u a9\g]5%=! 3/kl/jf/n] cfO/g tTj ld;fPsf] cGgsf] pkef]u a9fpg] ljifodf cleofg ;~rfng ug]{%=@ ;do ;dodf lk;fgL ldnx?sf] cg'udg u/L vfg]s'/fdf cfO/g tTj pko'Qm lsl;dn] ld;fPsf] ;'lglZrt ug]{k|ltkmn ^=) 3/fo;L pkof]usf] nflu kof{Kt cfof]l8go'Qm g'g pknAw x'g]5 .^=! b'O{ afnssf] nf]uf] ePsf Kofs]6sf]] g'gsf] pkef]u a9fpg ;d'bfodf cfwfl/t ;fdflhs ahf/Ls/0f k|a4{g x'g]5 .^=@ ;do ;dodf cfGtl/s tyf afXo cg'udg u/L vfg]s'/fdf cfof]l8g tTj pko'Qm lsl;dn] ld;fPsf] ;'lglZrt ug]{^=# vf;u/L sl7g kx'Fr ePsf If]qx?df ;fbf g'gsf] vkt sd ug{ b'O{ afnssf] nf]uf] ePsf] g'gsf] Kofs]6 b]ze/L ljt/0f ug]{5 .

sfo{of]hgf – :jf:YopknlAw @=)M dft[lzz' tyf afnaflnsfsf] ;"Id kf]if0fsf] l:yltdf ;'wf/ x'g]5 .k|ltkmn &=) 5 b]lv t]O; dlxgfsf lzz'aLr ;"Idkf]ifstTj o'Qm kfp8/sf] pkof]u a9]sf] x'g]5 . &=! ;"Idkf]ifstTj kfp8/ &% lhNnfdf lj:tf/ ug{]&=@ 5 b]lv t]O; dlxgfsf lzz'x?nfO{ ;"Idkf]ifstTj o'Qm kfp8/ v'jfpg'kg]{ ljifodf :jf:YosdL{ tyf dlxnf :jf:Yo :jo+;]ljsfdfkm{t cfdf Pj+ kl/jf/sf cGo ;b:onfO{ ;/;Nnfx ;]jf k|bfg ug]{

k|ltkmn *=) dft[lzz' tyf s]6fs]6Lx?df x'g] ;+qmd0f 36]sf] x'g]5*=@ IMCI k"gtf{huL tflnd dfkm{t dft[lzz' tyf s]6fs]6Lx?df x'g] ;ª\qmd0fsf ljifodf hf]8 lbg] *=@ CB-NCP&% lhNnfdf lj:tf/ ubf{ dft[, lzz' tyf s]6fs]6Ldf x'g] ;+qmd0f ljifodf hf]8 lbg]*=# ue{jtL, lszf]/lszf]/L tyf afnaflnsfsf lglDt cfjZos ;+Vofdf  LLIN sf] kof{Kt ljt/0f ug]{*=$  lgoldt bfb'/fsf] vf]ksf] ;+Vof a9fpg ;~rf/ dfWodsf] pkof]u j[l4 ug]{*=% IYCF tflnd Kofs]hdf ;fa'gn] xftw'g] ;Gb]z ;dfj]z ug]{

k|ltkmn (=) ^ b]lv %( dlxgf pd]/;Ddsf afnaflnsfx?n] le6fldg P SofK;'n / !@ b]lv %( dlxgf;Ddsfn] le6fldg P SofK;'n tyf h'sfsf] cf}iflw vfg]5g\ .(=! % jif{d'lgsf afnaflnsf nfO{ jif{sf] @ k6s cfd?kdf x'g] le6fldg P SofK;'n tyf h'sfsf] cf}iflw ljt/0f lg/Gt/ ug]{(=@ le6fldg P SofK;'n tyf h'sf lgoGq0f ug]{ cf}iflw ;]jg ug'{kg]{ ljifodf vf;u/L sd ;]jf k'u]sf, cw{ ;x/L tyf ;x/L If]qdf ;~rf/ dfWoddfkm{t hfu/0f a9fpg]

sfo{of]hgf – :jf:YopknlAw #=) lzz' tyf afnaflnsfx?df /x]sf] s'kf]if0fsf] kof{Kt Joj:yfkg ePsf] x'g]5.k|ltkmn !)=) ) b]lv #^ dlxgf;Ddsf afnaflnsfsf] kf]if0fsf] l:ylt cg'udg u/L clws s'kf]if0f klxrfg ug]{!)=! PHC/ORC k'gM lqmofzLn ubf{ s'kf]if0f ePsf afnaflnsfsf] klxrfg tyf kf]if0f :t/ cg'udg ;'b[9 ug]{!)=@ ljZj :jf:Yo ;+u7g j[l4 u'0f:t/ cg';f/ ;d'bfodf cfwfl/t j[l4 cg'udg sfof{Gjog x'g]5 .k|ltkmn !!=) kfFr jif{d'lgsf ;a} afnaflnsfsf] clts8f s'kf]if0f 36\g]5 .!!=! ;d'bfodf cfwfl/t s8f s'kf]if0f Joj:yfkg sfo{qmd w]/} clt s8f s'kf]lift afnaflnsf ePsf #% lhNnfdf lj:tf/ ug{] !!=@ w]/} clts8f s'kf]lift afnaflnsf ePsf #% lhNnfdf kf]if0f k'gM:yfkg u[x lj:tf/ ug]{k|ltkmn !@=) kfFr jif{d'lgsf ;a} afnaflnsfsf] dWod s'kf]if0f 36\g]5 k|ltkmn !@=) kfFr jif{d'lgsf ;a} afnaflnsfsf] dWod s'kf]if0f 36\g]5 .!@=! dWod s'kf]if0f;DaGwL dfu{bz{g tyf tflnd ;fdu|L tof/ ug]{!@=@ tof/ ePsf] dfu{bz{g tyf tflnd ;fdu|L dWod s'kf]if0f;DaGwL tflnd ;~rfng ug]{ !@=# nlIft lhNnfx?df RUSF cfk"lt{ ug]{

sfo{of]hgf – :jf:YopknlAw $M :jf:Yo If]qsf kf]if0f;DaGwL P]g, lgod, gLlt, /0fgLlt / dfkb08x?nfO{ cBfjlws ul/Psf] x'g]5 .k|ltkmn !#=) /fli6«o kf]if0f gLlt tyf /0fgLlt ;

+zf]wg tyf cBfjlws ul/Psf] x'g]5 .!#=! ;/sf/L tyf u}/ ;/sf/L ;/f]sf/jfnfx?sf] ;xof]udf ljBdfg /fli6«o kf]if0f gLlt tyf /0fgLlt ;+zf]wg ug]{ .

!#=@ kf]if0fsf] ;~rf/ /0fgLlt th'{df ug]{ .!#=# ;+zf]lwt /fli6«o kf]if0f gLltcg'?k :jf:Yo If]qsf] nufgL;lxtsf] ax'jifL{o kf]if0f of]hgf th'{df ug]{ .

k|ltkmn !$=) kf]if0f;DaGwL a[xb\ tflnd Kofs]hx? tof/ ul/g]5 .!$=! ljBdfg ljleGg kf]if0f;DaGwL tflnd ;fdu|L k'g/fjnf]sg u/L ;+zf]wg ug]{ .!$=! ljsf; ;fem]bf/x?;Fu ;dGjo u/L  kf]if0f;DaGwL a[xb tflnd Kofs]hx? d:of}bf ug]{ .

k|ltkmn !%=) g'gsf] pTkfbg, ljt/0f tyf cg'udgsf] pko'Qm lgodg ug]{ .!%=! g'gsf] pTkfbg, ljt/0f tyf cg'udg;DaGwL ljw]ossf] d:of}bf tof/ ug]{ .

sfo{of]hgf – :jf:YopknlAw %M ax'If]qLo kf]if0f of]hgfdf :jf:Yo If]qsf] :jf:Yo If]qsf] ;'wf/fTds of]ubfgsf] nflu ;+:yfut ;'b[9Ls/0f tyf Ifdtf ljsf; ePsf] x'g]5 .k|ltkmn !^=) ax'If]qLo kf]if0f of]hgfsf] k|f?k cg'?k ;a} txdf ;+:yfut Joj:yf k'g/fjnf]sg ug]{, :jf:Yo tyf hg;+Vof dGqfnocGtu{t /fli6«o kf]if0f s]Gb| :yfkgf;lxt!^=! ;+u7g tyf Joj:yfkg l8hfOg tyf n]vfhf]vf ug]{ Ifdtf ljsf; cfjZostf;lxt!^=@ /fli6«o kf]if0f s]Gb|sf] ;+u7gfTds ;+/rgf tof/ u/L :jLs[t ug]{!^=# ;+u7g tyf Joj:yfkg n]vfhf]vf tyf /fli6«o kf]if0f s]Gb|sf] ;+u7gfTds ;+/rgf cg';f/ Ifdtf ljsf; of]hgf th'{df ug]{!^=$ :jLs[t ;+u7gfTds ;+/rgfsf] b/jGbL cg';f/ kbk"lt{ ug]{

k|ltkmn !&=) ;a} txdf :jf:YosdL{x?sf] -dlxnf ;fd'bflos :jf:Yo sfo{stf{;lxt_ kf]if0f;DaGwL Ifdtf ljsf; ug]{!&=! a[xb kf]if0f tflnd Kofs]h cg';f/sf tflnd sfo{qmd ;~rfng ug]{

k|ltkmn !*=) dft[lzz' s'kf]if0f 36fpg :jf:Yosf hgzlQmn] cGo If]q;Fu ;dGjo u/L of]ubfg ug]{!*=! cg'?k :jf:ysdL{x?sf] ljBdfg sfo{ ljj/0f k'g/fjnf]sg ug]{!*=@ ax'If]qLo kf]if0f of]hgfsf ljleGg ;ldltx?df clgjfo{?kdf ;xefuL e} of]ubfg ug{ ;a} txsf :jf:YosdL{x?nfO{ cf}krfl/s kl/kq dfkm{t ;~rf/ ug]{

glthf

z[+vnf

ljj/0ffTds ;+If]k

sfo{;Dkfbgsf ;"rsx?

nIo k'8\sf]kg 36fpg hf]8 lbg] ax'If]qLo k|of;df lzIff dGqfnosf] of]ubfgdf clej[l4 x'g]5 .

@)!^ sf] cGTo;Dddf lhjgofkgsf ;Lkdf cfwfl/t kf]if0f sfo{qmd;DaGwL tflnd k|fKtug]{ lzIfsx?, ;|f]t JolQmx? tyf afn Snasf ;b:ox?sf] ;+Vof a9]sf] x'g]5 .

p2]]Zo 

lszf]/Lx?sf] lzIff, lhjgofkgsf ;Lk tyf kf]if0f:t/df ;'wf/ ePsf] x'g]5 .

;g @)!& sf] cGTo;DddfM@)!^ sf] cGTo;DddfMlszf]/Lx?dWo] sIffdf xflh/L tyf sIff plQ0f{ x'g]sf] b/ a9]sf] x'g]5 ./QmcNktf lj?4 slDtdf @ k6s lgoGq0ffTds÷ vfgfdf kf]if0f tTj ;dfj]z u/]sf 5f} eGg] lszf]/Lx?sf] ;+Vof a9]sf] x'g]5 .ljBfno k9g] lszf]/Lx?df h'sfsf] ;+qmd0f 36]sf] x'g]5 .ljBfno k9g] lszf]/Lx?dWo] ljBfno 5f8\g] b/ 36]sf] x'g]5 .

sfo{of]hgf –lzIff If]q

sfo{of]hgf – lzIff If]q pknlAw !=) ue{ tyf lzz' tyf afnaflnsfsf] j[l4 ;DaGwdf lszf]/Lx?sf] hfu/0f / Jojxf/df ;'wf/ cfPsf] x'g]5k|ltkmn !=! bL3{sfnLg s'kf]if0f Go"gLs/0f ug]{ ljifo lszf]/Lx?nfO{ k|bfg ul/g] hLjgofkg;DaGwL lzIffdf a9L eGbf a9L ;dfj]z ul/Psf] x'g]5 -;an jftfj/0fsf] l;h{gf ug]{_ .k|ltkmn !=@ lszf]/Lx?df bL3{sfnLg s'kf]if0fnfO{ Go"gLs/0f ug]{ 1fg / ;Lksf] clej[l4 x'g]5 .

pknlAw @=) ;–;fgf afnaflnsfsf] x]/rfx / cfxf/ Jojxf/df ;'wf/ u/L j[l4 ljkmntfsf] km}nfj6 /f]Sg ;lsg] ljifodf cleefjsx? -dlxnf_ /fd|/L ;';"lrt ePsf x'g]5g\ .k|ltkmn @=! afnaflnsf x]/rfx tyf cfxf/ Jojxf/sf ;'wf/sf nflu cleefjs lzIff;DaGwL ;|f]t ;fdu|L tof/L÷cBfjlws x'g]5 .k|ltkmn @=@ afnaflnsf x]/rfx tyf cfxf/ Jojxf/sf ;'wf/;DaGwL cleefjssf] 1fgdf a9]sf] x'g]5 .

sfo{of]hgf – lzIff If]q pknlAw # lszf]/L 5fqfx?sf] kf]if0f:t/df ;'wf/ x'g]5k|ltkmn #=! ECD afnaflnsf tyf lszf]/L 5fqfx?n] -* sIff ;Dd_ lbjfvfhf k|fKt ug]{5g\ .k|ltkmn #=@ cfwf/e"t lzIffdf -sIff !–*_ lszf]/L 5fqfx?sf] z}lIfs ;xeflutf tyf pknlAwdf ;'wf/ x'g]5 .

pknlAw $ ax'If]qLo k|of;df of]ubfg of]ubfg k'¥ofpg lzIff If]qsf] Ifdtf cleaj[l4 ePsf] x'g]5 k|ltkmn $=! kf]if0f lglb{i6 lzIff cWofkg ug{ lzIff dGqfnosf k|lzIfs Pj+ lzIfsx? -k"j{ ;]jfsfnLg tyf ;]jfsfnLg_ k"0f{?kdf tof/ ul/Psf] x'g]5 .k|ltkmn $=@ k'8\sf]kg 36fpg] ljifodf lzIf dGqfno tyf cGo If]qsf sd{rf/Lx?aLr ;xof]u tyf ;dGjodf ;'wf/ x'g]5 . k|ltkmn $=# lzIff dGqfnoleq cg'udg tyf d"Nofª\sg / ;"rgf k|0ffnL tof/ ePsf] x'g]5 .

glthf

z[+vnf

ljj/0ffTds ;+If]k

sfo{;Dkfbgsf ;"rsx?

nIo k'8\sf]kg 36fpg] sfo{df ltj|tf lbg] ax'If]qLo k|of;df zx/L ljsf; dGqfnosf] of]ubfg x'g]5 .

zx/L ljsf; dGqfnosf] jflif{s tyf ax'jflif{s of]hgfdf vfg]kfgL tyf ;/;kmfO sfo{qmdx? dfkm{t s'kf]if0f 36fpg of]ubfg k'Ug] nIf k|ltlalDat ul/g]5

p2]]Zo 

l56f] aRrfkfpg] cfdfx?, lszf]/Lx?, lzz'x? / afnaflnsfx?df emf8fkvfnf / ARI sf 36gfx?df sdL cfPsf] x'g]5 .

;g @)!& sf] cGTo;DddfMl56f] aRrf kfpg] cfdfx?, lszf]/Lx?, lzz'x? / afnaflnsfx?df emf8fkvfnf / ARI sf] b/ Ü n] 36g]5

sfo{of]hgf –vfg]kfgL tyf ;/;kmfO -zx/L ljsf;_

pknlAw !

;fa'g kfgLn] xftw'g] cEof; a9]sf] x'g]5 .

pknlAw @

;a} nlIft ljBfno, uflj; Pj+ gu/kflnsf v'Nnf lb;fd'Qm If]q x'g]5g\ .

pknlAw #

hn ;'/Iff If]q 3f]if0f ePsf] x'g]5

pknlAw $

;+o'Qm sfo{ of]hgf tyf cg'udg k|0ffnL :yfkgf ePsf] x'g]5

pknlAw %

s]Gb|Lo tyf :yfgLo:t/df hgzlQm ljsf; x'g]5 .

k|ltkmn !

;a} l56f] aRrf kfpg] cfdfx? tyf lszf]/Lx?sf] xftw'g] ;'ljwfx?df kx'Fr e} xftw'gsf] nflu ;fa'g k|of]u u/]sf x'g]5g\ .

k|ltkmn @

;a} l56f] aRrfkfpg] cfdfx? tyf lszf]/Lx?n] ;'wfl/Psf] ;/;kmfO ;'ljwf tyf :jR5s/ Jojxf/ k|of]u u/]sf x'g]5g\ .

k|ltkmn #

;a} ue{jtL Pj+ :tgkfg u/fpg] cfdfx?sf ;fy;fy} @ jif{d'lgsf afnaflnsfn] ;kmf kfgL k|of]u u/]sf x'g]5g\ .

k|ltkmn $

lhNnf tyf uflj;:t/df :yfgLo lgsfo, :jf:Yo, s[lif, tyf lzIff If]qx?aLr ;xof]u ;'b[9 ePsf] x'g]5 .

  ax'If]qLo k|of;df of]ubfg k'¥ofpg s]Gb|Lo, :yfgLo tyf :yfgLo:t/df sd{rf/Lsf] Ifdtf ljsf; ePsf] x'g]5 .

glthf z[+vnf

ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx?

nIf bL3{sfnLg s'kf]if0f 36fpg] sfo{df tLj|tf lbg] ax'If]qLo k|of;df s[lif tyf ;xsf/L dGqfnosf] of]ubfgdf clej[l4 x'g]5 .

s[lif sfo{qmd kf]if0f ;+j]bgzLn x'g]5 .

p2]Zo

sd cfo ePsf lszf]/lszf]/Lx? / sd pd]/df ue{jlt x'g]] cfdfx? tyf afnaflnsfx?aLr lalawtfk"0f{ vfgf vf;u/L ;"Id kf]if0fo'Qm vfgf h:t} h}ljs ;|f]tdf cfwfl/t vfgfsf] pkef]u a9]sf] x'g]5 .

;"Id kf]if0fo'Qm vfgfsf] pkef]u %)Ü n] a9]sf] x'g]5 .

k|f0fLhGo ;|f]tsf] vfgfsf] k|of]u @%Ün] a9]sf] x'g]5

pknlAw

dft[lzz' bL3{sfnLg s'kf]if0f 36]sf] x'g]5 .

nlIft ;d'xsf] bL3{sfnLg s'kf]if0f %)Ü n] 36]sf] x'g]5

sfo{of]hgf – s[lif If]q

k|ltkmnx?

   

k|ltkmn !=)

3/kl/jf/ / ;d'bfosf] txdf vf;u/L ;"Id kf]ifstTjo'Qm ef]hg h:t} h}ljs ;|f]tdf cfwfl/t vfgf, xl/of ;fukft / kmnkm"n, Rofp, bfn cflb ljljwtfk"0f{ vfgfsf] pknAwtf 3/kl/jf/ / ;d'bfo :t/df j[l4 x'g]5 .

cfufdL % jif{df 3/kl/jf/ / ;d'bfodf:t/df ;"Id kf]ifstTjo'Qm vfgfsf] pTkfbg %)Ü a9g]5

k|ltkmn @=)

sd cfoePsf kl/jf/sf] cfo j[l4 e} o;\df sd pd]/df ue{jlt x'g]] cfdfx? / lszf]/lszf]/Lx?sf] o:tf] cfodf kx'r tyf lgoGq0f x'g]5 .

cfufdL % jif{df nlIft 3/kl/jf/sf] cfodf @)Ü a'l4 x'g]5

k|ltkmn #=)

dlxnfx?sf] sfo{af]emdf sd e} 3/ tyf sfo{ jftfj/0f ;'wf/ x'g]5 .

dlxnfx?n] lalaw sfo{df ;do afF8kmfF8 u/]sf x'g]5g\

k|ltkmn $=)

ax'If]qLo k|of;df of]ubfg ug{ s[lif tyf ;xsf/L dGqfnosf sd{rf/Lsf] Ifdtf clej[l4 x'g]5 .

uflj;:t/df lj:tf/ sfo{stf{x? pknAw x'g]5g\

sfo{of]hgf – s[lif If]q

glthf z[+vnf

ljj/0ffTds ;+If]k sfo{;Dkfbgsf ;"rsx?

nIf kf]if0f k|a4{g sfo{df ltj|tf lbg] ax'If]qLo k|of;df :ygLo ;'zf;g Pj+ ;fdflhs ;'/Iffsf] of]ubfgdf clej[l4 x'g]5 .

lhNnf:t/df kf]if0f ;"rgfsf] kx'Frdf clej[l4 e} kf]if0f ;]jfx?df ;'wf/ x'g]5 .

p2]Zo

kf]if0f k|a4{g sfo{df ltj|tf lbg] k|of;df ;xof]u k'¥ofpg :yfgLo ;/sf/sf] Ifdtf ;'b[9 x'g]5 .

;g @)!@ b]lv :yfgLo ;'zf;g gLlt tyf sfo{qmddf l8hfOg tyf th'{dfdf kf]if0f k|ltlalDat x'g]5 .

;g @)!# b]lv :jf:Yo, lzIff, vfg]kfgL tyf ;/;kmfO / s[lif If]qn] kf]if0f sfo{qmddf ;+o'Qm hjfkmb]xLtf ;+oGq cjnDag ug]{5g\ .

;g @)!$ sf] cGTo;Dddf :yfgLo lgsfo alu{s/0f k|fjwfg k'gM kl/eflift u/L kf]if0fsf ;"rsfÍ ;dflxt ul/g]5 .

sfo{of]hgf – :yfgLo ;'zf;g

k|ltkmn !M :yfgLo lgsfosf of]gfdf kf]if0f :ki6?kdf /flvg]5

;g @)!# b]lv lhNnf tyf gu/ ljsf; cfjlws of]hgf / oL ;+:yfsf] jflif{s of]hgfdf kf]if0f ljifo k|ltljlDjt x'g]5 .

;g @)!# b]lv :yfgLo lgsfo cg'bfg lgb]{lzsfdf nlIft ljsf; sfo{qmdsf] k|a4{gfTds nufgL If]qcGtu{t ;dflxt ug{;Sg] u/L kf]if0f ;dfj]z ul/Psf] x'g]5 .

k|ltkmn @M k'8\sf]kg tLj|t/?kdf Go"g ug{ :yfgLo ;|f]t kl/rfng qmlds ?kdf a9b} uPsf] x'g]5 .

;g @)!$ b]lv 5gf]6 ul/Psf uflj;x?df ==Ü uflj;:tl/o ;fd'bflos ;+:yfx? kf]if0f;DaGwL k}/jLdf ;+nUg x'g]5g\ .

;g @)!# b]lv ;fdflhs k/LIf0f tyf ;fj{hlgs ;'g'jfO d~rx?sf 5nkmndf kf]if0fnfO{ :yfg lbFb} ;f] ljifo logsf k|ltj]bg tyf sfo{ of]hgfdf /flvPsf] x'g]5 .

;g @)!# b]lv ;fdflhs kl/rfngsf] kf7\oqmddf kf]if0f zLif{s ;dfj]z x'g]5 .

k|ltkmn #M k'8\sf]kg 36fpg sfo{df ;fdflhs ;'/Iff sfo{qmdsf] k|r'/ of]ubfg x'g]5 .

;g @)!# sf] cGTo;Dddf uef{j:yf b]lv % jif{d'lgsf afnaflnsfnfO{ afn cg'bfg k|bfg ug]{ ;+oGq Joj:yf ePsf] x'g]5 .

pknlAw !

:yfgLo ;'zf;g /0fgLlt tyf sfo{qmd l8hfOg ubf{ kf]if0f b[li6uf]r/ ul/g]5

pknlAw @

:yfgLo ;/sf/sf] th'{df ul/Psf] of]hgfsf] k|ltkm Pj+ ljleGg If]qaLr ax'If]qLo ;dGjo ug]{ Ifdtf ljsf; ePsf] x'g]5 .

k|ltkmn $

lhlj; Pj+ uflj;:t/df :yfgLo lgsfo, :jf:Yo, s[lif / lzIff If]qaLr ;xof]u ;'b[9 ePsf] x'g]5 .

;g @)!@ sf] cGTo;Dddf lhlj;, gu/kflnsf / uflj;:t/df kf]if0f tyf vfB ;'/Iff lgb]{zd ;ldlt lqmofzLn x'g]5 .

;g @)!# b]lv lhNnfdf sfof{Gjog x'g] kf]if0f;DaGwL sfo{qmd :jLs[t ug{ Pj+ k|ult ;dLIff ;DalGwt If]qaf6 u/fO{ bL3{sfnLg s'kf]if0f 36fpg cfjZos lqmofsnfkx? l;kmfl/; ug{ ;ldltsf] a}7s q}dflzs ?kdf a;]sf x'g]5g\ .

k|ltkmn %

ax'If]qLo k|of;df of]ubfg k'¥ofpg sd{rf/Lsf] Ifdtf ljsf; ul/g]5 .

;g @)!# b]lv :yfgLo lgsfosf ;Dks{ ;+:yfx?n] kf]if0f sfof{Gjog / cGo ;+:yfx?;Fu ;dGjo, cfˆgf] sfo{ ljj/0f cGtu{tsf] sfdsf] ?kdf, u/]sf x'g]5g\ .

;g @)!# b]lv :yfgLo lgsfosf ;Da4 sd{rf/LnfO{ kf]if0f;DaGwL sfo{ut lhDd]jf/L lbOPsf] x'g]5 .

;g\ @)!$ sf] cGTo;Dddf :yfljd+ tyf :yfgLo lgsfosf tf]lsPsf d'Vo sd{rf/LaLr kf]if0f;DaGwL 1fg a9]sf] x'g]5 .

k|ltkmn ^

lhNnf ul/aL cg'udg tyf d"Nofª\sg k|0ffnL dfkm{t ax'If]qLo kf]if0f of]hgfsf sfo{qmd sfof{Gjogsf] k|ult dfu{lrq u/L PsLs[t ul/Psf] x'g]5 .

;g @)!# b]lv kf]if0f;DaGwL k|ult -lnË, hghflt / ;d[l4 5'6\ofOPsf]_ lhNnf ul/aL cg'udg tyf d"Nofª\sg k|0ffnLdf PsLs[t u/L k|sflzt ul/Psf] x'g]5 .

NEPALFar-WesternRegion Mid-Western Region

Western Region

Central RegionEastern Region

Initial MSNP Roll-out Districts

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASI

KAPIL-BASTU RUPAN-

DEHI

DANG

BANKE

ACHHAMKALIKOT

JHAPAMORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSABARA

RAUT-AHAT

DHANUSA

MAHO-TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN-PUR

CHITWAN

KASKIBAG LUNG

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR PA CHE THA R

DHAN-KUTA

TAPLEJUNG

RAME CHHAP

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

LALIT

BHAKKATHM SULUK-

HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUT-HAN

ROLPASALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

SIX INITIAL MOEL DISTRICTS (Bajura, Jumla, Kapilvastu, Nawalparashi, Parsa and Jumla) PROPOSED BASED ON 14 INDICATORS

Criteria/Indicators for selection1. Average of 1 to 4 quarters food security phase2. Net Enrolment Rate (NER) Basic Education3. Working Children 10-14 years4. Sanitation coverage 5. Per Capita Development Budget Expenditure6. DPT 3 immunization under 1 year of age7. Expected frequencies of diarrheal outbreaks 8. Ratio of girls to boys in secondary education9. Proportion of severely underweight children less than 5 years10. Minimum Conditions and Performance Measures (MCPMs) of Local Bodies of Nepal11. Proportion of births attended by Skilled Birth Attendant as % of expected pregnancies:12. Stunting Prevalence13. Access 14. Similar MSNP actions by on-going programs/partners

Central Region

MSNP implementation period (First Phase): 2013-2017

;+u7gfTds tyf Joj:yfksLo ;+/rgf

/fli6«o txM pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt

dfggLo pkfWoIf, /fli6«o of]hgf cfof]u, cWoIf/fli6«o of]hgf cfof]usf dfggLo ;b:ox? -:jf:Yo, s[lif tyf jfl0fHoIf]q x]g]{ ;b:o;lrj, s[lif tyf ;xsf/L dGqfno ;b:o;lrj, :jf:Yo tyf hg;+Vof dGqfno ;b:o;lrj, :yfgLo ljsf; dGqfno ;b:o;lrj, jfl0fHo tyf cfk"lt{ dGqfno ;b:o;lrj, cy{ dGqfno ;b:o;lrj, lzIff dGqfno ;b:o;lrj, ef}lts of]hgf tyf lgdf{0f dGqfno ;b:o;lrj, dlxnf, afnaflnsf tyf ;dfhsNof0f dGqfno – ;b:o$ hgf lj1x? -kf]if0f, vfB ;'/Iff, jfl0fHo tyf cfk"lt{;DaGwL_ ;b:o;b:o ;lrj, /fli6«o of]hgf cfof]u ;b:o ;lrj;x;lrj, ;fdflhs ljsf; dxfzfvf, /fli6«o of]hgf cfof]usf] ;lrjfno ;x–;b:o ;lrj

gLltut dfu{bz{g / cg'udgsf ;fy} pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt lgDg sfo{x?sf nflu klg lhDd]jf/ x'g]5 M• ax'If]qLo kf]if0f / vfB ;'/Iff;DaGwL a[xt

gLltx? th'{df ug]{Ù• cfGtl/s tyf afXo ;|f]tx? ;'lglZrt ug]{Ù• /fli6«o tyf cGt/f{li6«o txdf kIfkf]if0f ug]{ /

k|lta4tfx? JoQm ug]{Ù• sfo{qmd sfof{Gjog l:yltsf] ;dLIff tyf

d"Nofª\sg ug]{Ù /• kf]if0f / vfB ;'/Iff;DaGwL If]qut gLlt /

sfo{qmdnfO{ ;dGjo ug]{ .

pRr:t/Lo kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldltsf] ;xof]usf nflu Ps ;lrjfno /xg]5 hf] lgDg sfo{x?sf nflu lhDd]jf/ x'g]5 M• ;"rgf Joj:yfkgM ul/aL cg'udg tyf

ljZn]if0f k|0ffnL, lhNnf ul/aL lgjf/0f tyf ljZn]if0f k|0ffnL, :jf:Yo Joj:yfkg ;"rgf k|0ffnL, lzIff Joj:yfkg ;"rgf k|0ffnLnufot;Fu ;DaGw :yflkt ug]{ .

• ;"rgf ;Dk|]if0f÷kIfkf]if0f ug]{ .• Ifdtf ljsf;sf nflu ;xof]u ug]{ .• ljQLo ;+oGqx?sf nflu ;xof]u ug]{ .

df=;b:o -:jf:Yo tyf kf]if0f If]q_, /fli6«o of]hgf cfof]u –;+of]hs

df=;b:o -s[lif If]q_, /fli6«o of]hgf cfof]u–;x–;+of]hs

;x–;lrj, gLlt of]hgf tyf a}=;= dxfzfvf, :jf:Yo tyf hg;+Vof dGqfno–;b:o;x–;lrj, vfg]kfgL dxfzfvf, ef}lts of]hgf tyf lgdf{0f dGqfno

–;b:o;x–;lrj, ah]6 tyf sfo{qmd dxfzfvf, cy{ dGqfno–;b:o;x–;lrj, k|zf;g, ;+:yfg tyf cfk"lt{ dxfzfvf, jfl0fHo tyf cfk"lt{ dGqfno

–;b:o;x–;lrj, of]hgf tyf j}b]lzs ;xof]u ;dGjo dxfzfvf, :yflgo ljsf; dGqfno–;b:o;x–;lrj, of]hgf dxfzfvf, s[lif tyf ;xsf/L dGqfno–;b:odxflgb]{zs, s[lif ljefu–;b:odxflgb]{zs, kz';]jf ljefu–;b:odxflgb]{zs, vfB k|ljlw tyf u'0f lgoGq0f ljefu–;b:odxflgb]{zs, l;+rfO ljefu–;b:odxflgb]{zs, lzIff ljefu–;b:odxflgb]{zs, dlxnf tyf afnaflnsf ljefu–;b:olgb]{zs, afn :jf:Yo dxfzfvf, :jf:Yo ;]jf ljefu–;b:olgb]{zs, kl/jf/ :jf:Yo dxfzfvf, :jf:Yo ;]jf ljefu–;b:osfo{sf/L lgb]{zs, g]kfn s[lif cg';Gwfg kl/ifb –;b:o;+of]hsaf6 dgf]lgt kf]if0f tyf vfB ;'/Iff If]qsf rf/hgf ljifo lj1x? -kf]if0f–@, vfB ;'/Iff–@_

–;b:o;x–;lrj, s[lif tyf u|fld0f ljsf; dxfzfvf, /f=of]=cf=;lrjfno–;b:o;x–;lrj, ;fdflhs ljsf; dxfzfvf, /f=of]=cf=;lrjfno–;b:o ;lrj;ldltn] ljsf;sf ;fem]bf/x? UNICEF, WB, World Food Program, FAO, USAID / HKI International nfO{ cfdlGqt ;b:osf x}l;otn] lgoldt ?kdf a}7sdf cfdGq0f ug]{5 / cGo ;fem]bf/ tyf ljlzi6 JolQmTjx?nfO{ cfjZstf cg';f/ cfdGq0f ug{ ;Sg]5

/fli6«o kf]if0f tyf vfB ;'/Iff ;dGjo ;ldlt

kf]if0f tyf vfB ;'/Iff If]lqo ;dGjo ;ldlt

ax'If]lqo kf]if0f of]hgfsf] sfof{Gjogdf ;xof]u / ;dGjo ug{ tyf sfof{lGjt sfo{qmdsf] ;'kl/j]If0f / cg'udgsf nflu If]lqo:t/df cfjZostf cg';f/ If]lqo k|zf;ssf] ;+of]hsTjdf ;Dj4 ljifout lgsfox? / ;/f]sf/jfnfx? ;d]t ePsf] kf]if0f tyf vfB ;'/Iff If]lqo ;dGjo ;ldlt u7g ug{ ;lsg]5 .

 

lhNnf:t/M kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt

lhlj; ;efklt, cWoIflhNnf :jf:Yo÷hg:jf:Yo clws[t ;x–cWoIf:yfgLo ljsf; clwsf/L ;b:onfOg Ph]G;Lsf k|d'vx? -s[lif, kz' ;]jf, lzIff, vfg]kfgL_ ;b:ox?dlxnf ljsf; clws[t ;b:osfo{sf/L clws[t, gu/kflnsf ;b:ocWoIf, lhNnf pBf]u jfl0fHo ;+3 ;b:ocWoIf, lhNnf u}/;/sf/L dxf;+3 ;b:ok|ltlglw, lhNnf:t/df sfdug]{ ljsf; ;fem]bf/÷-c_u};;x? ;b:o;"rgf tyf clen]v clws[t, lhlj; ;b:osfo{s|d clws[t, ;fdflhs ljsf; zfvf, lhlj; ;b:ok|ltlglw, lhNnf pBf]u afl0fHo ;+3 tyf pBf]u Jofkf/ ;+3 ;b:olhNnf :jf:Yo÷hg:jf:Yo clws[t ;b:o ;lrj lhNnf ;ldlt a}7sdf cfjZostf cg';f/ ;ldltn] cGo JolQmx?nfO{ cfdGq0f ug{ ;lsg]5 .

;fªs]lts?kdf pQm lgb]{zs ;ldltsf] sfof{b]z lgDgfg';f/ x'g]5 M• lhNnfdf sfof{Gjog x'g] kf]if0f;DaGwL

sfo{qmdx?sf] ljZn]if0f, ;dLIff, cg'df]bg ug]{ / ax'If]qLo kf]if0f of]hgfsf] dd{cg'?k lhNnf kl/ifb\df :jLs[ltsf nflu l;kmfl/; ug]{ .

• lhNnfsf] cfjlws / jflif{s of]hgfx?df kf]if0fsf ;"rsx? ;dfj]z ug]{ .

• nfOg Ph]G;Lx? / lhNnf ul/aL cg'udg tyf ljZn]if0f k|0ffnLsf] k|ult ;dLIff ug]{ .

• lhNnfdf /x]sf] bL3{ Go"g kf]if0f 36fpgsf nflu ax'If]qLo ;dGjo ug]{ .

gu/kflnsf :t/ M kf]if0f tyf vfB ;'/Iff;DaGwL

lgb]{zs ;ldlt d]o/, gu/kflnsf cWoIflhNnf :jf:Yo÷hg:jf:Yo clws[t ;x cWoIfsfo{sf/L clws[t, gu/kflnsf ;b:ok|d'v, nfOg Ph]G;Lx? -s[lif,kz' ;]jf, lzIff, vfg]kfgL_

;b:ox?of]hgf clws[t, lhlj; ;b:ok|d'v, gu/ :Jff:Yo s]Gb|, gu/kflnsf -ljBdfg eP_ ;b:ocWoIf, lhNnf u};; dxf;+3 ;b:ok|ltlglw, lhNnf:t/df sfo{/tljsf; ;fem]bf/÷-c_ u};;x? ;b:oof]hgf clws[t, of]hgf zfvf, gu/kflnsf ;b:oclws[t, ;fdflhs ljsf; zfvf, gu/kflnsf ;b:o ;lrj

uflj;:t/M kf]if0f tyf vfB ;'/Iff;DaGwL lgb]{zs ;ldlt

cWoIf, uflj; cWoIfk|ltlglw, s[lif ;]jf s]Gb|, kz' ;]jf s]Gb| / :jf:Yo rf}ls jf s]Gb| ;b:ox?k|ltlglw, :jf:Yo ;]jf Joj:yfkg ;ldlt ;b:ocWoIf, ljBfno Joj:yfkg ;ldlt w]/} eP 5flgPsf] !_ ;b:ok|ltlglw, jf8{ l;l6hg kmf]/d, ;b:o;lrj, uflj; ;b:o ;lrj

;fª\s]lts?kdf pQm lgb]{zs ;ldltsf] sfof{b]z lgDgfg';f/ x'g]5M• lhNnfdf cjnDag ul/Psf] ax'If]qLo kf]if0f

of]hgf cg'?k x'g] u/L uflj;sf jflif{s of]hgfx?df kf]if0fsf sfo{qmdx? ljZn]if0f ug]{ / ;dflxt ug]{ .

• kf]if0f sfo{qmdx?sf] sfof{Gjogsf] k|ult ;dLIff ug]{ .

• uflj;df bL3{ Go"gkf]if0f 36fpgsf nflu ax'If]qLo ;dGjo ug]{ .

ah]6 af+8kmf+8 tyf sfof{Gjog