2. DEFINITION OF THE CHILD (ARTICLE 1 OF THE CONVENTION)
The 1992 Children’s Act is the basic law that takes care of the matters relating to children. The children below 10 years of age are immunized from criminal and civil liabilities and depending upon the offence there is provision of penalty for children between 10-14 years of age. Similarly, it provides half of the penalty that is given to an adult for the same offence for children between 14-16 years of age.
Various legislations have variations of age in defining a child. The GoN has drafted a new Bill on “Act Concerning Children” to replace the 1992 Children’s Act with the provision of defining a child as a person below18 years of age. This definition of a child has been made under various legislations and policy documents as revealed in the following:
The 2007 Human Trafficking (Control) Act defines “child” as a person below the age of 18 years.
The Tobacco Control and Regulation Act defines the age of a child as less than 18 years.
The legal age of marriage for boys and girls is 18 years with the consent of parents/guardians and 20 years without such consent.
The CFLG strategic framework of the MoFALD defines the age of a child as below 18 years.
3. GENERAL PRINCIPLES (ARTICLES 2, 3, 6 AND 12)
Non-discrimination (article 2)
The Constitution and other relevant laws prohibit discrimination based on race, caste and gender and guarantee to all citizen equal treatment before the law. Furthermore, it prohibits discrimination concerning remuneration and social security between men and women for the same work.
Article 14 of the Constitution prohibits discrimination making provisions as follows: (1) no person shall be discriminated against as untouchable and subjected to racial discrimination in any form, on grounds of caste, race, community or occupation. Such discriminatory treatment shall be punishable, and the victim shall be entitled to such compensation as determined by law, (2) no person shall, on grounds of caste or race, be deprived of the use of services, facilities or utilities available to the public or of the access to any public place or public religious sites or of the performance of any religious function, (3) In producing or distributing any goods, services or facilities, no person belonging to any particular caste or tribe shall be prevented from purchasing or acquiring such goods, services facilities nor shall such goods, services facilities or facilities be sold or distributed only to the persons belonging to any particular caste or tribe, and (4) No such act as to purport to demonstrate any superiority or inferiority of the person or persons belonging to any caste, tribe or origin or to justify social discrimination on the ground of caste or race or to publicize ideology based on racial superiority or hatred or to encourage caste discrimination in any manner shall be allowed.
Other Legal provisions have already been reported in the initial (CRC/C/3/Add.34) and second periodic (CRC/C/65/Add.30) reports. Different commissions such as NHRC, National Dalit Commission, National Foundation for Development of Indigenous Nationalities (NFDIN) and National Women Commission (NWC) have been set up at the national level to promote the rights of all sections of the society. These commissions have been implementing programs for the promotion of the rights of men, children, Dalits and women. In addition, NFDIN is functional in promoting and protecting the rights of indigenous nationalities. All these commissions and other government offices are making efforts through various programs to end the discriminatory treatment towards children from vulnerable communities.
The TYP (2010/11 to 2012/13) adopts the strategy of bringing all children of the country progressively within the net of social protection by starting from the children of poor, conflict affected and marginalized communities as well as at-risk and children with disabilities. The National Human Rights Action Plan has also framed strategies in: promoting and protecting the rights of the child; ensuring the rights of the child as enshrined in the CRC and its Optional Protocols; and eliminating all types of discrimination and violence against children.
The GoN budget 2009/10 introduced a Child Protection Grant of NRs 200 per month per child under the age of five for up to two children for each poor Dalit family across the country and all families in Karnali Zone. The GoN allocated an amount of Rs. 720 million in 2009/2010 to the child grant programme. The amount has been increased in later years. The implementation of the child protection grant has shown significant result in reaching the unreached and has contributed in increasing birth registration of children in Karnali.
The current TYP has set an objective to enable economically vulnerable and socially excluded marginalized individuals, groups and communities to cope and manage risks and vulnerabilities by providing them social security and protection. To achieve its objectives, the TYP has adopted a strategy of expanding social protection programs to the poor, marginalized individuals, regions and communities. In addition, in order to achieve the goal of "social protection for all", the GoN has adopted strategies of encouraging community initiatives and community-based social care and security; linking social protection programs with socioeconomic and human development; consolidating existing and scattered social protection programs into an appropriate, effective and integrated social security system; and improving the effectiveness of implementation of social protection programs.
The TYP has also adopted strategies for the provision of free, quality, basic health and education services to all the people specifically to poor, marginalized and vulnerable individuals, groups and communities. The GoN is implementing programs in such a way that brings senior citizens, children, widows, and persons with disabilities and vulnerable people of all castes, ethnicities and groups within the net of social protection system. In addition, the GoN has adopted strategy in expanding shelter homes with livelihood provisions for the abandoned and destitute in the long- run.
The GoN has undertaken a number of audio-visual campaigns to raise awareness against the evils of social discrimination; and media, both government and private, has played a significant role in raising awareness. Various socially responsible campaigns have been held in the interest of the public by development partners and the private sector to raise awareness against discrimination.
In the health sector, there has been little difference in early childhood mortality between boys and girls, but gaps have emerged among the residents of rural and urban areas. Caste, ethnic and regional attributes and socioeconomic status have also contributed to such gaps.5
The disaggregated analysis of health data has indicated the need of social inclusion on health and has made important contributions to advocacy. The health services for the marginalised and vulnerable population appear in a status of under-utilisation. While there is little difference in infant and child mortality by sex, the high rates of maternal mortality and poor access to reproductive and maternal health services highlight the challenges to reducing gender inequities in health.
Nepal achieved the target of gender parity at primary level education. The number of trained teachers (about 60%) including recruitment of female teachers at all levels has increased. Nepal has made remarkable improvements (93 %) in the Net Enrolment Rate (NER) at primary level in 2009. However, the progress is lagging behind the target set under the Education for All (EFA) Plan for 2004-2009.
(B) Best interests of the child (article 3)
The working policy of the TYP for children aims to achieve the elimination of all forms of exploitation, discrimination, violence and risks against all children. It also aims to create a conducive and enabling environment for the physical, mental, emotional and intellectual development of children. The GoN has put emphasis on promoting child friendly local governance while promoting the concept of child friendly schools, services, local bodies and communities. Accordingly, the GoN has given priority to the rights and needs of children in all relevant sectoral policies, programmes and projects with the concept of "children first" and “best interest of child”.
The TYP-Approach Paper (2010/11 to 2012/13) has analysed that the services and facilities provided to children and efforts made to protect them during the TYIP were inadequate. Challenges of resource mobilization and efficient utilization of available resources still exist which have hampered the services to children.
The GoN has introduced the Child Protection Grant in the (2009-10) budget to improve overall situation of children in Nepal. The grants are being provided to the children under-five years from all poor Dalit families across Nepal and to all children under five years in the Karnali zone. The grant is limited to two children from each mother. The major objective of the child protection grant is to address malnutrition, promote childcare practices, and address child poverty including multi-dimensional deprivation faced by the children.
The MoFALD has introduced the concept of child friendly local governance that incorporates the concept of survival, development, protection, and meaningful participation. This is being achieved by introducing CFLG national framework and adoption of child friendly local governance by VDCs, municipalities and districts. The authority has been given to VDCs, municipalities and districts to be declared as child friendly local bodies based on an assessment of achievement in line with the indicators identified during the adoption and strategic planning. The MoFALD has made a mandatory guideline to local bodies (municipalities and VDCs) to earmark 15 per cent of capital grant for funding projects designed to empower children in adopting child friendly local governance under the CFLG National Strategic Framework.
The GoN is receiving support and assistance from development partners on CFLG as per the objectives of the CFLG national framework that foresees to increase coordination and foster financial and technical partnership between the government, non-governmental and private agency working in the field of children.
The GoN has taken all the necessary measures to ensure the incorporation of the concept of "best interest of the child" into national legislations, programs and policies and has formulated them accordingly. Examples include the incorporation of the concept of the importance of family integrity and preservation and the importance of avoiding the removal of the child from her/his home; the health, safety and/or protection of the child under all circumstances; and the assurance for the care of removed child from home. In addition, criminal and civil cases involving children are treated with the maximum priority and victims are provided with adequate legal, medical and psychological support.
(C) The right to life, survival and development (article 6)
National Immunization Day has enabled Nepal to remain polio-free in 2009, and a measles campaign in 2008 targeting children below five years of age enabled to achieve good progress toward measles control. The polio campaign coverage in 2009 was 89 per cent in the first round and 84 per cent in the second round, and the measles campaign total coverage was 96 per cent. Some cases of polio reappeared in 2010. However, with intensive mop-up campaign, the virus was contained. The MoHP introduced the pentavalent vaccine (DTP-HepB-Hib) in a phased manner in 2009, starting from the western and far western development regions.
About 89 per cent of children of 12-23 months of age are fully immunized in rural Nepal6. While reviewing the individual vaccines, it can be noted that 95 per cent of children received the BCG vaccine; 94 per cent received Diphtheria, Polio and Tetanus (DPT)-1; 93 per cent received DPT-2; and 90 per cent received the DPT-3 vaccine. Although, the DPT and polio vaccines were given at the same time, there was one per cent difference in the polio coverage compared to the DPT, which was primarily due to the immunization campaigns. However, this gap has narrowed over the years. About 92 per cent of children of 12-23 months of age are vaccinated against measles.
The National Immunization Program (NIP) is a high priority program of the GoN, and covers all the districts, municipalities and VDCs of the country and is provided free of cost7. NIP delivers the services through routine and supplemental immunization program.
The incidence of severe pneumonia among children below five years of age declined from 1.2 per cent to 0.78 per cent between 2007-08 and 2008-09, and the reported case of fatality rate, declined from 0.2 to 0.01 per 1,000. While the number of reported diarrhoea cases increased greatly in 2007-08, the proportion of severely dehydrated cases was maintained at the level of 1 per cent.
About 48 per cent of the women in the National Family Health Program (NFHP) - II Mid-term Survey districts who gave birth in the three years preceding the survey received antenatal care from a skilled birth attendant, which is a significant increase from the baseline figure of 45 per cent as reported in 2006. There has been a significant rise in women receiving antenatal care from doctors (25 per cent), while there is a reduction in antenatal care (ANC) services from nurses/midwives (23 per cent). About 19 per cent of women received antenatal care from mother and child health (MCH) workers, while 14 per cent received care from health assistants or health workers, and 5 per cent received care from Village Health Workers (VHWs). As the practice of seeking antenatal service from qualified providers has increased, the number of women seeking antenatal care from Female Community Health Workers (FCHVs) only has declined significantly. The proportion of women who did not receive any antenatal care has declined significantly from 23 per cent in 2006 to 13 per cent in 2009.
In January 2009, the MoHP launched the Aama Suraksha (Mothers’ Safety) Program, which aims to save maternal and newborn lives by encouraging more women to deliver in a health facility. It combines free delivery services at any public health facility (and a number of private facilities) with the Safe Delivery Incentives Program (SDIP). Women who deliver in a health facility receive a lump sum payment to help offset their travel costs, and health workers have provided with a financial incentive to attend home deliveries where women do not deliver in a health facility.
Despite the measures taken, Nepal is unlikely to achieve the MDG target of halving the prevalence of underweight among children under five years of age (bringing it below 27%) by 20158. About 46 per cent of under-five children are stunted and some 16 per cent are severely stunted in rural Nepal9. This is a significant decline from the baseline of 2006 where it was 50 per cent and 21 per cent, respectively. This indicates that the nutritional status of children is improving over time. However, the study indicates a significant rise in the proportion of children having inadequate nutrition in the period immediately preceding the survey, with the proportion of children wasted rising by 17 per cent. Similarly, there has been a rise in children severely wasted by 43 per cent. There has been a significant reduction in the proportion of underweight children from 43 per cent to 40 per cent in the last three years. This indicates a reduction in the situation of acute and chronic malnutrition among children in rural areas.
About 10.02 million people contacted FCHVs for information and services related to family planning, safe motherhood, and childhood illnesses in 2009-1010. FCHVs have promoted health services in Nepal for nearly 20 years. Their close proximity to communities underlies their success in providing undisrupted services even during times of violent conflict. FCHVs made Nepal the first country in the world to achieve national coverage of vitamin A supplementation to children aged six months to five years. FCHVs have delivered vitamin A supplements for children bi-annually since 1993. Now, they reach 3.5 million children (90%) of the country in this age range. This program alone has saved an estimated 12,000 children’s lives every year. FCHVs have managed more than one million cases of pneumonia in children each year. FCHVs are integral to the success of Nepal’s Community Based Integrated Management of Childhood Illness (CB-IMCI) program.
About 18 per cent of rural women, aged 15-19 have already had a birth or are pregnant with their first child. Teenage pregnancy has been observed in reducing pattern.
The prevalence of anaemia among children and women has fallen sharply in the past decade. The GoN has an iron-foliate supplementation program for pregnant women all over the country. FCHVs are distributing the supplements at the community level in more than two-thirds of the country. There has been a significant rise in the proportion of women taking iron tablets (46%) and Vitamin A supplements (48 per cent) postpartum since the baseline of 2006. About a quarter of children, were found to have consumed iron-rich food in the 24 hours prior to the survey. This has remained stagnant over the years.
Two out of three children (67%) consumed foods rich in Vitamin A in the 24 hours before the survey. Although not statistically significant, this is a slight improvement from the baseline 2006 status (63%). Children are more likely to consume foods rich in Vitamin A, as they grow older, with 29 per cent of children aged 6-8 months taking food rich in Vitamin A, compared to 76 per cent in the age group of 24-35 months. There is a slight gender difference in the practice of taking foods rich in Vitamin A, with more female children taking it: 71 per cent compared to 63 per cent among male children. The coverage of vitamin A supplementation and de-worming was 98 per cent in the last distribution round in April 2009.
Measles, which is a major killer among all vaccine-preventable diseases, remained a high priority activity of the MoHP. Activities have been initiated towards measles elimination by 2016 as mentioned in objective four under the Multi Year Plan for Immunization (MYPI, 2011-2016). Following National Measles Catch-up Campaign in 2005 and Measles Follow-on campaign in 2008, both measles like outbreaks and laboratory, confirmed that measles cases have decreased drastically. To sustain the achievements gained so far, the GoN has plans to conduct national measles follow-up campaign in 2012 targeting 100 per cent of children older than 9 months to younger than 5 years of age.
The CB-IMCI package addresses five major killer diseases of children–acute respiratory infection (ARI), control of diarrhoeal diseases (CDD), fever including malaria and measles, ear infections and malnutrition. The CB-IMCI package being implemented up to the community level in all 75 districts has already shown positive change in the management of childhood illness11.
The practice of taking children with illness to a health care provider (excluding pharmacy, retail shops and traditional practitioner) has improved over the years, with more than one in three children suffering from diarrhoea being taken to a health provider. This is a 24 per cent increase in the appropriate practice of seeking care from a health provider12.
Neo-natal health has been made an integral part of safe motherhood program. Neo-natal mortality accounts for 54 per cent of under-five children mortality and is significant landmark to achieve the MDG 4 goal. Provisions have been made to deliver proper neo-natal care through all the health facilities at community level. At facility level, facility based CB-IMCI, Basic Obstetric Care (BOC) and Comprehensive Emergency Obstetric Care (CEOC) for pregnant women are also available. At community level, Community Based New-born Care Package (CB-NCP) is rapidly being expanded. These interventions are expected to help lower the neo-natal mortality rate.
The Nepal Health Sector Program-Implementation Plan (NHSP-IP) also intends to improve access to and utilization of health care services for the poor, vulnerable and marginalized people in a sustainable way. Free Health Care Policy, 2007 has the same targets and expects to deliver the health services at the doorsteps, and hence it is expected to raise the demand for health services in coming years.
Wide differences in infant and under-five mortality are observed in rural-urban residence. Mortality in urban area is consistently lower than in rural area, with under-five mortality being 35.9 per cent lower in urban areas than in rural areas, and infant mortality being 36.6 per cent. There is also considerable variation in mortality by ecological zones, with under-five mortality ranging from a low of 62 per 1,000 live births in the hills to a high of 128 per 1,000 live births in the mountains. Under-five mortality is also relatively higher in the mid-western and far-western development regions than in other regions. Infant mortality is 99 per 1,000 live births in the mountain region, but only 47 in the hill region. Infant mortality is also higher in the mid-western (97 per 1,000 live births) and far-western development region (74 per 1,000 live births) than in other regions.
About 70 per cent of children (including non-breastfed) receive the minimum dietary diversity in rural Nepal. This is a significant increase from the baseline of 2006, where 62 per cent of children received this type of dietary diversity. Children receiving the minimum dietary diversity improve with ages, as older children tend to get a variety of foods.
Breastfeeding is almost universal in Nepal, and the per cent of children ever breastfed does not vary much by background characteristics. It was found that more than one-third of new-borns were breastfed within one hour of birth and 85 per cent were breastfed within one day of birth13. NFHP-II Review Report estimates that most children are likely to be breastfed in the first day of birth (87%). However, more focus will be paid on the remaining 13 per cent of children who were not breastfed in the first day of birth. This delay could be harmful for the newborn. These children most often receive pre-lacteal feed, which includes items (honey, glucose, sugar syrup. etc) other than breast milk. However, there has been significant decline in newborns receiving pre-lacteal feed over the years (39% in 2006 to 31% in 2009).
Health education, information and communication activities carried out through various media down to the community level, have greatly contributed to raise awareness and knowledge of the people in promoting improved health status. This has also prevented diseases through the efforts of the people themselves and through full utilisation of available resources. The easy availability of IEC materials at the local level has led to increased demand for health services, whether it is related to child health or other. People living even in remote area with no education are also very much conscious about the health, and hence the communities do not miss any opportunity to take advantage of health benefit whenever the health campaign takes place in their locality.
Out of the total budget allocated for child health and nutrition-related programs (NRs 1,306 million), the budget specifically earmarked for nutrition-related programs amounts to NRs 108 million (8.3%). Given the magnitude of nutritional problems in the country and their impact on child morbidity and mortality, this allocation is low and the GoN is taking an initiative to mobilize external resource to meet the requirement.
(D) Respect for the views of the child (article 12)
Nepal has made progress in recent years in increasing the participation of children in national and local level decision-making processes. The GoN has developed a single national policy framework on children. The guideline and procedure for promoting child participation is already developed and being practiced.
The TYP envisages the implementation of child friendly programs in the districts and makes provision of rewarding the local bodies that are able to develop a clear guideline for child friendly programs and promote child participation.
The stakeholders in the process of regional consultations for the preparation of the present Report, especially the representatives of the child clubs have identified various achievements during the reporting period. A total of 13,291 child clubs (out of which 7,149 are enlisted in DCWB in 52 districts) and their networks have been established at VDC and DDC levels. The number of children affiliated with child clubs has reached 339,446, out of which 158,653 are boys and 180,793 are girls. So far, 45 district level networks of child clubs, 42 regional/constituents level network, 1277 village level and 17 municipal level networks of child clubs are functional in the country. The VDCs have initiated allocating budget from their annual budget for conducting activities for children through child clubs in supporting activities to protect the rights of the child. The rate of child participation is increasing even though it varies greatly between and within the communities and districts. The impacts of child clubs have been clearly observed in improving children's health, participation, leadership development and education on the rights of child. The participation of children in DCWB and District Child Protection Committee (DCPC) activities and in the meetings/activities at the community level (VDC/SMCs/DDC) has increased even though it varies greatly between and within the communities and districts. Overall, the participation of children at all levels has noticeably increased and awareness regarding the participation of children and respecting their views is increasing in recent years14.