The community at Kailash Rural Municipality in Makwanpur district is defined by a hidden transition. An overwhelming majority of its residents belong to the Chepang community, one of the most underprivileged and underrepresented ethnic groups of Nepal. The Chepang people are historically a nomadic group who started settling down only in recent decades due to societal pressures. This means that the perspective with which they interact with the outside world is completely different — they lack the understanding of modern social systems and are unable to fit into them easily.
This backdrop intimately figures into the projects that SDA operates in the region. Perhaps the most upsetting expression of this cultural misfit is the widespread issue of malnutrition across Kailash Rural Municipality, which predominantly affects children. With a history that has been completely divorced from organised society until recent decades, the Chepang people do not have a consistent source of income. Their livelihood relies primarily on sustenance farming, but harvests usually only last a family for half the year. This problem is further exacerbated by a lack of basic knowledge about malnutrition — its signs, risks, and preventative measures are far from embedded in the community.
As such, creating a track for long-term solutions hasn’t been easy. As is the case with many social problems, traditional views and broader economic pressures tie into the issue of childhood malnutrition at Kailash Rural Municipality. At the Niko Health Post in Tamlang-7 of Kailash, Health Post Incharge Babita Chepang tackles the most number of childhood malnutrition cases across the rural municipality.
At the time of the interview, Incharge Chepang was overseeing rehabilitation of around 21 children with malnutrition. “Around the end of the Nepali calendar, in the months of Falgun and Chaitra, people of Kailash in general face a food shortage,” she explained, “They make a meagre living doing day labour around this time.” She shared that families have ample food after the harvest season, around the months of Bhadra and Asoj (which falls around the Nepali months of August/September). By Chaitra, which comes six months later, much of the food runs out, leading to a spike in cases of child malnutrition.
Krishna Yadav, head of Kailash Rural Municipality’s Health Department, pointed out that a lack of proper awareness about malnutrition is what has kept the issue alive. “The people here have inadequate knowledge on nutrition and proper diet habits,” he said, “it is because they consume nutritionally inadequate diets that has led to this issue.” At the same time, the remote location of Kailash RM, deep in the hilly areas, means that a clear picture about the severity of childhood malnutrition cases can be difficult to obtain for government officials.
Several programs have been started in recent months to remedy this situation and to provide proper resources for rehabilitation. Department head Yadav shared that the rural municipality has started nutrition surveys in which health workers visit each Kailash ward to discover cases of child nutrition. The health posts of Kailash have also started offering Outpatient Therapeutic Care, under which children suffering from malnutrition are put under a rehabilitation program where they receive Ready-to-Use Therapeutic Food (RUTF).
These programs have been effective on a case-by-case basis to rehabilitate children suffering from malnutrition. But the children do not receive proper attention from the parents in the days following rehabilitation. Incharge Chepang remembers countless instances where parents of malnutritioned children agree to their medical recommendations with all appearance of sincerity — only for her to discover later that they followed none of them. “In every case, traditional thinking comes as an obstacle,” she said, repeating a few lines she hears time and again. “This isn’t a serious illness, there is no need to go to the hospital,” and “the kid’s elder siblings had the same problem, they turned out fine,” were just some of them.
The need for extended awareness programs with a long-term view makes itself known through these obstacles. Department Head Yadav claimed that the budget available for malnutrition programs is far from enough to conduct ideal programs. “Each home must be aware on what nutrition is, and what it’s consequences are in the future,” he said, “and for that, general awareness has to improve — not through one-day or one-month programs, but this has to be taken to longer term of 1 to 2 years where nutrition awareness has to take place. This will allow the issue to be treated from the roots.”
Shangri-La Development Association has been active at Kailash Rural Municipality for about a decade at this point, with its malnutrition-focused programs being conducted through an integrated approach of its three projects. Of all its project activities oriented towards malnutrition mitigation, the cornerstone program is the Malnutrition Screening and Awareness Camp. Taking place under the SDA Health Project, the Malnutrition Screening Camp has so far been conducted four times — in 2019, 2021, 2022, and 2024. These camps have always taken place over multiple days in different significant clusters of our working area, in order to reach the maximum number of beneficiaries. By mobilising various stakeholder groups in the community, from Female Community Health Volunteers to mothers’ groups, the SDA Malnutrition Screening Camps have till date conducted 4,326 screenings, and sent cases of acute malnutrition to the Nutrition Rehabilitation Home at Sunakothi, Lalitpur.
SDA’s Health Project operates primarily with a focus on vulnerable groups, mainly pregnant women, new mothers, and children. Under this scope, the organisation conducts multiple other programs regularly to help mitigate malnutrition in its working area. Nutrition education and screenings of malnutritioned children is an ongoing activity conducted by SDA throughout the year at Kailash Rural Municipality. Meetings with different stakeholder groups such as mothers’ groups and Female Community Health Volunteers is a monthly activity conducted by the SDA Health Project, and in these meetings SDA conducts regular orientation and training sessions on malnutrition, among other health-related issues.
SDA’s nutrition education efforts also take place through other fronts — since the past August, SDA has conducted various Nutrition Education Programs at the SDA-supported community schools of Kailash, giving awareness sessions to a total of 120 students, along with teachers and parents. The SDA Health Project also conducts School Health Screening Programs at regular intervals in these schools, which is also used as an opportunity to screen for cases of malnutrition while also providing crucial information about it. Through these combined programs, SDA has referred 14 children to the Nutrition Rehabilitation Home in the past year.
The Mid-Day Meals Program operated by the SDA Education Project is another significant SDA project activity aimed towards malnutrition mitigation. Started in the early days of SDA, the Mid-Day Meals Program provides nutritionally rich meals to school students at five community schools that are supported by the SDA Education Project. Conducted in collaboration with local stakeholders including the School Management Committees and parents of the school students, the Mid-Day Meals Program remains one of our most successful programs, cherished and supported by the Kailash community and presenting multisectoral benefits.
Parents in KRM are often unaware about the importance of formal education for their students, preferring to keep them at home to help out with chores. In addition, the commute to and from school is a tough one for most children, involving foot travel for as much as two hours one-way. Since food insecurity is such a prevalent issue in the community, the promise of a freshly prepared meal is an effective motivation for parents to send their children to school. But with regular nutritious meals, the students also gain nutritional health, leading to improvements in their school performance.
The SDA Agriculture Project also operates with a goal of alleviating the food insecurity prevalent in Kailash. Operating with a long-term view, the Agriculture Project includes numerous facets that, again aims for multisectoral impact: by promoting the use of modern, organic farming techniques, and operating its own organic farm in Kailash, it seeks to capacitate the local farmers so that they may transition from purely sustenance farming to commercial farming using environmentally sustainable farming practices. In the meanwhile, the harvests from Achim’s Agriculture Farm, where SDA’s Agriculture Project is based, support our Education Project by supplying fresh, organic vegetables for the SDA Literacy Home, and for the Mid-Day Meals Program.
The many programs that are operated by Shangri-La Development Association at Kailash Rural Municipality work in an integrated fashion seeking positive change of a permanent nature. It’s an expansive effort that aims to create change in the very way of life at Kailash Rural Municipality, bringing about a drastic quality of life improvement in the long term that positively impacts future generations as well. Through close collaboration with stakeholders including the Rural Municipality itself and farmers’ groups, the organisation seems to develop programs at the ground level in a fashion that ownership can eventually transform to the local community, and grow organically.