Would you replace a public system that looks (and acts) like this?

by Mark Arnoldy · 2009-07-26 01:26:00 UTC
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Last Wednesday, the Government of Nepal “eclipsed” expectations when they declared a public government holiday because of a brief solar eclipse that took place before most government officials wake for their morning tea.

What does this have to with our work of trying to deliver a life-saving fortified peanut butter to Nepal’s severely malnourished children?

Unfortunately, a lot. A great product without a great distribution system is useless. And events like these by the Government of Nepal coupled with the usual historical criticisms of the Nepali government (neglect, nepotism, incompetence, laziness, corruption, and more) raise doubts about using the Government’s Logistics Management System (LMS) to deliver the ready-to-use therapeutic food (RUTF) we are working to produce.

No doubt there are some extraordinary, dedicated government employees (including the Chief Nutrition Officer at the Child Health Division, Raj Kumar Pokharel). But I have visited far too many derelict, unstaffed “government-run” health posts in rural Nepal (like the one pictured below in one of the richest hilly districts in all of Nepal) to believe that the few dedicated civil servants can ensure that this life-saving peanut butter would (a) make it to its destinations across rural Nepal and (b) actually be used in the appropriate way if it reaches its destinations.

So this begs a difficult question that is applicable across all fields of development:

How can you design a program that provides what should already be a guaranteed public service without totally circumventing the public system and thus making it weaker and less accountable to the people it should be serving?

The potentially great thing about this Community-based Management of Acute Malnutrition (CMAM) that is being piloted in Nepal is that it could really enhance existing public health structures and programs (because it also includes protocols beyond only treating severe malnutrition with RUTF including de-worming, systemic infections, and vaccinations). It is currently being implemented not by some INGO but through the Government system in one district, and my recent trip to document the program indicates that it is working SO FAR.

But what happens when the pilot needs to expand beyond this one district that is quite accessible and has decent infrastructure? Will the LMS of the Government of Nepal guarantee this product reaches all the malnourished children that need it the most?

Experience suggests not, as many health posts remain unstaffed and are devoid of essential medicines that are all supposed to go through the LMS.

That’s why we are planning on working to design a distribution network for this product that operates as a Public-Private Partnership to identify and fill the gaps where the LMS doesn’t reach.

Our challenge is to do this in such a way that doesn’t completely replace the public system and relieve it of its rightful responsibilities. Any successful examples of doing this from around the world would be much appreciated…Thanks!

p.s. I have published a new photo album from my recent trip to rural Nepal to study the CMAM program. See the photos on Picasa here:

http://picasaweb.google.com/markarnoldy/NepalNUTritionPeanutButterCMAM?feat=directlink

or on Facebook here:

http://www.facebook.com/album.php?aid=2423516&id=10221248&l=3868ea7760

Mark Arnoldy
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