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Bhutan

It’s time to end malnutrition in South Asia

Idah Z. Pswarayi-Riddihough's picture
Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.
Chronic malnutrition remains prevalent across South Asia as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.

In Sri Lanka, as in the rest of South Asia, improving agricultural production has long been a priority to achieve food security. 

But growing more crops has hardly lessened the plight of malnutrition. 

Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices. 
And children and the poorest are particularly at risk.

South Asia is home to about 62 million of the world’s 155 million children considered as stunted-- or too short for their age. 

And more than half of the world’s 52 million children identified as wasted—or too thin for their height—live in South Asia. 

Moderate-to-severe stunting rates ranged from 17 percent in Sri Lanka in 2016 to a high 45 percent in Pakistan in 2012–13, with rates above 30 percent for most countries in the region.

Moderate-to-severe wasting rates ranged from 2 percent in Bhutan in 2015 to 21 percent in India in 2015–16, with rates above 10 percent for most countries in the region. 

The social and economic cost of malnutrition is substantial, linked to impaired cognitive development, chronic disease, and lower future earnings.

And sadly, much remains to be done to ensure children across South Asia can access the nutritious foods they need to live healthy lives. 

From Japan to Bhutan: Improving the resilience of cultural heritage sites

Barbara Minguez Garcia's picture
This page in: 日本語
 Barbara Minguez Garcia 2018
When it comes to their heritage buildings, both Bhutan and Japan have one common enemy: Fire. A view of Wangduephodrang Dzong in Bhutan which was destroyed by fire in 2012. Credit: Barbara Minguez Garcia 2018

About 2,749 miles, three countries, and a sea separate Kyoto, Japan, and Thimphu, Bhutan. The countries’ languages are different, and so are their histories.

But when it comes to their heritage buildings, both nations have one common enemy: Fire.

And to help prevent fire hazards, there’s a lot Bhutan can learn from Japan’s experience.

To that end, a Bhutanese delegation visited Tokyo and Kyoto last year to attend the Resilient Cultural Heritage and Tourism Technical Deep Dive to learn best practices on risk preparedness and mitigation, and apply them to Bhutan’s context.

Such knowledge is critical as Bhutan’s communities live in and around great heritage sites.

Helping Bhutan’s parliamentarians better understand economics

Yoichiro Ishihara's picture
Bhutanese Council Members and World Bank Staff
Bhutan's newly elected council members with World Bank staff. 

Members of parliament are valuable partners for the World Bank. They enact laws, shape and review development policies, and hold governments accountable for World Bank-financed programs. This applies for the landlocked Himalayan kingdom of  Bhutan. The role of its parliament has been increasing since the country’s successful transition from monarchy to constitutional monarchy in 2008. Through its engagement with these elected representatives, the World Bank effectively integrates citizen voice in its programs to achieve lasting and inclusive development results.
 
A joint workshop between the World Bank and National Council of Bhutan, the upper house, was a great opportunity for the World Bank to engage with the 25 newly elected National Council members.

Promoting better nutrition in Bhutan

Izabela Leao's picture
 Izabela Leao / World Bank
School children singing and dancing in Samtse Dzongkhag. Photo Credit: Izabela Leao / World Bank

Bhutan is no ordinary place.

A landlocked Himalayan kingdom tucked in a mostly rugged mountainous terrain between India and China, it measures prosperity by assessing its citizens’ level of happiness by way of a Gross National Happiness index.

Equally striking, Bhutan’s constitution mandates that 60 percent of its national land be preserved under forest cover, making Bhutan the world’s only carbon-negative country.

Bhutan’s geography – with land rises ranging from 200 meters in the southern foothills to 7,000 meters in the high northern mountains – consists of three major agro-ecological zones that allow for a rich biodiversity and seasonal foods.

This natural wealth, however, comes with its caveats as Bhutanese living in isolated rural areas can’t access a reliable diverse diet throughout the year.

"Many families in rural Bhutan practice two meals rather than three meals a day," reports Ms. Kinley Bidha, Tarayana Foundation Field Officer in Samtse Dzongkhag. "Some for cultural reasons, others due to a shortage of food, others due to a shortage of land too farm," she adds.

Overall socio-economic development in the last three decades has led to a rapid improvement in health and nutrition outcomes in Bhutan – the country’s infant mortality rate declined to 30 per 1,000 live births in 2012 down from 90 per 1,000 in 1990; while the rate of stunting in children under 5 years declined 24 percent from 1986 levels.

Nonetheless, the lack of variety of foods in diet remains a key concern, especially for pregnant and nursing women as well as young children. And while most families feed their children complementary food, fewer than a quarter of parents provide them nutritious meals essential to their health.

In addition, 67 percent of Bhutanese adults consume less than the recommended five servings (or 400 grams) of fruits and/or vegetables per person a day [National Nutrition Survey (NNS) 2015].

When consumed, vegetables consist for the most part of two national staples, potatoes and chilies, which hardly provide essential vitamins and minerals.

Keeping regional variations in mind, between 16 and 34 percent of children under 5 are stunted—or too short for their age—seven percent of children are underweight, 35 percent of children of age 6-59 months and 44 percent of women of reproductive age are either anemic or iron deficient. Exclusive breastfeeding rates for six-month-old children remain at a low 50 percent (NNS, 2015).  

Damages caused by malnutrition during pregnancy and the first years of a child’s life are irreversible and contribute to stunting and lower immunological and cognitive development, and predispose to adult-onset diseases (including metabolic syndrome).

Thankfully, the negative impact of malnutrition on Bhutan’s economy is now better understood and has become a priority to promote its national development.

Encouraging more women to take part in regional trade

Mandakini Kaul's picture

Across South Asia, women represent a hugely underutilized source of growth. In fact, the South Asia region has some of the world’s lowest rates of female labor force participation - only 36%. Even where women work, they are mostly confined to less-remunerative low-skill jobs, and remain excluded from most trading activity. To make it easier for more women to work in all fields of endeavor, World Bank projects in the region have begun to look at development projects through a more gender-focused perspective.
 
One such area is regional trade and connectivity. After a long hiatus, the political momentum for cooperation within the eastern region is growing, especially in the Bangladesh Bhutan India Nepal (BBIN) corridor.  The Indian government’s Act East Policy, combined with the new Motor Vehicles Act that allows vehicles to cross the BBIN border with ease, represent a unique opportunity to reimagine inclusive growth by enabling more of the region’s women to benefit from this corridor.
 


Accordingly, the South Asia Regional Trade Facilitation Program (SARTFP), an Australian government-funded program being implemented by the World Bank, seeks to improve the conditions for women to trade between these nations and to create more remunerative livelihoods.

Regional cooperation in conservation: South Asia shows the way

Andrew Zakharenka's picture
Illegal trade in wildlife and conservation often were not considered high priority for countries of the South Asia Region. In the first ever attempt, the governments of Bangladesh, Nepal, and Bhutan joined forces to strengthen regional cooperation for wildlife conservation. And it was a successful one.

The regional project assisted the governments in building and enhancing shared capacity and institutions to tackle illegal wildlife trade across their borders and invest in habitat and wildlife conservation of critically endangered species. It was clear from the onset that these issues would require both national leadership and regional coordination.
 
Launched in 2011, the project initially had a delayed start. Yet, by December 2016, when the project ended, it became clear that governments coordinated efforts successfully. The three countries participated in regular joint action planning and practice-sharing meetings, signed protocols for and cooperated in transboundary actions, as well as held consultations and public events at the local, national, and international levels.
 
The project supported conservation programs of dozens of endangered species, including crocodiles being released here into the wild. Sundarban area, 2014

Voices of Youth: A Hope for One South Asia from Young Economists at Students' Meet

Nikita Singla's picture
Young economists from South Asia at South Asia Economics Students’ Meet (SAESM) 2018, Chittagong, Bangladesh
Young economists from South Asia at South Asia Economics Students’ Meet (SAESM) 2018, Chittagong, Bangladesh
Photo Credits: Nikita Singla/World Bank

At the 14th South Asia Economic Students’ Meet (SAESM), more than 100 top economics undergraduates and faculties from seven countries in South Asia convened in Chittagong, Bangladesh to discuss how greater regional integration in South Asia can help countries achieve the Sustainable Development Goals (SDGs). As these young economists engaged in vigorous academic competitions and research presentations on South Asia’s development opportunities, they also created fond memories and built lifelong friendships. Was SAESM 2018 a new hope for #onesouthasia? Let’s hear it from the students themselves.

“With the momentum built up, the stage set, with a banner that in all its glory was decorated with the flags of the seven South Asian states, we sat in our respective country groups to embark on a three-day long journey that was to change my perception of South Asia forever. The dis-embarkment on this passage saw us divided by geographical boundaries, as India and Pakistan made sure to sit the farthest away from each other. The end to this voyage, however, painted a story not many foresaw – twenty Indians and Pakistanis crammed together in a single bus, discussing our common history with a fondness anew to most, accompanied by bursts of people from either side breaking into rounds of Antakshari. At that point, we were one!" – Alizeh Arif, Lahore School of Economics

Moving towards gender equality in Bhutan

Tenzin Lhaden's picture
Accompanying rapid economic development, Bhutan has greatly reduced gaps in gender equality.
Photo Caption: Sonam 'Sherlock' Phuntsho/World Bank

“…never did I imagine that I would live to see this day, when a woman would be serving at this level,” said my 86-year-old grandmother with her eyes beaming while watching the inauguration ceremony of the first female Minister of Bhutan.

Bhutan is a small country nestled in the eastern Himalayas between China and India, has managed to maintain its rich and unique cultural heritage in this modern-day age, partly due to its relative isolation during much of the last century. Bhutan is one of the smallest but fastest-growing economies in the world and a success story in poverty reduction.

Accompanying rapid economic development, Bhutan has greatly reduced gaps in gender equality. The net primary enrolment rate, that is the percentage of children attending school in 2016 was 98.8% for girls compared to 97% for boys. There has also been an increasing representation of girls at the higher secondary level although the lag continues at the university level.

Gender gaps in labor markets and job quality was identified as one of the main areas of gender gaps in the 2013 World Bank Gender Note Policy. Although tremendous progress has been made, - 58% of Bhutanese women working for pay or looking for jobs - the female labor force participation saw a slight decline compared to men in 2016. It remains one of the highest in the region[1].

South Asia’s prosperity will require more women to work for pay

Annette Dixon's picture

Women in the Work Force

South Asia has enjoyed a growth rate of 6 percent a year over the past 20 years. This has translated into declining poverty and improvements in health and education. While worthy of celebration as we mark International Women's Day, the success could have been more dramatic if more women worked for pay. Only 28 percent of women in South Asia have a job or are looking for one, compared to 79 percent of men. This is the second lowest in the world, after the Middle East and North Africa region at 21 percent.

With the largest working-age population and growing middle class, South Asia’s development potential is vast. But the lack of women in employment and economic participation reflects lost potential. In India and Sri Lanka, tens of millions of women have dropped out of the work force over the last twenty years.

Many factors are holding them back. Almost half of South Asia’s adult women are illiterate and its girls suffer from the highest malnutrition rates in the world. Rates of violence against women and maternal mortality remain among the highest in the world. All these factors translate into a labor market characterized by low participation, high unemployment and persistent wage gaps for women.

What can be done to better prepare and encourage women to participate in the work force? It starts with valuing our daughters as much as our sons – providing them with the same access to nutritious foods and investing in their education for them to reach their potential. Let’s spark the interest of young girls in subjects like science and mathematics, and convince them that they are just as capable as boys –that they too can build careers in engineering, scientific research, IT, and other fields that are in demand by employers. We must also raise our sons to respect girls and women, and make it clear that there is zero-tolerance for gender-based violence.

Improving Agricultural Systems and Raising Prosperity in Rural Bhutan

Izabela Leao's picture
Tara Nidhi, farmer and beneficiary of the Remote Rural Communities Development Project
Tara Nidhi, farmer and beneficiary
of the Remote Rural Communities
Development Project (RRCDP) in Bhutan.
Photo Credit: Izabela Leao/World Bank

“I never thought I would see a road passing by my house in this lifetime,” says Tara Nidhi, a 70-year old farmer who lives in a remote community of Samtse Dzongkhag in Southwest Bhutan. A beneficiary of the Remote Rural Communities Development Project (RRCDP), he and his family have benefitted from the construction of a new farm road and protection from landslides through RRCDP support – a project that promotes the increasing of agricultural productivity and development of communities’ access to markets, irrigation, agricultural technologies, and community infrastructure in 26 Gewogs (village groups) under six Dzongkhags (districts) in Bhutan: Chhukha, Dagana, Haa, Samtse, Trongsa, and Wanduephodrang.

Driving Prosperity through Access to Rural Roads

Coming to completion in May 2018, RRCDP has improved road access to markets to at least 11 project Chiwogs (hamlets) in Samtse and Trongsa Dzongkhags – building 22.9 kilometers of farm roads and benefitting about 299 households. With the construction of new farm roads, the most commonly marketed agricultural and livestock products amongst farmers in project areas have been cardamom, vegetables, butter, cheese, and citrus, and to a lesser extent, rice, potatoes, and eggs. Additionally, beneficiaries have also reported a significant reduction in the time of travel between their households and markets – up to 8 hours in some cases! The majority of the Bhutanese population live in remote rural areas – hours, sometimes days of walking from the nearest road. They walk their children through dense forests and rivers to reach schools and health clinics; they carry their agricultural and livestock products to nearby markets on their backs – an average load of 30kg. A horse carrying a 50kg load costs approximately Nu.5 per kilogram.

Now, with road accessibility, farmers use pick-up trucks at the cost of Nu.2 per kilogram. After a RRCDP farm road construction in Samtse, for example, four households bought pick-up trucks and ten individuals bought motorcycles – mainly benefitting the transport of cardamom. Better road accessibility through RRCDP have also fostered the construction of concrete flush toilets outside households and the construction of new concrete-built homes, as well as the expansion of irrigation schemes. Finally, road accessibility has also impacted social dynamics in rural areas benefitted by the project. While in the past mostly men would go to the nearest town markets on their own, today, all family members, including women and children can go to the market in the morning and return to their homes in the evening. Some women have even reported that they are learning to drive.[1]

The project has also supported beneficiaries in 88 Chiwogs with access to community and marketing infrastructure, such as power tiller tracks, power tiller machinery, and food bridges – with a total of 3,597 households benefitted. In Norgaygang Gewog, for example, with support from the project, the construction of 4 kilometers of power tiller track in 2016, has brought multiple benefits to the community, such as easier access to schools and healthcare in case of emergency.


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