Nurses ensure nutrition for Nepal’s childrenNurses in Nepal’s public schools do not just take care of medical needs but also ensure that students eat better
Nurse Sabita Gyawali goes to school bright and early as the first rays of the sun hit Mt Dhaulagiri to the north, and she gets to work right away.
Shen the students start arriving, she checks that they follow cleanliness routines, and teaches them how to wash hands properly. She provides first-aid to those who need it, and is responsible for the students’ physical and mental health.
But her main priority is to make sure that no student has brought junk food for lunch. In fact, she has prohibited packaged chips and noodles from the school grounds.
Gyawali has been a nurse for nine years, much of it at Kathmandu’s Sahid Gangalal National Heart Center. In 2019, she came to Baglung to work at Bidya Mandir Secondary school under the Health Ministry’s new 'One School, One Nurse' program.
Once there, Gywali designed the school’s lunch menu and already there has been a positive change in the eating habits of students – even teachers.
“Initially, students from elementary to high school would eat packaged store-bought lunch, she explains. “It was very difficult to wean the children off their junk food habit, but it is now under control.”
The World Food Programme (WFP) has been managing school meals across Nepal for 45 years, and the government has been gradually assuming responsibility and expanding the project. Now, thanks to the initiative, students don’t go home for lunch anymore and attendance rates have increased, resulting in fewer dropouts.
However, there are challenges. The Rs15 per student charge for lunch is beyond the means of some students who have working parents, or are in single parent households, and there is not enough time to bring a tiffin box.
For some students, this means coming to school on empty stomachs. For others, it was cheaper and more convenient to buy quick-and-easy junk food.
“The budget provided by the government was low enough that only little snacks or small meals used to be served," notes Gyawali, who then came up with a lunch menu that would fit the budget.
And while the school lunch menus made by the government might be applicable to rural schools, they do not work for public schools in urban areas with the same budget.
The other problem is not having enough nurses. There are 82 public schools within Baglung Municipality, out of which only five secondary schools have nurses.
Ram Prasad Khanal, the head of the municipality's health department, says that the municipality has asked the state government to appoint nurses to all the schools. “Every school that has a nurse has shown positive growth,” notes Khanal.
At Bageshwari Secondary School in Bhaktapur’s Chyamasing, students have stopped consuming junk food for lunch due to the efforts of nurse Sajina Manandhar. “It is very difficult to take students off instant noodles, but we have managed to do it.”
The ‘One School, One Nurse’ program is run by the Nursing and Social Security Division under Nepal’s Department of Health Services (DoHS) and aims to encourage children to have a balanced diet and improved hygiene. The program also supports adolescent sexual and reproductive health, as well as mental health.
“The school nurse program has brought about a noticeable improvement in nutrition-related problems, mental health, menstrual health, and even school dropout issues,” says Bala Rai, a senior hospital nursing administrator at the Nursing and Social Security Division.
But there is a long way to go. So far, only about 1,000 schools out of 10,644 public secondary schools nationwide have appointed school nurses.
The DoHS measures nutrition impact through 'anthropometry' — measuring the heights and weights of children to determine whether or not they are malnourished. A recent Demographic Health Survey (DHS) revealed that 25% of children under five have stunted growth while 8% are underweight as compared to 36% and 10% respectively in 2016.
There is improvement, but more can be done, and the government has set a target to reduce the growth stunt down to 15% by 2030.
The survey also revealed the program, which involves nurses also making home visits, has been instrumental in identifying children who have learning disorders, mental health issues, or those who have been victims of domestic violence. Illnesses have been identified and reported to hospitals, and it has also become easier to educate adolescents about sexual and reproductive health.
"We have appointed health-in-charges to each class so that students feel comfortable speaking to and about themselves,” explains Sajina Manandhar. “We continuously meet with those in charge, and provide them information related to reproductive health and family planning.”
Nurse Anamika Sharma says that the number of girls who miss school while having their period has gone down by 90% since she began working as a school nurse, largely because it is easier for female students to ask for pads at school. Menstrual health counseling is also more readily available.
Binu Kakshapati is the School Nurse Focal Person of Bagmati Province, and says the attendance of female students has gone up since the province began distributing pads in public schools. “Students have started to become more open to using pads since the government started distributing them in Bagmati,” she adds.
In some schools, nurses even fill in when a math or science teacher is absent. Bala Rai says she had to send a circular to the local units to ask them to stop forcing nurses to do jobs that they are not there to do.
Translated from the Himal Khabar original by Shristi Karki.