ADB_book_18 April.qxp - Himalayan Document Centre - icimod

provision remains inadequate because of theexponential growth in population. Furthermore, theprovision of the facilities in rural areas is grosslyinadequate compared with urban areas. Thedistribution of facilities is also uneven by region. TheTerai appears to be more accessible for services thanthe Hill and Mountain regions. In addition, there islittle information available on the actual quality of theservices.The five services can be divided into two broadgroups. The first group includes road, electricity, andirrigation, which are fundamental infrastructure forrural development in Nepal. Although provision ofthese infrastructures has provided beneficial impactson social and economic environments, theiravailability in rural areas is too low and the efforts toprovide them have been slow because of limitedresources. On the other hand, development of theseinfrastructures has also been accompanied by anumber of adverse environmental impacts such aslandslides, slope instability, soil erosion, siltation, andloss of habitat and biodiversity. These negativeenvironmental impacts have often been the result ofincompatible techniques used for naturally dynamicand fragile slopes. Roads, electricity, and irrigationare interlinked. Watershed conservation andmanagement should be an integral part of developingthese infrastructures. Impact assessments forinfrastructure projects should not only be carried outin situ but also in other potentially affected areas.Construction technologies for these infrastructuresshould be environmentally friendly (green roads,micro-hydro, and so on). Management and operationof these infrastructures should be by users’ groups.The second group includes health andeducation services, which are also fundamentals forenvironmental conservation and rural development.Most rural people depend directly on naturalresources for their livelihoods, and the wellbeing andfuture of this society depends on its ability to live inharmony with the natural environment. Pooraccessibility to health and education services is amajor constraint to socioeconomic developmentefforts in Nepal. The majority of rural people are stillilliterate, this is the challenge for education. Thechallenge to the health sector is to improve accessand quality of health services for rural people. Theseservices should be provided adequately in ruralareas, with due attention given to sustainability.Health and SanitationRural HealthQuality drinking water and sanitation facilities arebasic human needs. Development of this sector willhave positive impacts upon health, and healthyworkers will contribute to the growth of otherproductive sectors. Safe drinking water will significantlycontrol waterborne diseases and minimizehealth expenses incurred in treating such diseases.Access to drinking water sources is important, as itrelates to the time spent fetching water. The savedtime can be utilized in productive work, in turnproviding opportunities to earn more income andreducing poverty. Development of the drinking watersector contributes to healthy workers, additionalincome generation, and less health expenditure ontreatment of diseases. In rural Nepal, many diseasesare related to poor water and sanitation. Sanitation inrural Nepal can be described in terms of access ofpeople to toilet types and wastewater generation andmanagement, the condition of which indicates thestate of environment.Different parameters directly and indirectlyrelated to health and sanitation are discussed interms of rural and urban areas, and mountain, hill,and Terai regions.Table 2.16 shows various health indicatorscontrasted between urban and rural areas. Theperformance of the selected health indicators isuniversally less in rural areas than in urban areas.Table 2.16: Selected Health IndicatorsDescription Urban Rural NepalTotal fertility rate women age 15 –49 (expressed/woman) a 2.1 4.4 4.1Current use of contraception (any method) — married men a 66.0 46.8 —Chronic malnourishment of children under 5 years of age (%) 36.6 51.5 50.5Life expectancy at birth 64.53 60.61 60.98Population without access to safe water (%) 11.46 22.19 20.48Population with access to sanitation (%) 77.06 32.05 39.22Childhood mortality per thousand live bi rthsInfant a 50.1 79.3 —Child a 16.7 35.4 —Under-5 a 65.9 111.9 —— = not availableSource: UNDP (2001), a MOH/New Era/ORC Macro (2002 )16 Environment Assessment of Nepal : Emerging Issues and Challenges