September 6, 2013
By Minh H. Pham
With less than 1,000 days to go before the global deadline for reaching the Millennium Development Goals (MDGs), Lao PDR has a number of critical areas that still require special attention, as the country’s third MDG Report, being launched today, clearly shows.
At the same time, the Report, a collaborative effort of the Government and all United Nations Agencies, also serves as a key means for showcasing the considerable national achievements of the past two decades. These have improved the well-being and living standards of many poor communities through expansion of basic services, strengthening of rural infrastructure and substantial poverty reduction.
Yet persistently high rates of malnutrition (MDG1), infant and maternal mortality (MDGs 4 and 5), and school dropouts (MDG2), as well as shortfalls in UXO clearance (MDG9), continue to keep several of the MDGs in Lao PDR off-track. As the Report highlights, taken together, the MDGs reflect the many interconnected dimensions that contribute to extreme poverty, including income poverty, hunger, disease, and exclusion. Thus, during the short time until the 2015 target date, renewed efforts by the Government and the international community alike will be essential for the country to contribute fully to the most successful global anti-poverty movement in history and meet the aspirations of the people.
In particular, the Report’s findings starkly illustrate a priority issue emerging for Lao PDR: the silent scourge of stunting, or chronic malnutrition. Stunting affects 363,000 or 44 percent of Lao children younger than age 5. The national stunting rate is among the highest in the region. A child who is stunted often appears normally proportioned but is actually short for his or her age. Nevertheless, the consequences of stunting are dramatic.
Stunting alone is responsible for 15 per cent of total under-five deaths, which translates into an estimated 2,400 child deaths per year in Lao PDR. It develops before birth and is caused by poor maternal health and nutrition; inadequate child feeding practices, in particular limited food diversity; and frequent infections. It is a well-established risk factor for poor child development, associated with poor cognitive and motor development, lower achievement in school and productivity in the work-place. Lao PDR loses approximately US$51 million annually from reduced GDP caused by stunting.
The current pace of decline in stunting in Lao PDR - less than 1 percentage point per year - is lower than the global annual rate of decline (2.1%) and insufficient to halt or reverse the continuously growing number of stunted children in the country. All of this has ominous implications for future generations of Lao people.
Critically, this is linked to the broader issue of food and nutrition security – and again, to the interconnectedness of the necessary response. It therefore will be essential to give food and nutrition security the sense of urgency that it deserves in Lao PDR. Interventions emanating primarily from the health sector, such as micronutrient supplementation and supplementary child feeding, are necessary, but require further strengthening to substantially improve the national situation. Instead, broader and complementary actions – involving improved food production and rural infrastructure along with increased awareness of nutritious dietary practices, for example – can be provided by a host of other actors in sectors such as agriculture, education, water and sanitation, and social protection.
A “convergence” approach in vulnerable areas of these two streams of interventions, which has been successful in countries such as Bangladesh and Brazil, could prove effective in Lao PDR as well. This would combine the direct addressing of nutrition issues with the addressing of root determinants of malnutrition and resulting in synergistic benefits. Strengthened coordination also will be needed among institutions at both central and provincial levels to further promote the integration of nutrition into other development priorities.
As a signal of the Government’s commitment on this issue, the recent establishment of the National Nutrition Committee, headed at the level of Deputy Prime Minister, is most welcome, and an important signal that an integrated approach is under way. Given that a mind is a terrible thing to waste, it is imperative that nutrition issues be addressed with no delay.
All this paves the way for the post-2015 era, which demands a new vision and a responsive framework. This can start with the preparation at the end of this year of the Eighth National Socio Economic Development Plan (NSEDP) 2016-2020, which will provide the contours of the development agenda as the national goal of Least Developed Country (LDC) graduation in 2020 approaches.
Throughout both the pre- and post-2015 processes, the need to keep a close eye on significant national inequalities and the situation of vulnerable groups – at the core of the MDGs – will be paramount. For example, as the Report points out, a child born in Phongsaly is nearly five times more likely to die by age 5 than a child born in Vientiane city, and more than four times more likely to die by age 1. Strong imbalances such as these are found with regard to access to many public services, and increased allocations in the health, education and agriculture sectors could strengthen prospects for all off-track MDGs.
The medium-term national vision, as expressed in the Eighth NSEDP 2016-2020, thus will need to begin to answer a number of key questions. For now, the Government has the opportunity to generate an inclusive debate on the post-2015 agenda through the holding of a broad-based set of national consultations. The National Assembly should be one of the critical partners; if the people also are meaningfully engaged, this will enable even broader voice and participation.
Achieving the MDGs represents an important step toward equitable and sustainable development. But this is only a first step: Lao PDR has bigger ambitions including LDC graduation, and for that will need to go beyond the basics. Transformative change that encourages creativity and innovation will be needed to develop interconnected, homegrown solutions to continuing challenges. With the Government’s enlightened leadership, Lao PDR can reaffirm its commitment to fundamental human development values.
Minh H. Pham is the Resident Coordinator of the United Nations in Lao PDR and the Resident Representative of the United Nations Development Programme.