Survey of Family in Kathmandu Final

Survey of Vulnerable Families
In Kathmandu
July / August 2005
Submitted To:
Enfants` and Developpment
Submitted By :
Irada Parajuli Gautam
Independent Consultant
TABLE OF CONTENTS
I. ACKNOWLEDGEMENT ___________________________________________________ 3
II. ABBREVIATIONS _________________________________________________________ 4
III. LIST OF TABLES _________________________________________________________ 6
1. Family Information ________________________________________________________ 6

2. Status of Housing _________________________________________________________ 6
3. Health Status of children under 5 yrs of age ____________________________________ 6
4. Status of Family Planning, Pregnancy and Delivery ______________________________ 7
5. Status of Hygiene and Sanitation _____________________________________________ 7
6. Status of Preschool and School Attendance _____________________________________ 7
7. Economic Status __________________________________________________________ 7
8. Problems Faced by the Families______________________________________________ 8
9. Support Received by the Families _____________________________________________ 8
II. EXECUTIVE SUMMARY ____________________________________________________ 9
CHAPTER ONE ______________________________________________________________ 11
INTRODUCTION ___________________________________________________________ 11
1.1 Background ____________________________________________________________ 11
1.2 Objectives of the Survey __________________________________________________ 12
1.3 Survey Area ____________________________________________________________ 12
CHAPTER TWO _____________________________________________________________ 14
METHODOLOGY ___________________________________________________________ 14
2.1 Survey Areas ___________________________________________________________ 15
2.2 Documents Review ______________________________________________________ 16
2.3 Ethical Consideration ____________________________________________________ 16
2.4 Limitation of Study ______________________________________________________ 16
CHAPTER THREE ___________________________________________________________ 17
RESULTS AND DISCUSSION _________________________________________________ 17

1. Family Information _______________________________________________________ 17
2. Status of Housing ________________________________________________________ 23
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3. Health Status of children under 5 yrs of age ___________________________________ 25
4. Status of Family Planning, Pregnancy and Delivery _____________________________ 35
5. Status of Hygiene and Sanitation ____________________________________________ 39
6. Status of School Attendance and Preschool: ___________________________________ 41
7.Economic Status __________________________________________________________ 48
8. Problems Faced By the Families ____________________________________________ 52
9. Support Received By the Families ___________________________________________ 63
Available Facilities / Resources in Ward No 10, 11 and 3 _________________________ 67
Existing structure and Groups in Survey Areas _________________________________ 68
Health Facilities Available in Kathmandu _____________________________________ 69
Ministry of Health, Department of Health Services ______________________________ 70
National Health Service Coverage Fact Sheet __________________________________ 70
CHAPTER FOUR_____________________________________________________________ 71
4. ANALYSIS AND CONCLUSION _____________________________________________ 71
CHAPTER FIVE _____________________________________________________________ 74
5. RECOMMENDATIONS ____________________________________________________ 74
BIBLIOGRAPHY: ______________________________________________________________ 79
ANNEXES ___________________________________________________________________ 80
ANNEX I: KEY INDICATORS OF KATHMANDU ______________________________________ 80

ANNEX II: SURVEY TEAM _____________________________________________________ 81
ANNEX III: SURVEY QUESTIONNAIRE ____________________________________________ 82
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I. ACKNOWLEDGEMENT
I would like to extend my heartfelt gratitude to Ms. Daniele, Cheysson

President/ Director of Enfants` and Development (E & D) for supporting in the
conduction of this Survey of vulnerable families in Kathmandu. I am grateful to
Chantal Rodier Consultant, E & D for providing her critical comments while
designing tools, and during finalizing the report. My deepest appreciations and
thanks go to Mr. Krishna K. Thapa Director of VOC for his valuable comments
on my draft report and for his recommendations for the selection of survey sites.
I am grateful to all my colleagues in the Survey team for helping to carry out
this survey successfully and the secretariats for providing computer support for
data entry and tabulation. My special thanks go to Mr. Tek Bahadur Khadka and
Kamal Sharma who played the supervisory role and were very supportive during
this survey. They have made an immense contribution to the field study.
My sincere gratitude goes to the local organizations, which allowed us to

interview the families from three different areas. I would like to express my
sincere appreciations and thanks to all the families who participated in the
survey by giving the valuable time and expressing their feelings openly that
made it possible to produce this report. Special thanks go to Ms. Prashikha
Chhetri for her tremendous effort in structuring the report, without which it
would not have been possible to produce it in this form.
Thank you!
Irada Parajuli Gautam

Independent Consultant,
September 2005
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II. ABBREVIATIONS
AIDS Acquired Immuno Deficiency Syndrome
AMDA Association of Medical Doctors of Asia
ANC Antenatal Care
ARI Acute Respiratory Infection
BCC Behaviour change communication
BNMT Britain Nepal Medical Trust
CAC Comprehensive abortion Care
CDD Control Diarrhoeal Diseases
CHD Child Health Division
CWIN Child workers in Nepal
DHO District Health Office
DOE Department of Education
DPT Diphtheria, Polio and Tetanus
E&D Enfants and Development
ECCD Early child hood care and development
EDHAG Environment Health Development Advisory Group

EPI Expanded Program of Immunization
FPAN Family Planning Association of Nepal
HIV Human Immuno Deficiency Virus
HMG His Majesty of Government
IAISP Intensification of Antenatal Iron Supplementation Program
INGO International Non Government Organisation
IUD Intra Uterine Devices
MCH Maternal and Child Health
NER Net Enrolment Rate
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NFCC Nepal Fertility Care Center
NFE Non Formal Education
NGO Non Governmental Organisation
NLSS National Living Standard Survey
OPD Out Patient Department
PAC Post Abortion Care
PPS Pre-primary School
RH Reproductive Health
SIP School Improvement Plan
SPN Sunaulo Parivar Nepal
STI Sexually transmitted Infection
TBA Traditional Birth Attendants
TT Tetanus Toxoid
VCT Voluntary Counselling and Testing
VDC Village Development Committee
VOC Voice of Children
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III. LIST OF TABLES
1. Family Information
1.1 Percentage distributions by Types of Respondents

1.2 Percentage distribution of caste/ethnicity
1.3 Percentage distributions of family members living in the household
1.4 Percentage of Age wise distribution of family members in the household
1.5 Percentage of Sex wise Distribution of the Family Members
1.6 Percentage of Marital status of the family members
1.7 Percentage distribution of Religion followed by the families
1.8 Percentage distribution of Monthly incomes in the family
1.9 Percentage distribution of Occupation of the family members
1.10 Percentage distribution of Family members with voter card

1.11 Percentage distribution of Family members with citizenship card
1.12 Percentage distribution of Family members with identity card
1.13 Children with birth registration certificate
1.14 Presence of family members during the daytime
2. Status of Housing
2.1 Duration of living in the current place

2.2 Percentage distribution of Land holding
2.3 Condition of Hygiene/sanitation inside and outside the house
2.4 Furniture and Materials available in the house
2.5 Flooding during the rainy season
3. Health Status of children under 5 yrs of age
3.1 Percentage Distribution Breast feeding practices for children

3.2 Percentage Distribution The time of stopping breast feeding
3.3 Percentage Distribution of Practices for giving bottle feeding
3.4 Food practices of children less than 5 years old
3.5 Practices undertaken before feeding the child
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3.6 Accidents experienced by the children
3.7 Practices of seeking assistance when children have medical problems
3.8 Percentage Distribution of Children deceased and causes for their deaths
3.9 Presence of handicap members in the family
3.10 Percentage distribution of families suffer from chronic illness
4. Status of Family Planning, Pregnancy and Delivery
4.1 Number of Pregnancy in Life

4.2 Check-up practice during Pregnancy
4.3 Practices of Child Birth
4.4 Check-up practices after last pregnancy
4.5 Practices of Family planning Methods
5. Status of Hygiene and Sanitation
5.1 Distribution practices of sources of drinking water

5.2 Methods used to make water consumable
5.3 Practices of waste management system
5.4 Availability of Toilet Facility
6. Status of Preschool and School Attendance
6.1 Level of education among children aged 5 and above

6.2 Family members age 16 to 25 who do not attend school
6.3 Ready to Spend Money for the Schooling
6.4 Actual Money spent for different level of education for the children
6.5 Children Attending Nursery School
6.6 Participation of children in clubs
7. Economic Status
7.1 Types of work done by the family members during life time
7.2 Activities done during spare time
7.3 Average Amount of money spent for daily expenses of food
7.4 Means of transportation
7.5 Loans (borrow) taken by the families
7.6 Percentage Distribution of Period for food shortage
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7.7 Methods used of overcoming economic crisis
8. Problems Faced by the Families
8.1 Percentage distribution of main problems felt in the villages

8.2 Percentage distribution of solutions to the problems faced
8.3 Ranking for the problem of drinking water
8.4 Ranking Problem of housing
8.5 Ranking for the problem employment
8.6 Ranking for the problem health and hygiene
8.7 Problems faced by women and girls in the village
8.8 Solutions to the problems faced by women and girls in the village
8.9 Prioritizing the problems of women and girls in the village
8.10 Solutions for the problem of early marriage
8.11 Solutions for the problem of alcoholism
8.12 Problems faced by the adolescents
8.13 Possible solutions for the problems faced by adolescents
8.14 Percentage of drug abusers present in the village
8.15 Solutions for the problem of drug use
8.16 Solutions for the problem of not care what parent said
9. Support Received by the Families
9.1 Services received from Government/ municipality/ VDC, Ward

9.2 Meetings attended by families
9.3 Services received from NGO
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II. EXECUTIVE SUMMARY
Survey of vulnerable families commissioned by Enfants and Development was conducted in

Kapan, Shankhamul, and Tripureshwor area of Kathmandu district. The main objectives of
the survey were to identify the general situation of the families in the relocation areas, explore
the real needs and expectations of the exposed populations in the targeted areas, and make
recommendations for future course of action to be undertaken for family support program.
The survey was conducted in July-August 2005 by using rapid quantitative research
methodologies, with families in the three selected areas at Kathmandu.
There are enormous problems faced by the vulnerable families, which needs to be addressed
by the development agencies by designing programs so as to provide them with opportunities.
Almost all housing features are in public land, which are owned by the government, and the
families have been living there since last 10 to 25 yrs by building their houses. Generally, the
houses are constructed by using mud and bricks and have only one window and one front
door. In Tripureshwor, more than 95 % families have low quality wooden houses. The outer
walls of households are walled by mud-bonded bricks. Other materials used include "wood
and tree branches". Tiles/slates, mud; wood, plank, etc are mostly used for Roofing. More
than 99 percent of housing has earth flooring.
In all the areas average number of rooms per household are 2: indicating a greater degree of
crowd in poorer and largely populated households. Housing plots on average are very small in
size, which include building area and surrounding area up to 20x 24 square feet.
(i.e. e. 1 Anna).
Majority of the families works as laborers for earning a minimum of Rs. 1100 to Rs 3000 per
month. Regarding the medical support, most of them prefer to seek medical care rather than
going to the traditional healers when they become sick. The treatment of general illnesses in
public institution is encouraging although there is question of seeking timely treatment.
The problem of drinking water (especially in Kapan) and illness from water born diseases,
alcoholism, domestic and sexual violence against women and girls, problems of housing,
health and hygiene, drug abuse among adolescents and unemployment are the major problems
prevalent in all areas. Likewise, the infant mortality is quite high in all places and parents are
not aware of the causes for the infant’s deaths. It is because they lack awareness on child hood
care and development for children below 5 years. An urgent and systematic program
intervention is needed to address those problems. Similarly, the effects of violence on
children, family members and society are so distressing and an immediate action is desirable.
Families expressed their frustration to the survey team about how most of the organizations,
despite the initial commitment, have limited their information only for research purpose rather
than providing actual support through program intervention. On the other hand, it was also
observed that there was a lack of awareness about the social support mechanisms among
families. The families need to be united into groups to have an access to support mechanisms
at the time of need.
Initially, the concept and the purpose of the survey were discussed among the families who
were very much excited with their expectations towards the program intervention for children
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and women in their area. They urged for immediate actions and also suggested that raising
awareness is not sufficient in the poor communities, but provision of free service (health
service, social support against violence, education, child care center, employment
opportunities) is also required in order to benefit all vulnerable families.
The survey revealed that there was negligence on women’s health care practices especially
during pre-natal and post-natal, which had a significant impact on infant mortality. The
families were characterized by low economic and social problems that led to multiple
problems for their livelihood. Based on the findings of the survey, certain recommendations
have been put forth to intervene in the poor state of these families.
The capacity of local organizations that are representative of the poor families needs to be
enhanced to create favorable environment in the villages. Listening to the families’ problems
and encouraging them to participate actively in existing groups and structures may help to
enhance their self-esteem and to develop a sense of identity in the society. The families
should be involved in the decision making process regarding the implementation of program.
An integrated program is essential for the betterment of poor families targeting children below
5 years, women, adolescents and men. The existing resources and services that are available
in the communities should be identified and the families should be linked with these
resources. There is a primary need for raising awareness among the vulnerable families on the
issues such as women and child health, family hygiene and gender related violence.
Strategies to raise awareness among the male, female, children and all the community
members on pre–and post natal care, health and hygiene, early child hood care and
development, gender based violence and discrimination between girls and boys, gender roles
and responsibilities within the family, family violence such as drinking alcohol, beating wife
and its effects to children and family itself etc are recommended.
There is a need to support basic education of already enrolled students or who never been
school and like to go in school through the provision of scholarship. Similarly, literacy classes
are to be conducted for providing non- formal education to the illiterates. Creation of
employment opportunities will help the poor families to raise their income.
Community-based awareness program that target family members especially mother in law,
husbands, women and men groups and children will be critical. Raising awareness and
knowledge against violence, about common problems during pregnancy, delivery and the
postnatal period will be important to enable family members and the community to identify
and respond to the problems in a timely and appropriate manner.
Where culture and tradition dominate the living practices, educating communities about the
cost and consequences of violence, risks and problems related to health, early pregnancy and
child birth as well as the importance of overall child development need to be a top priority.
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CHAPTER ONE
INTRODUCTION
1.1 Background
Kathmandu is the capital of the kingdom of Nepal. Situated in a valley, Kathmandu is a city
of inexhaustible historic artistic and cultural interest. Like other major cities in the world,
Kathmandu has its own challenges. Rapidly growing urban population and a changing society
continues to put pressure on the city's natural resources, physical infrastructure and
management capabilities. Migration from the villages to the urban center is not a new
phenomenon in Nepal. The families from the rural areas of Nepal often migrate to Kathmandu
in search of better opportunities for their families and this trend has persisted since ages. In
Kathmandu Valley there are more than 60 poor urban areas/communities who live in scattered
area. Out of 60 communities the selected three survey areas have bigger number of
inhabitants.
The World Bank describes Nepal as one of the least developed countries in the world. The
annual per capital income of Nepal is US$227, well below the World Bank's extreme poverty
line which is drawn at US$275 per annum.
Against this backdrop, urbanization in Nepal is accelerating. At present, 15% of people live in
urban areas; however, the urban growth rate has now reached 6% per annum, the highest of
any country in South-East Asia. If this trend continues, by 2025, the urban population of
Nepal will have topped 36%.
According to NLSS II, 2003/2004 about 5 percent of the total children (less than 15 years old)
is absent or away from household. More children from rural areas leave home for work. 45
percent of absentee children from the poorest quintile left home. Kathmandu lays unique
opportunities for mobilizing resources and working together as a team to explore and utilizing
it to the extent possible for the benefit of this city and its citizens.
In urban cities, the households have access to primary schools, health clinic/hospitals,
cooperatives, market center, roads and public transport such as bus, tempo, taxi within 10 to
30 minutes. Access to primary schools means time for a household in the richest quintile to
reach a primary school is 10 minutes and that in the poorest quintile is 14 minutes. Access to
health post and hospital presents a somewhat different scenario. Only 62 percent of
households in the country are within the reach of 30 minutes. Urban-rural gap is large (89
percent versus 57 percent).
Differences in access to market center across urban-rural areas and consumption quintiles are
quite large. On the other hand, the mean time to reach a nearest market is 22 minutes for
urban households and 1 hour and 16 minutes for rural households. More than 80 percent of
urban households have easy access to Co-operatives (Sajha), while only 25 percent of rural
households have such access. Cooperative is an institution that provides credit in low interest,
supplies goods (including farming inputs such as fertilizers and seeds) to households.
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Since 2000, Enfants & Development (E&D) has been providing technical and financial
support to Voice of Children (VOC), a Nepalese NGO, to implement their “Support and
Protection for the Street Children of Kathmandu” Project. Experiences from the past few
years’ have shown that there is a strong need for developing family follow up activities. These
activities are not only to facilitate family reinsertion of the street children (which is the first
priority for the child - whenever possible) but also to prevent deteriorating living conditions
of the poor families, which might discourage children to live in the street. With this purpose,
E&D has initiated this survey of vulnerable families in Kathmandu and it plans to submit a
project proposal to the European Commission possibly by October 2005.
This survey serves both to identify the needs in the targeted areas and as a database, which
provides the required information for designing and launching a family-support program.
Finally, this study can be used as a comparative database to evaluate the impact of the
activities among these families in the various areas. According to the results of the survey,
further selection among those areas will be made to identify where the project shall need to
work.
1.2 Objectives of the Survey

The Objectives of the survey is to know about the general situation of the families in the
relocation areas. This survey has helped to determine precisely the real needs expressed by the
exposed populations in the targeted areas on the relevant issues and the recommendations
have been made accordingly for future course of action to be undertaken for family support
program.
1.3 Survey Area
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Characteristics:
Kapan Pathivara Tole:
• This village is under Kapan Village development committee (VDC), ward number 3
and lies in the northern part of Kathmandu. It is adjoining of metropolitan city and 400
meter distance from outside of Ring road.
• The inhabitants are living in this area since 1994.
• There are 166 households
• The populations are from diverse religion (Hindu, Buddhists, Christian) caste and
ethnicity.
• The surface of plot is very small in-terms of population and households.
• One house plot is equal to 20x 26 square feet
• The residents mostly work as labor, collecting sand from river, working in carpet
factory.
• No private land.
• Mother group is very active and a German project is also working there.
Buddhanagar Shankhamul
• This village is in ward number 10 of Kathmandu metropolitan city.

• There are 105 households
• The inhabitants are living in this area since 1974
• This area is quite organized and it is also the area of central office for urban poor
where representatives from 66 urban poor villages meet together in every 15 days.
• No private land, however surface of the plot is better than other 2 villages.
• One of the INGO called Lumanti is also working in this area.
• People mostly came from eastern part of Nepal and from Kathmandu itself.
• Proximity to Bagmati riverside and Southern part of Kathmandu.
Tripureswor, Bamshighat Tole:
• This village is in ward number 11 of Kathmandu metropolitan city.

• There are 104 households.
• The inhabitants are living in this area since 1988 and most of them are Hindu.
• Most families are living as tenant.
• More than 95 % have low quality wooden house.
• Women and girls mostly work as domestic worker in Marwadi (Indian ethnic and run
business in Nepal) house
• Less intervention of development projects and degree of poverty is quite high
compared to 2 other places.
• No private land,
• Proximity to Bagmati riverside and Southern part of Kathmandu.
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CHAPTER TWO
METHODOLOGY
Before carrying out the survey, a meeting was conducted with the director of VOC, and the
representatives of Enfants and Development in Nepal and the questionnaire was revised in
Nepali. The revised questionnaire was sent to E & D in Paris for feedback and the comments
of Chantal Rodier (consultant for Enfants and Development) were incorporated. The finalized
tools were translated into Nepali.
The areas were visited by team leader and supervisors based on the recommendations of VOC
and some other NGOs working for street children. Based on the observations, three areas
were chosen as per the criteria. Those three areas are larger in terms of number of households
to meet 300 households. Supervisors identified the list of households of those three areas
(Please see 2.1 below for the criteria of selecting 3 areas) before training and allocated list
of households for each surveyor and explained during the training. The sampling was done
applying purposive methods.
Altogether 16 teams (including team leader) were deputed for fieldwork in 3 different areas.
Each team was provided with the name list of the households with extras (just in case the
selected household could not be found). If any inconsistencies appeared in this process, the
households were immediately revisited to correct the mistakes during the field work. The role
of supervision was very crucial in accomplishing such a comprehensive and multi-topic
survey.
Before survey, a three days training was conducted (from 21st to 23rd July 2005) focusing on
the following themes.
• Why the Survey?

• The survey form itself
• Differences between a quantitative and a qualitative survey.
• Differences between an open and closed question.
• The difference between the personal perception of things and the reality
• Survey process: how to start the interview
• Survey objectives: know the general situation of the vulnerable families of the area
• With whom to take interview, if some management problems arise then what to do?
• Time for the interview.
• How to end interview
• Ethical consideration, and
• Explanation about if the family ask some question about the type of project then what
answer will give (the answer is that the survey will indicate the project orientation but
depends of the field reality, that is why the family must honestly answer to the
questions).
• Understanding vulnerable families: Before starting the interview with the family,
decide by the surveyor that this family is vulnerable.
• Role of Team leader, supervisors, surveyors, and secretaries on every day.
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Supervisors contacted the local committee and local organizations (see in ANNEX for name
of the organizations), and got support during the whole survey process. Pre-test of
questionnaire was done for practice and to clarify any confusion. Actual survey was
conducted between 24th July to 8th August 2005. On each day, supervisors went along with
surveyors in the field to ensure that surveyors are doing their performance well. The
surveyors were also responsible for reporting and management of the field constraints and
difficulties. Every evening, the surveyors had meeting with supervisors and they returned the
completed survey forms. They reported to AAWAAJ contact office between 5 pm to 7 pm
everyday.
Each day supervisors checked the survey form, and provided the feedback to the surveyor.
Each evening, the surveyor returned their completed interview forms to the secretary in order
to enter the data into the computer. The survey time was maximum 40 minutes per family.
This survey primarily used quantitative and qualitative methodology along with direct
observation to extract the information as much as possible. The team also observed the
physical setting of the households, cleanliness, and availability of resources including
materials and utensils at home.
(Please see in ANNEX for the detail questionnaire for Data collection)
2.1 Survey Areas

Three areas were selected for the survey of vulnerable families. The criteria of selecting those
3 areas are as follows:
• No private land and occupied public land near by riverside, families just built houses
in public land owned by the government
• Housing criteria: generally the houses are constructed by using mud, bricks, and Earth
flooring
• One story with only one window and one front door,
• Low quality wooden house, outer walls of households are walled by mud-bonded
bricks.
• Tiles/slates, mud; wood, plank, are used for Roofing.
• More number of inhabitants compared to other places and living since last 10 yrs and
less chance of moving to other places
• Limited space and have a greater degree of crowd compared to its spaces.
• Housing plots on average are small in size (includes building and surrounding area up
to 20x 24 square feet). (i.e.1 Anna).
• Working status mostly laborers for income such as collecting brick, sand, cement,
worked in carpet factory, working as porter, working in housing construction, working
as housemaid,
• Poor hygiene of their house and surroundings
• Opportunities to work with group (mother’s group, women’s group) and have existing
structure of poor urban families
• Comparison of urban poor families in VDCs and municipalities.
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Table 1: Areas and Number of Households
Areas Total Total No of Selected

households Population households in Households
Survey areas in Survey
Kapan VDC, ward 1002 6223 166 141
number 3,
Tripureshwor, ward 3197 16988 105 84
number 11,
municipality
New Baneswor 7974 43261 105 75
ward number 10,
municipality
Total 21173 66472 376 300
The total number of households in municipality is higher than in the village development
committee and so is the population. However, the number of households in the survey area is
higher in VDC than in the municipalities revealing the existing pattern of urban–poor housing
structures.
2.2 Documents Review
The National Annual report of department of health services of 2002/2003 was reviewed,
along with the National living standard survey 2003/2004; the profiles of the municipalities
were also reviewed for the survey.
2.3 Ethical Consideration
During survey, an extreme care was taken to respect individual views, ethnic characteristics
and gender differences. Individuals were clearly explained about the purpose and process of
the survey beforehand.
2.4 Limitation of Study
The field survey was rapid need assessment of vulnerable families and completed within very
short time. Only 14 days were allocated for the whole survey of 300 families. Due to the time
constraint, exploration of more qualitative information (such as getting the facts on why and
how it happened) was not possible which would have been more interesting to readers? And
despite every effort to reduce other limitations, we also acknowledge the usual difficulties
inherent in a household survey and try to clarify to minimize families’ expectation during the
whole survey period.
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CHAPTER THREE
RESULTS AND DISCUSSION
The members of the family were found to have been born in different districts including India.
Majority of them were born in Kathmandu and some were born in the neighboring districts as
well in very remote areas of Nepal.
Table 1.1: Percentage Distributions by Type of Respondents:
Types of respondents Kapan Shankhamul Tripureshwor Total

Mother 68.8 63.1 70.7 67.7
Father 11.3 19.0 17.3 15.0
Both 12.8 7.1 8.0 10.0
Others heads of the household 7.1 10.7 4.0 7.3
Total 100.0 100.0 100.0 100.0
Out of the total 300 respondents, 67.7 percent are mothers, 15 percent fathers, and 7.3 percent
are other household heads. Among those interviewed, 10 percent belonged to both mother and
father.
Table 1.2: Percentage Distribution of Caste/Ethnicity:
Caste/Ethnicity Kapan Shankhamul Tripureshwor Total

Tamang 20.9 22.3 23.9 22.1
Chhetri 12.5 18.1 24.2 17.2
Newar 4.4 26.2 21.0 15.4
Kami/Damai/Sarki 17.4 9.3 12.4 13.6
Rai 13.3 7.2 2.7 8.7
Brahmin 7.8 8.4 8.6 8.2
Magar 8.2 3.4 2.4 5.3
Limbu 10.0 0.9 - 4.6
Gurung 4.1 4.3 4.8 4.4
Tharu 1.3 - - 0.6
Total 100.0 100.0 100.0 100.0
The above table shows that Tamang is the dominant caste in all areas. The other castes are
Brahmin, Chhetri, Newar and Dalit (Kami, Damai, and Sarki). Few families belong to ethnic
groups like Rai, Magar, Limbu, Gurung and Tharu who are less representation at communities
than other caste. It was found that about 15 % of families felt caste discrimination in different
areas; such as participating in community festivals and religious activities, getting access to
drinking water, receiving public services and so on. They even felt hesitated to enter the house
17
of their friends or other liberal non dalits due to the fear of humiliation and getting false
charges of theft.
Limited denial of services includes getting loans, access to resources and information. The
resources provided by local authorities were captured by the local elites and dalits were not
informed about the facilities. The dalits felt that service providers do not behave well with
them. Rampant denial of kinship includes inter-caste marriage between non-Dalits and Dalits.
Dalits were not invited during religious activities and festivals. Prevailing denial of
participation is in feasts/party, festivals, politics, marriage procession and funerals. Practices
of untouchables are exhibited and reinforced in a visible way during such events. For instance
dalit and non-dalit rarely sit and eat together. Many dalits hesitate to participate on such
occasions due to fear of humiliation even if they are invited cordially.
Table 1.3: Percentage Distributions of Family Members Living in Household
Number of family members Kapan Shankhamul Tripureshwor Total

1-3 24.8 7.1 20.0 18.7
4-5 27.0 33.3 29.3 29.3
6-10 8.5 19.0 13.3 12.7
11 and more 39.7 40.5 37.3 39.3
Total 100.0 100.0 100.0 100.0
Number of adults in the family
1-2 48.9 35.7 49.3 45.3
3-5 45.4 53.6 45.3 47.7
6 and more 5.7 10.7 5.3 7.0
Total 100.0 100.0 100.0 100.0
Number of children in the family
None 15.6 20.2 5.3 14.3
1 34.0 22.6 32.0 30.3
2 30.5 32.1 37.3 32.7
3 13.5 14.3 18.7 15.0
More than Three 6.4 10.7 6.7 7.7
Total 100.0 100.0 100.0 100.0
The family sizes vary in different households. However, in all areas, majority of the
households have larger number of family members. For instance, on an average 39.3 percent
and 29.3 percent have 11 or more, and 4-5 family members respectively. Among these
families, majority has 3-5 adults in their households.
It was found that majority of the families had one to two sons and daughters. 17.2 percent of
the families had no son and 25.9 percent of the families had no daughters. Few families had
more than two sons and daughters as well who were all alive. 15 percent of these families
have 3 children, 14.3 percent do not have any children and only 7.7 percent have more than
three children in the family. Looking at number of children in the households, parents seemed
to be aware on family planning methods. On the other it may be the fact that less number of
children were alive due to the high infant mortality.
18
Table 1.4: Percentage of Age Wise Distribution of Family Members
Age group Kapan Shankhamul Tripureshwor Total

Less than one year 0.6 0.2 0.8 0.6
One to five years 9.5 7.2 9.7 8.9
6 to 18 years 33.6 33.4 34.4 33.7
19 to 59 years 52.5 54.2 50.8 52.6
6o years and above 3.8 5.0 4.3 4.3
Total 100.0 100.0 100.0 100.0
The table shows that according to age, only 0.6 percent of the families have members’ less
than one year old and 8.9 percent have family members between the age group of 1- 5 years
old. The age group of 19 to 59 years covers the highest portion of the families (52.6 percent)
followed by members falling in the age group of 6-18 years who cover 33.7 percent. The
numbers of old people are only 4.3 percent.
Table 1.5: Percentage of Sex wise Distribution of the Family Members
Gender Kapan Shankhamul Tripureshwor Total

Male 50.6 49.0 51.1 50.2
Female 49.4 51.0 48.9 49.8
Total 100.0 100.0 100.0 100.0
The number of male members is found to be slightly higher except in Shankhamul, where
percentage of female is higher than male. However, the difference is less significant.
Table 1.6: Percentage Distribution of Marital Status of the Family Members
Kapan Shankhamul Tripureshwor Total

Marital Status
Married 87.2 92.9 92.0 90.0
Separate 3.5 - - 1.7
Widow 9.2 7.1 5.3 7.7
Alone with children 9.9 1.2 2.7 5.7
Single without children 0.7 - - 0.3
Total 100.0 100.0 100.0 100.0
The table indicates that about 90 percent of the family members in all areas are married. Only
few are separated and widow. There are also few members who are alone with children and
some are only single.
19
Table 1.7: Percentage Distribution of Religion Followed By the Families
Religion followed Kapan Shankhamul Tripureshwor Total

Buddhist 14.2 17.9 22.7 17.3
Hindu 63.1 70.2 60.0 64.3
Christian 19.9 11.9 16.0 16.7
Kirat 2.8 - 1.3 1.7
Total 100.0 100.0 100.0 100.0
The majority of population in all areas is Hindu, which is about 64 percent. Quite a few
percentages are represented by Buddhists and Christians. The Kirati population is very
insignificant and only available in Kapan and Tripushewor.
Table 1.8: Percentage Distribution of Monthly Incomes in the Family
Income per month Kapan Shankhamul Tripureshwor Total

Below 500 3.6 - 1.8 2.1
550 to 1000 6.3 7.4 6.3 6.6
1100 to 3000 46.9 43.0 61.6 49.4
3100 to 7500 31.8 37.8 27.7 32.6
7600 and above 10.4 11.9 2.7 8.9
Don’t know 1.0 - - 0.5
Total 100.0 100.0 100.0 100.0
The table shows that higher percentage (49.4) of the families have a low average income
(Rs.1100 to 3000 per month), as compared to the little number of families (32.4%) who have
a high average income (Rs.3100 to 7500/month). Only 8.9% of the families earn more than
7600 Rs. while around 6 % have very low income. In-terms of monthly income, the level of
poverty is most vulnerable in Tripureshwor as compared to Kapan and Shankhamul.
When looking at the daily income, 51.6 % of the families have less than hundred rupees and
23.7 percent of the families have an income of rupees 105 to 150. Families earning Rs155 to
250 was 17.4 % and 7.4 % of families earned more than Rs 255.
As per the NLSS report in2003/04, per capita average household income is Rupees 15,162.
The table below (1.9) shows that 38 percent of the total family members were students. The
remaining 62 percent of the members did various kinds of works like labour, household work,
business; tailoring etc. 1.4 percent of the family members (mostly older parents) were
unemployed.
Children of 6 to 18 years old who do not attend school are about 10% out of which 16 %, are
supporting their parents in household work, 10 % work in furniture factory, 66.7 % do
nothing and 6.7 % are learning tailoring and working as housemaid.
20
Table 1.9: Percentage Distribution of Occupation of the Family Members
Occupation Kapan Shankhamul Tripureshwor Total

Student 37.6 39.9 36.6 38.0
Labor 12.3 9.0 12.2 11.3
Household work 10.3 7.6 14.3 10.5
Business 7.1 5.9 8.6 7.1
Household worker 5.2 9.8 6.5 7.0
Service 4.0 5.1 3.9 4.3
Private company staffs 3.1 5.4 5.1 4.3
Tailoring 4.0 3.9 3.9 3.9
Driver 2.6 3.7 3.6 3.2
Work in foreign country 3.5 2.9 2.4
Stay in home 3.1 2.0 0.3 2.0
Unemployed 0.5 2.0 2.1 1.4
Carpenter 1.9 0.5 0.3 1.1
Agriculture 1.4 0.7 0.6 1.0
Cook 0.5 0.7 0.9 0.7
Mistri 1.0 0.2 0.6 0.7
Others* 1.7 0.7 0.6 1.1
Total 100.0 100.0 100.0 100.0
* Painting, guard, News paper seller, plastic collection, Priest, Social worker, dancer
As per the NLSS survey report in 2003/2004, unemployment rate among 15-24 year olds
remains high at 6 percent. NLSS estimates that 62.55 percent of children are attending school
but not working, but 21 percent who are attending school and working at the same time. 11
percent of children are working only, and the remaining children are idle. This implies an
overall child labor incidence of 32 percent. This is much higher among 10-14 years old than
5-9 years old (50 percent vs. 14 percent). It is even higher among the female children and
especially in rural areas than in urban. The percentage of children involved in “work only” is
much higher for those children from the poorest consumption quintile, implying a strong
association of poverty with child labor incidence.
While examining the working hours of child labor, 58 percent of children work less than 20
hours a week and about a quarter of them work for 20-39 hours, and 16 percent of them work
for 40 and more hours a week.
Table 1.10: Percentage Distribution Of Voter Card
Voter card Kapan Shankhamul Tripureshwor Total

Yes 2.2 25.1 13.4 12.1
No 97.8 74.9 86.6 87.9
Total 100.0 100.0 100.0 100.0
Only 12.1 percent of the family members had voter's card whereas 87.9 percent of the family
members did not have it. In Nepal, one must be 18 years of age to get a voter card. It might be
because 43.2% of population is below 18yrs and 56.8 % is adult population. Though families
21
have been settled down in these areas since 10 to 11 years they must have a legal document of
transfer from their original place to get the voter’s card. However local authorities and
politician allowed them for voting and use as voter bank without any legal document.
Table 1.11: Percentage Distributions of Citizenship Card
Citizenship card Kapan Shankhamul Tripureshwor Total

Yes 45.8 50.6 41.1 46.1
No 54.2 49.4 58.9 53.9
Total 100.0 100.0 100.0 100.0
Only 46.1 percent of the family members have citizenship card, which is provided after
reaching the age of 16. Many of them did not have legal documents for getting citizenship.
The implication of not having citizenship, birth registration affects people in many ways, for
instance, difficulties in accessing services, resources and opportunities. Similarly, if women
do not have citizenship, it affects marriage registration, and birth registration of their children.
It again affects for taking any legal actions.
Table 1.12: Percentage Distributions of Family Members with Identity Card
Identity card Kapan Shankhamul Tripureshwor Total

Yes 30.7 32.7 19.4 28.4
No 69.3 67.3 80.6 71.6
Total 100.0 100.0 100.0 100.0
The table indicates that 28.4 percent of the members have the identity card. Even though age
can be a factor for lesser number of card-holders, there is no enough awareness among the
people for having ID cards and their usefulness. It is also better to provide an ID card to all
age groups except infants.
Table 1.13 Children with Birth Registration Certificate
Children have birth registration Kapan Shankhamul Tripureshwor Total

Yes 37.6 39.3 41.3 39.0
No 62.4 60.7 58.7 61.0
Total 100.0 100.0 100.0 100.0
Only 39% of the children living in these families have birth registration certificate. This may
be due to the lack of enough information about importance and the process of registering a
child's birth. There is a strong link between birth registration and access to school education
as HMG/Nepal has made policies for a need of birth registration certificate during school
admission.
22
Table 1.14 Presences of Family Members Having Children below 5 years in Daytime
Presence of family members Kapan Shankhamul Tripureshwor Total
Both parents are present everyday 4.3 8.3 1.3 4.7

for the whole day
Only one of the parents is present 61.7 61.9 62.7 62.0
everyday for whole day
Another person than the parents 5.7 8.3 9.3 7.3
takes care of the children
The members of the family go back 28.4 21.4 26.7 26.0
home only in the evening
Total 100.0 100.0 100.0 100.0
The table shows that 62 percent of the families have only one parent for whole day in the
house. 26 percent of the family members who are out all-day and return only in the evenings
and children are left alone (9.5 % are below 5 years) without any guardianship. 7.3 percent of
the families have other members taking care of the children.
2. Status of Housing
Housing refers to a dwelling or a housing unit. Almost all houses are made of muds and brick
with one window and one front door. It was found that average number of rooms per
household is 2-3 indicating greater degree of crowd in poorer households.
Similarly, housing plots on average are small in size, and include building area and
surrounding area up to 20x 24 sq. ft. (that is, 1 Anna). Outer walls of households are
constructed with mud-bonded bricks. Other materials include "wood and tree branches". For
roofing, the materials mostly used are tiles/slates’ (earth, mud, wood, plank, etc.) and the most
common flooring material is Earth flooring. More than 99 percent of housing has earth
flooring.
Table 2.1 Duration of Living in the Current Place:
Duration of living in the house Kapan Shankhamul Tripureshwor Total

Less than one year 4.3 - 5.3 3.3
One year 3.5 2.4 8.0 4.3
2 to 5 years 11.3 4.8 13.3 10.0
6 to 10 years 51.1 6.0 8.0 27.7
11 years and above 29.8 86.9 65.3 54.7
Total 100.0 100.0 100.0 100.0
The table shows that majority of the families (around 55%) in these areas have been residing
there since last 11 years and more. However, the larger percentage of families in Kapan is
residing there for 6- 10 years unlike in other two areas. Only 4.3 percent and 3.3 percent of
the families has been residing there since 1 year or less than one year respectively. As shown
23
in the table, the most recent settlement is in Kapan, followed by Tripureshwor and
Shankhamul respectively.
It was found that 31 percent of the families are local residents of Kathmandu. The remaining
69 percent of the families migrated from the adjoining districts as well as farther districts
ranging from Lalitpur to Solukhumbu. Some have also migrated from India.
44.2% of families were born in Kathmandu and the rest of the families’ birth place are Kavre,
Morang, Ramechap, Dolakha, Jhapa, Sunsari, Sindhupalchowk, Sindhuli, Lalitpur, India,
Makwanpur, Nuwakot and other 31 districts. The birthplace of these families is scattered over
44 districts including Kathmandu.
Table 2.2 Percentage Distribution of Land Holding at household
Land holding Kapan Shankhamul Tripureshwor Total

No land - - 2.7 0.7
Less than one aana 50.4 16.7 20.0 33.3
1 Aana 14.9 52.4 44.0 32.7
1.5 Aana 0.7 1.2 2.7 1.3
2 to 5 Aana 16.3 2.4 16.0 12.3
More than 5 Aana 17.7 27.4 14.7 19.7
Total 100.0 100.0 100.0 100.0
The highest percentage of families (50.4% in Kapan, 52.4% in Shankhamul and 44% in
Tripureshwor) hold land less than one and one ana respectively. Some families have land area
ranging from 1.5 ana to 5 ana. In Tripureshwor 2.7% do not own any land. Almost all families
have built house in riverside occupying the public land, none of them have legal document for
the land.
Table 2.3 Conditions of Hygiene/Sanitation Inside and Outside the House
Hygiene/Sanitation Kapan Shankhamul Tripureshwor Total

Good 21.3 28.6 2.7 18.7
Medium 68.8 66.7 80.0 71.0
Bad 9.9 4.8 17.3 10.3
Total 100.0 100.0 100.0 100.0
Good =house surrounding is clean both inside and outside.

Medium =one side of house is poor hygiene
Bad =both side of house is poor hygiene
The survey indicated that that the highest percent of the families in all areas have medium
condition of hygiene and sanitation while least of them have bad hygiene. Very few families
in Tripureshwor have a good hygiene as compared to Kapan and Shankhamul.
24
Table 2.4: Furniture and Materials Available in the House
Physical facilities Kapan Shankhamul Tripureshwor Total

Bed 97.2 97.6 97.3 97.3
Chairs 60.3 78.6 64.0 66.3
Radio 68.8 75.0 76.0 72.3
Stove (Kerosene) 79.4 71.4 66.7 74.0
Table 77.3 71.4 48.0 68.3
TV 73.0 83.3 76.0 76.7
Stove (Gas) 24.1 32.1 10.7 23.0
Bhuse Chulo/firewood 9.9 8.3 17.3 11.3
Percentage total may exceed 100 due to multiple responses
Most of the families in survey areas owned bed, chairs, radio, stove, table and TV. Only 23
percent of the families use gas stove, 74 % of families use kerosene stove and 11.3 percent of
the families still use Bhuse chulo/firewood (traditional use of cooking). 63.7 percent of the
families have a separate kitchen in their house, whereas 36.3 percent of the families live and
cook in the same room. Similarly almost all families have electricity in their houses. Only 0.3
percent of the families use candles and oil to lighten their house.
Those families who use gas stove find it less smoky and easier to use and better for their
health. The cost of gas cylinder is 900 Rs per cylinder, which lasts for one month. Those
families who use kerosene stove find more smoky which affected the children health as well
as adults especially women.
Table 2.5: Flooding During The Rainy Season
House is flooded during the rainy Kapan Shankhamul Tripureshwor Total

season
Yes 19.1 64.3 78.7 46.7
No 80.9 35.7 21.3 53.3
Total 100.0 100.0 100.0 100.0
It was found that majority of families in Shankhamul and Tripureshwor experience the
problems of flooding during the rainy season unlike in Kapan where 80.9 percent of the
families were safe from floods, however in Shankhamul and Tripureshwor also don’t have
experience of flooding since last 5 years.
3. Health Status of children under 5 yrs of age
Table 3.1: Percentage Distributions of Breast Feeding Practices for Children Below 5 yrs
Number of times breast fed Kapan Shankhamul Tripureshwor Total

Two times 10.2 - 3.2 5.6
Three times 53.1 53.6 41.9 50.0
More than 4 times 36.7 46.4 54.8 44.4
Total 100.0 100.0 100.0 100.0
25
In the survey areas, 9.5% of the children were below five years old and 0.6 % were less than
one year old. The survey indicated that majority of the mothers (with children below five
years old) in Kapan and Shankhamul breast-feed their children at least 3 times a day, while in
Tripureshwor, the highest majorities (54.8%) of the mothers breast-feed their children 4 times
a day as they were the breastfeeding mothers. A few percentages of the mothers feed their
child with breast milk only twice a day. This is truer in urban area as both father and mother
have to do external work to meet day-to-day families’ needs.
When asking about their perception of breast-feeding, 68.3 percent of the respondents
mentioned that it is necessary to feed more than 4 times a day for a child less than 5 years old
and 31.7 percent of the respondents feel that 3 times a day is enough for such group of child.
According to the DOHs annual report (2002/2003), 30–35 % of children in Nepal is born with
low birth weight (below 2.5 kg). Despite low birth weight, most children grow well during
their first 6 months of life. This is due to the almost universal breastfeeding practices in
Nepal. For many children, the nutritional problems start at six months of age and the steep
increases in malnutrition prevalence occurs. This is because at this stage; breast milk alone
cannot sustain their rapid growth and complementary feeding is not managed properly.
Table 3.2: Percentage Distribution of Time for Stopping Breast Feeding
Time for stopping breast feeding Kapan Shankhamul Tripureshwor Total

When pregnant again 4.3 2.4 2.7 3.4
When the child was 1 year old 5.8 3.6 10.7 6.4
When there was no more milk 29.0 28.6 22.7 27.3
After three years 22.5 20.2 24.0 22.2
After two years 21.7 20.2 18.7 20.5
Currently breast feeding 5.8 8.3 13.3 8.4
After four years and more 10.9 16.7 8.0 11.8
Total 100.0 100.0 100.0 100.0
It was found that around 27.3 percent of the mothers stopped breast feeding after they stopped
milking and around 20-22 percent of the mothers stopped breast feeding only after the child
was 2 to 3 years old. It is good that only 6.2 % of them stopped breast-feeding after the child
was 1 years old. Some of them stopped breast-feeding after they became pregnant again. The
exceptional cases were also found breast feeding their child until 4 years old.
While asking the respondents’ opinion for the appropriate time to stop breast-feeding; 31
percent of them feel that it is appropriate to stop breast-feeding after the child is three years
old. Some of them also feel that breast-feeding need to be stopped after the milk stops. 1.3
percent of the respondents feel that breast-feeding should be stopped after becoming pregnant
again. Some of them also felt that it should be stopped only after the child is 2-5 years old.
As per the annual report of department of health services (2002/2003), the mean duration of
breast-feeding is 29 months. Nearly nine out of ten children less than 2 months of age are
exclusively breastfed. Almost all mothers initiate breastfeeding and they continue to
breastfeed for a long time. 40 % of the mothers are still breastfeeding their 3 yrs old children
(NDHS, 2001). By 6 to 7 months of age, 53 % children are provided with complementary
foods apart from breast-feeding. The growth monitoring of children below 3 years age of new
26
visits of health centre is 23.6 % in Kathmandu. Similarly, proportion of malnourished children
in Kathmandu are 12.1% of new visits who have done growth monitoring.
The Nepal demographic and health Survey conducted in 2001 showed that 50.5% of children
below 5 years of age are affected by stunting, which can be a sign of early chronic under
nutrition.
Table 3.3 Percentage Distributions of Practices for Giving Bottle Feeding
Practice of bottle feeding to a child less Kapan Shankhamul Tripureshwor Total

than 4 months
Yes 20.3 13.1 21.3 18.5

No 79.7 86.9 78.7 81.5
Total 100.0 100.0 100.0 100.0
Only a minimum of 18.5 percent of the respondents' bottle-feed their child below 4 months
old and the rest and majority did not start bottle feeding until their child is more than 4
months old. Comparatively, mothers from Shankhamul are the least in number who bottle-
feed their children below four months old.
3.4 Immunization Practices:

The survey found that all the families have immunized their children below 5 years with the
necessary vaccines like BCG, DPT, Polio and Measles. Only some families have vaccinated
their children against Hepatitis B. Most of the families vaccinated their child in the public
health centers and hospitals. Some of them were vaccinated during the visits of mobile health
camps, in private health centers, and in local committee and in schools. 64 percent of the
families start vaccination for their children after one month of birth whereas, 32.7 percent of
families vaccinated their children just after birth. Only 0.3 percent families vaccinated their
children after nine months of birth.
Regarding the vaccination fees, only 30.6 percent of the respondents pay the fee for such
purposes. Among them, 68.1 percent of the families pay Rs.2 to Rs 10, 25.3 percent pay Rs.11
to Rs. 50 and only 6.6 percent families’ pay Rs. 50 and more.
Vaccine Cover Rate in Nepal:
The Expanded programme (EP) on Immunization is a priority programme of his majesty‘s

Government of Nepal. EP is considered as one of the most cost effective health interventions.
As per the records of 2002/2003, 22,721 infants in Kathmandu were immunized and the
coverage of measles vaccines is 102.6 %. As per the districts categorized with problems and
priority, Kathmandu has a low drop out (less than 10 %) and high coverage (more than 80%).
Similarly, the record of 2002/2003 in central development region for the BCG coverage is
110.7 %, DPT3 coverage for below 1 year is 97.2%, Polio3 coverage for below 1 year is
86.2%, Measles for below 1 year is 86.3% and TT2 for pregnant women is 29.5.
27
Table 3.5 Food Practices Of Children Less Than 5 Years Old
Type of food given to children less Kapan Shankhamul Tripureshwor Total

than 5 years old
Rice 100.0 96.4 100.0 99.1
Vegetables 93.9 92.9 93.5 93.5
Fruits 77.6 53.6 54.8 64.8
Fish /meat 51.0 39.3 35.5 43.5
Eggs 51.0 25.0 38.7 40.7
Soya 34.7 42.9 38.7 38.0
Beans 34.7 35.7 45.2 38.0
Milk 18.4 17.9 9.7 15.7
Lito 12.2 14.3 3.2 10.2
Biscuits 8.2 - 6.5 5.6
Sweets 10.2 - - 4.6
Jaulo 2.0 7.1 6.5 4.6
Daal 6.1 3.6 - 3.7
Horlicks 6.1 - 3.2 3.7
Tea 2.0 - - 0.9
An overwhelmingly 99.1 percent of the respondents feed rice to their child below 5 years of
age. Similarly, 93.5 percent of them feed vegetables to these groups of child. Other types of
food like fish/meat, fruits, eggs, soya and beans are fed by most of the respondents however
frequency and volume of food given to children is not regular. Only a few percents of
respondents feed milk, lito, biscuits, sweets, green vegetables, sweets, jaulo, daal, horlicks
and tea to their child. Though families feed all type of food to their children their nutritional
status depend on how many times they feed per day, quality of food, hygienic condition of
food and volume of milk, meat, and fish provided to children. In my observation, middle class
family usually eat meat once a week and the poor families eat fish and meat once in 15 days
or once in month, depending on their earning level.
When getting opinion from the respondents’ regarding the type of food suitable for children
below 5 years old, majority of respondents expressed that rice, vegetable, fruits, fish, beans,
eggs, soya are suitable to feed them. Some of them also expressed that the children can also
be given milk, lito, green vegetables, jaoulo, sweets, cereals / pulses, horlicks/lacto and
biscuits.
Table 3.6 Cleanliness Practices Undertaken Before Feeding The Child
Practices undertaken before feeding Kapan Shankhamul Tripureshwor Total

the child
Wash hands 94.2 98.8 93.3 95.3
Wash the utensils 34.8 25.0 41.3 33.7
Others 0.7 1.2 0.7
With regard to cleanliness before feeding to child, it was found that 95.3 percent of the total
respondents wash their hands before feeding a child. 33.7 percent of the respondents wash the
28
utensils as well, in which the child's food is served, whereas 0.7 percent of the respondents
undertake other means of cleanliness before feeding the child.
It was found that 17.8 percent of the respondents masticate the food before giving to the child
and there might be chance of spread infection when mother have infectious diseases.
Table 3.7 Accidents Experienced By The Children

Child has had accident
Yes 20.3 11.9 13.3 16.2
No 79.7 88.1 86.7 83.8
Total 100.0 100.0 100.0 100.0
If yes, kind of accident
Slide down (Ladder) 39.3 50.0 50.0 43.8
Road accident 21.4 10.0 20.0 18.8
Others* Stove, lack of oxygen, dog bite, 25.0 - 20.0 18.8
electric shock and sudden faint
Hand/leg broken 3.6 30.0 10.0 10.4
Fire 10.7 10.0 - 8.3
Total 100.0 100.0 100.0 100.0
Things done after the accident
occurred
Hospital 87.7 84.5 96.0 88.9
First aid 6.5 9.5 1.3 6.1
Do treatment 2.9 4.8 2.7 3.4
Medical shop 1.4 1.2 - 1.0
Don’t know 1.4 - - 0.7
Nothing done 0.7 - 1.3 0.7
Health post - 1.2 - 0.3
Total 100.0 100.0 100.0 100.0
It was found that 83.8 percent of the respondent’s children have had no accidents and 16.2 %
of children have some sort of accident. Most of these accidents occurred when the child slide
down the ladder. The other kinds of accidents were road accidents, accidents with stove,
biting by dog, electric shock and fire. 88.9 percent of the respondents brought their child to
the hospital after the accident occurred. Some of them did first aid treatment on their own and
some took the child to the medical shop and health post. 0.7 percent of the respondents did not
do anything after the occurrence of the accident.
As per the record in 2002/2003, in the central development region, there was no available data
for the OPD visits however, for the admitted cases of injury (ACI)) it was 1.83% at National
level.
29
Table 3.8 Practices of Seeking Assistance When Children Have Medical Problems
Places visited for treatment of the Kapan Shankhamul Tripureshwor Total

following problems
Diarrhea
Hospital 68.5 37.7 67.2 58.7
Self treatment 19.4 40.3 34.3 29.8
Private hospital 14.8 20.8 6.0 14.3
Doctors 4.6 2.6 1.5 3.2
Medical 3.7 5.2 - 3.2
Total 100.0 100.0 100.0 100.0
Fever
Hospital 55.8 64.5 70.8 62.7
Self treatment 13.5 9.2 12.5 11.9
Doctors 5.8 7.9 4.2 6.0
Medical 4.8 1.3 1.4 2.8
Clinic 1.0 - - 0.4
Total 100.0 100.0 100.0 100.0
Typhoid
Hospital 69.0 75.0 77.8 72.7
Doctors 7.1 7.1 - 5.7
Medical 4.8 3.6 5.6 4.5
Self treatment 2.4 3.6 5.6 3.4
Clinic 2.4 - - 1.1
Total 100.0 100.0 100.0 100.0
Parasite
Hospital 51.5 31.6 100.0 51.7
Private hospital 21.2 26.3 - 20.0
Self treatment 6.1 31.6 - 13.3
Doctors 9.1 10.5 - 8.3
Medical 6.1 - - 3.3
Nothing 6.1 - - 3.3
Total 100.0 100.0 100.0 100.0
During the occurrences of diseases like diarrhea, fever, typhoid, parasite and accidents,
majority of the families' first priority was to take the child to the nearest hospital. Some of
them took the child to the private hospitals, medical shops, and to the clinics. Only a few of
them did self-treatment.
Taking sick children to the hospital is satisfactory compared to data shown by National figure
however; in the study area the infant mortality was as high as 49 % and 60 % of parents were
unaware of the causes of death of their children. It might be due to poor pre-natal and post-
natal care and not timely visit of hospitals.
30
Next reason of visiting to hospital is less expensive as compared to private clinic and nursing
home as the patients do not need to pay the consultation fee but registration fee needs to be
paid which is 20 rupees for new visit and 10 to 15 rupees for repeated visit in public hospitals.
The cost of investigation is also cheaper here as compared to the private hospitals. The
patients need to buy medicine both in public or private.
As per the NLSS report, 66 percent of people with an acute illness reported to have consulted
a medical practitioner in the country: 36 percent consulted paramedic, followed by doctor (26
percent), traditional (3 percent) and kaviraj/vaidya (1 percent). Doctors’ share of consultations
is much higher in urban areas and among richer quintiles. And not surprisingly, the proportion
of individuals who do not consult at all is higher among those from poorer households. With
all facilities in the country, pharmacy is attended by majority of sick people (40 percent).
Others visit sub-health post (17 percent), hospital/public health center (16 percent), health
post (11 percent), private hospital (9 percent) and others (8 percent). This pattern follows in
all regions except in mountain areas where the majority visit sub-health post (43 percent).
Among consumption groups, richer quintiles are more likely to visit private health
institutions. Poorer quintiles visit government health institutions. On average, total cost of
treatment at a government health facility is similar to that of a private health institution except
the consultation fee and disaggregating the total cost, diagnostic and other service costs are
slightly higher in private institutions.
There are no specific policies for urban poor to access health services especially for OPD
services. However there are mobile services available for eye camp, immunization campaign,
medical check up for women, Vitamin “A” capsule distribution and dental camp at least once
a year. For hospitalizing the patient, there is a quota system to admit 2-5% poor patients.
However, they need to look for recommendation from authorities, which is a lengthy and
difficult procedure for the poor.
As per the annual report of department of health services, the prevalence of worm infestation
in Nepal is very high. Like wise in 2002/ 2003 incidence of diarrhoea in Kathmandu was 77 /
1000 children for below 5 year and the incidence of ARI reported in Kathmandu is 92 /1000
for below 5 year children and proportion of severe pneumonia is 1.9 % in Kathmandu.
31
OPD New visits at Health facilities in 2002 / 2003 Annual Report
S No. OPD New visits at Central development Region Percent

1. Skin diseases 5.15%
2. ARI 3.14%
3. Diarrhea Diseases 3.19%
4. Intestinal worms 2.18%
5. Pyrexia unknown origin 2.18 %
6. Gastritis 1.76%
7. Ear Infection 1.55%
8. Arthritis, Rheumatism and Gout 0.48%
9. Chronic Bronchitis 1.04%
10. Sore eye and Complaints 0.95%
11 All other cases 78.38%
Total 100 %
Source: HMIS / MD, DOHS
As per the annual report of DOHs in 2002/2003, total new OPD visits, out of total population
in central development region is 31.6 % and ten leading Diseases (Total new visits as a
percentage of total population are recorded in the table above.
Reasons for Hospitalization in 2002 / 2003 National Health Annual Report
S No. Causes for Hospitalization (National level) Percent

1. Single Spontaneous Delivery 24.77%
2. Diarrhea and Gastroenteritis 5.80%
3. Pneumonia, Organism Un specified 4.84%
4. Typhoid and Paratyphoid fevers 4.84%
5. Unspecified Acute lower Respiratory 3.35 %
6. Unknown and Unspecified Causes 3.16%
7. Other Chronic Obstructive Pulmonary 2.75%
8. Unspecified Abortion 2.06%
9. Fever of unknown origin 2.05%
10. Injury of Unspecified Body Region 1.83%
11 All other cases 44.91%
Total 100 %
Source: HMIS / MD, DOHS
32
Table 3.9: Percentage Distributions of Children Deceased and Causes For Their Deaths

Number of sons dead
1 84.2 72.7 86.7 82.2
2 15.8 27.3 6.7 15.6
3 - - 6.7 2.2
Total 100.0 100.0 100.0 100.0
Age of the deceased
Below one year 52.6 54.5 33.3 46.7
One year 5.3 27.3 26.7 17.8
Two years 10.5 18.2 20.0 15.6
More than two years 31.6 - 20.0 20.0
Total 100.0 100.0 100.0 100.0
Cause of death
Don't know 31.6 54.5 33.3 37.8
Illness 5.3 18.2 26.7 15.6
Pneumonia 15.8 9.1 6.7 11.1
Jaundice 15.8 6.7 8.9
Poisonous food 10.5 - - 4.4
Suddenly 5.3 9.1 4.4
Mal nutrition 5.3 - 6.7 4.4
Lack of health facility (doctor) 5.3 9.1 - 4.4
Measles/ulcer - - 6.7 2.2
Tetanus 5.3 - - 2.2
Drowned - - 6.7 2.2
Parasites - - 6.7 2.2
Total 100.0 100.0 100.0 100.0
Number of daughters dead
1 78.6 80.0 70.0 75.9
2 14.3 20.0 10.0 13.8
3 7.1 - 20.0 10.3
Total 100.0 100.0 100.0 100.0
Age of the deceased
Below one year 42.9 80.0 50.0 51.7
One year 21.4 - 20.0 17.2
Two years 21.4 40.0 10.0 20.7
More than two years 42.9 - 50.0 37.9
Cause of death
Don't know 57.1 60.0 80.0 82.8
Illness 42.9 40.0 40.0 41.4
Pneumonia 42.9 - 20.0 27.6
Measles/ulcer 14.3 - 20.0 13.8
Mal nutrition 14.3 - 20.0 13.8
Poisonous food 14.3 - - 6.9
Fever 14.3 - - 6.9
Dog bite - - 20.0 6.9
Above table shows that highest mortality rate is in Tripureswor, followed by Kapan and
Shankhamul. Shockingly it was found that 82.2% of the total families had lost at least one son
due to death, with a majority (46.7%) of the deceased associated with below one year of age.
33
In these villages, there were also families who had lost 2-5 sons due to death by different
reasons. Children more than 2 years were the second highest in number to have died due to
various reasons followed by children of age 2 and 1 year.
Most of the parents (37.8%) were unaware about the cause of their son's death. 15.6% of the
children had died due to some sort of illness and 11.1% specifically due to pneumonia.
Jaundice, sudden death, mal nutrition, lack of health facility was some of the causes of the
children's death. The survey found that only Kapan had experienced 10.5% of the deaths due
to intake of poisonous foods and some deaths due to tetanus, whereas incidents of death by
measles and ulcers, drowning and parasites were found among the families of Tripureshwor
only.
In the case of daughters lost by death, 75.9% of the total families had lost at least a daughter,
with a majority (51.7%) of them dying before completing one year. There were also some
families who had lost 2-3 daughters with their death due to different reasons. Girl children
more than 2 years were the second highest in number to have died due to various reasons
followed by girl children of age 2 and 1 year.
82.8% of the parents were again unaware about the cause of their daughter's death. 41.4% of
the girls had died due to some sort of illness and 27.6% specifically due to pneumonia. Causes
of girls dying due to pneumonia, measles/ulcer, and mal nutrition were found only in families
living in Kapan and Tripureshwor. Whereas matching with the data of death of the sons, only
Kapan had 14.3% of the daughter dying due to intake of poisonous foods and fever. The
village in Tripureshwor was the only one area having 20% of the daughter who died due to
dog bites.
Table 3.10 Presence Of Handicap Members In The Family

Presence of handicap members in the
family
Yes 5.0 2.4 6.7 4.7
No 95.0 97.6 93.3 95.3
Total 100.0 100.0 100.0 100.0
If yes, type of handicap
Physical 85.7 100.0 100.0 92.9
Mental 14.3 - - 7.1
Total 100.0 100.0 100.0 100.0
Handicap by gender
Male 9.0 9.0 6.0 23.9
Female 41.8 22.4 11.9 76.1
Total 50.7 31.3 17.9 100.0
It was found that there were few handicapped children in different areas: Tripureshwor (6.7
%), Kapan (5.0 %) and Shankhamul (2.4 %) respectively. In total 4.7 percent of the
respondents who are members in the family were handicapped. Among them, 92.9 percent
have physical handicap and only 0.7 percent have mental handicap. The percentage of female
handicap is 76.1 % as compared to male handicap (23.9%).
34
Table 3. 11 Percentage Distribution of Families Suffer From Chronic Illness
Family members suffering from Kapan Shankhamul Tripureshwor Total

chronic disease
Yes 11.3 7.0 4.0 22.3
No 35.7 21.0 21.0 77.7
Total 47.0 28.0 25.0 100.0
If yes who are they
Self 13.4 19.4 7.5 40.3
Mother /Mother in law 20.9 - 1.5 22.4
Husband 7.5 6.0 4.5 17.9
Daughter 7.5 3.0 3.0 13.4
Son 1.5 1.5 - 3.0
Grand father/father in law - 1.5 1.5 3.0
Total 50.7 31.3 17.9 100.0
As per the annual report of department of health service (2002/2003), the proportion of
tuberculosis new smear positive was 43% and treatment success was 88% in Kathmandu.
4. Status of Family Planning, Pregnancy and Delivery
Table 4.1: Number of Pregnancy in Life Time
Number of pregnancies experienced Kapan Shankhamul Tripureshwor Total

Never 2.1 - - 1.0
Once 22.7 9.5 20.0 18.3
Twice 27.7 28.6 26.7 27.7
More than twice 47.5 61.9 53.3 53.0
Total 100.0 100.0 100.0 100.0
It was found that 53 percent of the total respondents have experienced pregnancy more than
twice in their lives. Among them, Shankhamul had the highest percentage of respondents
experiencing pregnancy more than twice (61.9 percent). It was found that only Kapan had a
small number (2.1 percent) of females who had never experienced pregnancy in their lives.
Regarding the appropriate time for pregnancy, positively, majority of the respondents opined
that the appropriate time for next pregnancy is after2-5 years of first child. Only a nominal
number of respondents thought the appropriate time for pregnancy to be after a year or after
six years. Some respondents also felt that one child is sufficient for them.
35
Table 4.2 Check-Up Practices during Pregnancy

Check up during last pregnancy
Yes 54.3 66.7 52.0 57.2
No 45.7 33.3 48.0 42.8
Total 100.0 100.0 100.0 100.0
If yes who did the check up
Doctor 59.5 58.9 56.4 58.6
Nurse 45.9 41.1 35.9 42.0
TBA - - 7.7 1.8
Total 100.0 100.0 100.0 100.0
Despite the importance of prenatal care for a woman and her child during pregnancy, only
57.2 percent of the pregnant women in these villages go for regular check up during
pregnancy. Majority of them visit doctor and nurses and only 1.8 percent visited the TBA.
Among these Shankhamul had the highest percentage of women taking prenatal care and
going for regular check up during their pregnancy. Women not doing any check ups during
pregnancy are 48 %, 45.7 % and 33.3 % in Tripureswor, Kapan and Shankhamul respectively.
According to the Nepal Micronutrient Status Survey 1998, the overall prevalence of current
night blindness in women of reproductive age and pregnant women was 4.7 % and 6 %
respectively, while 16.7% of women have night blindness during their last pregnancy. Iron
deficiency Anaemia is by far the most common nutritional problem in Nepal affecting
approximately three quarters of the women and children (NMSS 1998). Anaemia is one of the
underlying factors in pregnancy and childbirth morbidity and mortality.
The most common cause of anaemia in Nepal is considered inadequate intake of iron from
foods followed by parasitic infections. Around 70 % of the most at –risk population group viz.
young children and pregnant women are not consuming adequate amount of iron from their
daily diets.
A survey conducted among government high school adolescent girls of Kathmandu valley by
Nutrition Section; CHD on May 2003 revealed that anaemia was a severe nutritional problem
in adolescent girls even in urban areas. Approximately 64% of the adolescent girls were found
to be anaemic. Among the three districts, Kathmandu and Bhaktapur had the higher
prevalence rate of anaemia (70 %). Lalitpur showed comparatively lower prevalence of
anaemia (51.6%).
Antenatal iron supplementation is in place in Nepal since more than two decades. However,
the coverage and compliance of antenatal iron supplementation is beyond satisfaction. A
Baseline study was carried where Intensification of Antenatal Iron Supplementation Program
(IAISP) has been implemented. The findings in the program areas revealed that 27 % and
47% of pregnant women took iron tablets in the second and third trimester respectively.
Similarly drop out rate during second trimester was 19 % and 25% in third trimester. Lack of
knowledge about the importance of iron tablets stated to be the main reason for not taking
iron supplementation.
36
Table 4.3 Practices of Child Birth
Place of child birth Kapan Shankhamul Tripureshwor Total

At home 63.0 45.2 53.3 55.6
Hospital 37.0 54.8 46.7 44.4
Total 100.0 100.0 100.0 100.0
If at home who helped you?
Neighbor 31.8 42.1 38.5 35.8
Mother/Mother in law 17.0 26.3 25.6 21.2
Self (Lonely) 13.6 7.9 12.8 12.1
TBA 12.5 7.9 5.1 9.7
Husband 6.8 7.9 7.7 7.3
Relatives 6.8 7.9 2.6 6.1
Friends 8.0 - 7.7 6.1
Nurse 3.4 - - 1.8
Total 100.0 100.0 100.0 100.0
It was found that majority of the deliveries occurred at home (55.6 percent) followed by 44.4
percent deliveries in hospitals. This might be one reason of high infant mortality in study
areas. The practice of childbirth at hospital is 54.8%, 46.7 % and 37.0% for Shankhamul,
Tripureswor and Kapan respectively. The table shows that 35.8 percent of the deliveries are
assisted by neighbors followed by mother/mother in-law (21.2 percent), traditional birth
attendants TBA (9.7 percent), husbands (7.3 percent), relatives (6.1 percent), friends (6.1
percent) and nurses (1.8 percent). 12.1 percent of the women were found to have given birth
alone without any assistance. Only 44.4 percent of these women go to the hospitals for
delivery of baby.
As per the annual report of departmental health services (2002/ 2003) deliveries conducted by
health workers was 42.5 % in Kathmandu.
Table 4.4 Check-Up Practices after Last Pregnancy

Gone for check up after pregnancy
Yes 40.6 63.1 41.3 47.1
No 59.4 36.9 58.7 52.9
Total 100.0 100.0 100.0 100.0
If yes, who did the check up
Doctor 54.5 54.7 58.1 55.4
Nurse 56.4 47.2 38.7 48.9
FCHV - - 3.2 0.7
Total 100.0 100.0 100.0 100.0
Only 47.1 percent of the women have gone for check up after their pregnancy and 52.9 % do
not follow check–up practice after their last pregnancy. Shankhamul has the highest number
of women going for regular check up after pregnancy. Among those not going for post-natal
care the highest percentage of women (59.4 %, and 58.7%) are in Kapan and in Tripureshwor
respectively. Majority of them go to the doctor, some to them go to the nurse and some to
37
female community health volunteer. This data shows that the women in these villages ignore
the part of post-natal care.
As per the one study conducted by UNICEF in safer mother hood district in 1998, the health
seeking practices of pre and post natal care of women is determined by number of factors
such as support available from family and friends, cost of treatment, shyness, attitude of
mothers in law, transport and distance of health facilities, waiting time for health services,
behavior of health service providers and level of education. The support provided by family,
friends and the community was a major influence in determining women’s likelihood of
seeking health care as well as communicating problems with their husbands.
Study findings also show that women usually do not decide on their own to seek care,
reflecting the role of family in decision-making. The existing tradition and culture greatly
influence women’s communication capability regarding pregnancy – related problems and the
acceptance of problems as “something that comes along with pregnancy”.
Table 4.5 Practices of Family Planning Methods

Family planning method used
Yes 56.0 59.5 65.3 59.3
No 44.0 40.5 34.7 40.7
Total 100.0 100.0 100.0 100.0
If yes type of method used
Permanent Method 23.1 24.0 24.5 23.7
Temporary Method 76.9 76.0 75.5 76.3
Total 100.0 100.0 100.0 100.0
If temporary method is used, its type
Sangini 65.0 41.0 47.2 53.3
Norplant 3.3 10.3 30.6 12.6
Copper T 3.3 23.1 5.6 9.6
Depo 10.0 5.1 2.8 6.7
Kamal chhaki 6.7 5.1 5.6 5.9
Condom 5.0 5.1 5.6 5.2
Pills 5.0 7.7 2.8 5.2
IUD 1.7 - - 0.7
Nilocon white - 2.6 - 0.7
Total 100.0 100.0 100.0 100.0
Only 59.3 percent of the respondents use family planning method with a majority (76.3%)
using the temporary means of family planning. Only 23.7 percent of the users opt for
permanent method of family planning. The most commonly used methods of family planning
are Sangini (3 monthly injections for women). Only few numbers of respondents use
Norplant, kaparti, depo, kamal chakki, condom, IUD and Nilocon white. These data shows
that except from condom all the methods mentioned are for female, hence implying that
majority of the users of FP method are women.
As per the annual report of department of health services 2002/2003, the use of contraceptive
prevalence rate is 71.1% in Kathmandu. In 2002/2003, the current users of family planning
38
(all methods) in central region are 97 %. Likewise in same year minilap has done by 73.34%
and Vasectomy has done by 26.66%. The FP spacing method for the new acceptors in
Kathmandu is 12.69% for depo, condoms 1.24%, pills 1.74%, Norplant 0.80% and IUDs 0.98
in 2002 /2003.
5. Status of Hygiene and Sanitation

Table 5.1 Distribution Practices of Sources of Drinking Water
Source of drinking water Kapan Shankhamul Tripureshwor Total

Piped water supply by drinking water 12.1 23.8 96.0 36.3
office
Tube well with pump (ground water) 24.8 56.0 - 27.3
Natural tap water 51.1 1.2 1.3 24.7
Well 5.7 8.3 2.7 5.7
From neighbor 7.1 - - 3.3
Free from tanker 1.4 8.3 - 3.0
Protected well 3.5 3.6 - 2.7
Purchase of water 0.7 3.6 - 1.3
Total 100.0 100.0 100.0 100.0
Piped water is found to be the main source of drinking in the villages. 36.3 percent of the
respondents have access to piped water with a high percentage of its users in Tripureshwor
(96 percent). 27.3 percent of the families use water from tube well and 24.1 percent families
use natural tap water for drinking purpose. Only 3 percent of the families get free drinking
water from the tanker and 1.3 percent families buy drinking water. Some families also use
water from protected well for drinking.
Only 2.3 percent of the families' paid Rs. 100, which was the maximum amount, paid for
water whereas majority of the families paid amount ranging from Rs. 25 - 50.
Table 5.2 Methods Used To Make Water Consumable
Methods used to make water Kapan Shankhamul Tripureshwor Total

consumable from a non-protected well
Nothing 54.6 39.3 65.3 53.0
Boil in sun light 27.0 27.4 18.7 25.0
Boil and filter the water 10.6 25.0 13.3 15.3
Filter 5.0 6.0 1.3 4.3
Boil 5.0 1.2 2.7 3.3
Use medicine 2.8 2.4 - 2.0
Cover the storage jar 2.1 - - 1.0
Total 100.0 100.0 100.0 100.0
39
A majority of the families (65.3%, 54.6%, 39.3%) uses the water from a non-protected well
directly without making it consumable in Tripureshwor, Kapan and Shankhamul respectively.
The rest of the families used various means of purifying the water like boiling in sunlight,
boiling and filtering, using filter, using medicine and some only cover the storage jar. This
data shows that how vulnerable are the people in these areas to the water borne diseases. It
was found that majority of the families use iron and plastic jar for storing drinking water.
Some use water filters, silver pots, still pots and clay pots to store the drinking water.
Table 5.3: Practices of Waste Management System
Methods of waste disposal Kapan Shankhamul Tripureshwor Total

Throw in river 24.8 14.3 57.3 30.0
Throw on municipality’s truck 33.3 4.8 2.7 17.7
In a hole 3.5 44.0 10.7 16.7
Throw on Container 24.8 1.2 2.7 12.7
Any where 12.1 7.1 18.7 12.3
Born 1.4 28.6 8.0 10.7
Total 100.0 100.0 100.0 100.0
The garbage disposal facility to manage waste is found to be in a worst condition especially in
Tripureshwor. 57.3 % percent of the families in Tripureshwor throw their wastes in the river
followed by 24.8% in Kapan. Similarly, Kapan has a large number of families using the
municipality’s truck, and the container for throwing their garbage. In Shankhamul, the largest
percent of families throw their garbage in a hole. Some families also burn the garbage.
Table 5.4 Availability of Toilet Facility

Toilet facility available
Yes 97.9 98.8 88.0 95.7
No 2.1 1.2 12.0 4.3
Total 100.0 100.0 100.0 100.0
If yes, type of ownership
Collective 37.7 98.8 69.7 62.7
Individual 62.3 1.2 30.3 37.3
Total 100.0 100.0 100.0 100.0
Type of facility
Dry 76.8 83.1 62.1 75.3
Damp 23.2 16.9 37.9 24.7
Total 100.0 100.0 100.0 100.0
Majority of households (95.7%) in all areas have toilet facilities. Among them, the highest
percentage of families in Shankhamul (98.8%) and Tripureshwor (69.7%) has collective
toilets unlike in Kapan, where the majorities (62.3%) have individual toilets. In all areas the
majorities (75.3%) use dry toilets (modern latrines) and the rest has damp toilets (pit latrines).
The awareness level regarding diseases transmitted by stool seemed to be high among the
40
respondents. Diarrhea, Cholera and Dysentery were the major three diseases that majority of
the people were aware about. Only a few families were aware about typhoid, malaria,
parasites and jaundice.
6. Status of School Attendance and Preschool:

Both literacy and education attainment are important determinants of individual’s and
household’s welfare. They affect the level and pace of economic development. As per the
DOE report published in 2004, the National Net Enrolment Rate (NER) at primary level is
84.2 per cent. The NER at lower secondary level is 55.1%, for Kathmandu valley, which is 11
% higher than the national average. The valley has also higher NER at secondary level,
representing 24% higher than the national figure.
Table 6.1:Level of Education among Children Aged 5 and Above

Level of education Kapan Shankhamul Tripureshwor Total
Illiterate (who can’t read and 19.0 15.4 20.3 18.2
write)
Literate only (who can read and 13.1 15.9 16.4 14.8
write only)
Primary level 34.6 22.0 31.6 29.9
Lower secondary level 11.9 13.2 12.5 12.5
Secondary level 18.3 24.4 18.2 20.2
Inter mediate + 3.1 9.0 0.9 4.4
Total 100.0 100.0 100.0 100.0
The table shows that illiteracy is highest in Tripureswor, followed by Kapan and Shankhamul.
Among children 5 years and above, 29.9 percent were in primary level and 20.2 percent were
studying in secondary level. Among all, Kapan has a higher percentage (34.6%) of children
attending primary education and children attending secondary level were higher (24.4%) in
Shankhamul. The average illiteracy rate was higher (18.2%) as compared to the literacy rate
at 14.2%.
As per the national census data in 2004, never-attendance rate in school is 31 percent for male
population compared to 56 percent for females, and current-attendance rate is 35 percent and
25 percent for males and females respectively. Among the never-attendees, the highest
percentage (33%) reported the reasons for not schooling was "parents did not want" them to
go to school. It was found to be the primary reason for not schooling. Other reasons included
"had to work at home" (20 percent), "too expensive" (19 percent), “not willing to attend” (13
percent) and “school far way” (3 percent). By sex groups, the most cited reason for males was
"too expensive" (27 percent), while "parents do not want" (38 percent) was the dominant
reason for females. It should be noted that absence of nearby schools was reported by 4
percent of never-attendees. However, there are large differences across sex, geographic and
consumption group dimensions.
41
Comparison of Net Enrolment of Nationwide and Kathmandu Valley
Level of education in National Level / Male Females

KTM
Net enrolment at Primary school 90.1 78.0
Kathmandu Valley 100.0 91.0

Net enrolment at Lower secondary school 47.6 40.2
Net enrolment at Secondary level 35.2 28.8

All levels 66.9 57.1

Source: DOE, Educational Statistics of Nepal Flash Report I 2004
As per the NLSS, urban areas have higher rates relative to rural areas (74 percent versus 46
percent). It is probably due to the strong association between literacy rate and per capita
household consumption. 75 percent of the population in the richest quintile is literate while
only 25 percent is literate in the poorest quintile. Overall, adult literacy rate is 48 percent. But
gender gap is much smaller for younger cohorts in both urban and rural Nepal. For instance,
in rural areas, percentage of literates among 15-19 years old is 86 and 64 for males and
females respectively. But, among 50-54 years old, it is 39 for males and 4 for females.
Urban areas have a much lower never-attendance rate than rural areas. These disparities are
again sharpest across consumption quintiles, where never-attendance rate for those from the
poorest households is 64 percent while for those from the richest households is just 26
percent. For younger cohorts, urban areas have larger attendance rates relative to their rural
counterparts, and the same is true for male population relative to females. Not surprisingly, 44
percent of the students from the richest quintile are enrolled in private school, while less than
7 percent of students from the three poorest quintiles are in private institutions.
As per the DOE, the specified age group is categorized for primary level is 6-10 years, while
it is 11-13 years for lower secondary, 14 -15 years for the secondary.
The table below indicates that in all areas, there were members in a family who could not
attend to school due to dropouts at their early age and during teens. Such dropouts were
highest (20%) in Tripureshwor as compared to other two areas. On an average 10 % children
in these areas did not go to school. Among which, 58% are girls and 42 % are boys. It was
frustrating to know that 66 percent of these members are not doing anything whereas the rest
of them work in furniture factories, learn tailoring and do household chores. All the drop-outs
in Shankhamul and about 80% in Kapan are staying idle
42
Table 6.2 Family Members age 16 to 25 yrs who drop out from School

Presence of family members age
16 to 25 who do not attend
school due to drop out
Yes ( drop out ) 7.1 6.0 20.0 10.0
No ( drop put ) 92.9 94.0 80.0 90.0
Total 100.0 100.0 100.0 100.0
If yes, things they do
Work in furniture factory 10.0 - 13.3 10.0
House hold work 10.0 - 26.7 16.7
Nothing 80.0 100.0 46.7 66.7
Learning tailoring - - 13.3 6.7
Total 100.0 100.0 100.0 100.0
Age of dropout
6 - 20.0 - 3.3
8 - - 6.7 3.3
9 20.0 - 6.7 10.0
10 10.0 - 20.0 13.3
11 - - 13.3 6.7
12 40.0 - 6.7 16.7
13 - 20.0 46.7 26.7
14 - 20.0 6.7 6.7
15 10.0 40.0 13.3 16.7
16 30.0 20.0 - 13.3
Level of schooling when they left
school
Primary 40.0 40.0 60.0 63.3
Lower secondary 20.0 20.0 33.3 26.7
Secondary 40.0 40.0 6.7 23.3
Causes for leaving school
Parents act against their will 20.0 - 13.3 13.3
Bad company 30.0 - 20.0 20.0
Fail in examination 10.0 20.0 26.7 20.0
Unable to pay fee 20.0 80.0 60.0 50.0
Due to conflict 10.0 - - 3.3
For service 10.0 - - 3.3
No guide - 20.0 - 3.3
Percentage total may exceed due to multiple responses
On an average, 26.7 percent of these members were dropped out from school when they were
13 years’ old. Similarly, about 6.7 percent and 13.3 percent were dropped out when they were
12, and 10 -16 years old respectively. Some were dropped out when they were only 6 years
old. The highest dropout rates were found to be at primary level (63.3 %), followed by
(26.7%) and (23.3%) at lower secondary, and secondary level respectively.
43
About 50 % dropouts were due to unable to pay fees, while, 20 percent failed the exam and
the other 20% dropped out due to the influence of a bad company. The other reasons reported
are due to conflicting situation, due to work, lack of good guidance, and when parents acted
against their will.
As per the Nepal Living Standards Surveys Description 2003/04, 32 percent of school
dropouts were due to “poor academic progress” while 27 percent reported to “help at home”
These two were the primary reasons for leaving school. Only 12 percent indicated “too
expensive” to be the factor. Adult literacy rate for male is 64.5 % as compared to female at
33.8% indicating the high rates of dropouts among female children at national level as well.
Table 6.3: Ready to Spend Money for the Schooling
Amount of money ready to spend per Kapan Shankhamul Tripureshwor Total

month for the school
No children for schooling 17.7 9.5 20.0 16.0
Below 100 Rupees 5.7 2.4 4.0 4.3
120 to 500 34.0 35.7 44.0 37.0
525 to 1000 20.6 15.5 14.7 17.7
1100 to 1500 9.9 13.1 8.0 10.3
1600 to 2000 4.3 14.3 1.3 6.3
2000 and above 5.7 9.5 4.0 6.3
Free 2.1 - 4.0 2.0
Total 100.0 100.0 100.0 100.0
Table 6.4: Actual Money Spent For Level of Education for the Children

Money spent on primary level of education
Less than one hundred 3.4 5.8 4.0 4.2
120 to 500 47.7 46.2 52.0 48.4
525 to 1000 26.1 19.2 24.0 23.7
1100 to 2000 15.9 17.3 10.0 14.7
2100 and above 4.5 9.6 2.0 5.3
Free 2.3 1.9 8.0 3.7
Total 100.0 100.0 100.0 100.0
Money spent on secondary level of
education
Less than one hundred 6.7 5.1 15.0 7.7
120 to 500 31.1 23.1 35.0 28.8
525 to 1000 31.1 35.9 10.0 28.8
1100 to 2000 20.0 25.6 20.0 22.1
2100 and above 8.9 2.6 5.0 5.8
Free 2.2 7.7 15.0 6.7
Total 100.0 100.0 100.0 100.0
44
As shown in the table 6.3 above, the survey indicated that most of the parents (37%) in all
areas were ready to pay the minimum average of 120-500 rupees per month for the schooling
of their child. Such representation is the highest (44%) in Tripureshwor as compared to other
two. Only around 6.3 percent of the parents were ready to pay Rs. 1600 and above reveals the
minimum threshold of the population to reach this income level. Around 18 and 10 percent of
the parents were ready to pay the medium average ranging from 525-1000 Rs. and 1100–1500
Rs. per month respectively.
As indicated in table 6.4, it was found that around 48.4 % of parents in all areas are actually
spending Rs.120-500 for the primary level education for their children. Tripureshwor has the
highest number of parents spending this minimum range of amount for primary education.
Only around 14.7 % of the parents have spent more than thousand for the primary education.
However such variations in expenses also represent the variation in the number of children
attending the primary schools.
Regarding the secondary education, it was found that 6.7 percent of the parent's got free
education for their children. Around 28.8 percent of parents were found to be spending the
minimum range of Rs. 120–500 and the medium range of Rs. 525-1000 for their children at
secondary level. Around 22% of the parents have spent the high average amount ranging from
Rs.1100-2000 for the same purpose. The amount of money spent in secondary education
depends on the status of schools as well as the number of children attending the secondary
education. For instance, the private boarding schools are relatively expensive than the public
schools. In survey areas about 90 % children are attending the public schools and only 10 %
are in private schools.
Average Amount of Fee Required For the School Education in Public / Private
Average amount of Public School Private School Remarks

money required for Rs Rs
school education
Primary Level In public school there is a policy of
550 / Annum 450 / Month primary education is free but fee has
taken for admission and exam fees but
school management can make local
policies.
Lower secondary Level 700/ Annum 600 / months Fees for private school is vary and the
fee mentioned in this table is lowest
range for average private school,
highest range start from Rs 1000 to
4000 even for primary school.
Secondary Level 1100/ Annum 1000/ months
Government Policies:
The government has a good policy for improving the quality of education however; lack the
implementation mechanism for the same. There are number of scholarship policies for poorest
of the poor children to motivate them to go to school. Similarly, the government provides
number of facilities to access and for quality education. However, these facilities are more
focused in country side. Some of the educational strategies for the poor are listed below;
45
¾ Dalit scholarship @ 250 Rs per year for all dalit children
¾ Girls scholarship @ 250 Rs per year for 50 % of girls in school
¾ Booster scholarship @ 500 Rs per year for those who had never been to school and
are now in schools.
¾ At least one female teacher in every primary school
Secondary Education Support program:
¾ Dalit scholarship @ Rs 500 per student per year for 6 to 10 grade dalit students in
school,
¾ Full scholarship for 6 to 10 grade poor students @ Rs1700 per student per year
¾ Free ship scholarship @ Rs 700 per school for 6 to 10 grade students
¾ Girls hostel in 20 districts for 6 to 10 grade students
Like wise to address quality issues of education; the government has School Improvement
Plan (SIP) in all 75 districts under EFA. SIP focuses on the following areas:
¾ How to increase student achievement

¾ Discuss with stakeholders and identify the needs of school for better learning
¾ Classroom teaching / learning activities
¾ SIP appraisal committee to monitor school activities and support
¾ Teacher training which is need based and refresher training
¾ Block Grant Funding
¾ School Incentive Program
¾ Curriculum development
Table 6.5 Children for below 5yrs Attending Nursery School

One of the children attends nursery school
Yes 0.7 0.3
No 99.3 100.0 100.0 99.7
Total 100.0 100.0 100.0 100.0
If no, reasons for not attending
Over age 28.5 34.5 25.3 29.4
Don’t know 16.8 13.1 14.7 15.2
Go to school 16.8 10.7 13.3 14.2
Not available of nursery school 13.1 20.2 12.0 15.9
Self care 8.0 11.9 13.3 10.5
No money 10.9 7.1 10.7 9.8
No time 2.2 1.2 2.7 2.0
No child 2.2 1.2 2.7 2.0
Only small children 1.5 - 5.3 2.0
Total 100.0 100.0 100.0 100.0
Interested to send the child to nursery school
Yes 58.1 27.6 32.4 44.0
No 41.9 72.4 67.6 56.0
Total 100.0 100.0 100.0 100.0
An overwhelmingly 99.7 percent of the respondents pointed out that their children do not go
to nursery schools. Most of these children did not attend nursery school due to exceeding the
46
age bar. Some of the respondents felt that such schools are not available in their area, whereas
some expressed that they did not have enough time for preparing their children to go to
nursery school. Some of the families did not send their children to nursery school due to lack
of money, and lack of awareness about early child hood care and development. It was also
found that only 44 percent of the families expressed their desire to send their children to
nursery school due to lack of awareness and not availability of ECD in their places.
As per the DOE report published in 2004, most of the private schools are offering ECD/ pre
primary schools whereas all the public schools do not have ECD/PPC classes. The Gross
Enrolment Rate of ECD/ PPC is 39.4 % in National level.
Table 6.6 Participation of Children in Clubs
The children belong to a club

Yes 11.6 11.9 12.0 11.8
No 88.4 88.1 88.0 88.2
Total 100.0 100.0 100.0 100.0
If yes name of the club
Youth Club 56.3 10.0 - 28.6

Asha Child club - 10.0 77.8 22.9
Tripahil Child Club - 50.0 - 14.3
Pathivara Youth club 25.0 - - 11.4
Adolescent Group - 10.0 11.1 5.7
Prayas Nepal 6.3 - - 2.9
Sirjana Youth Club 6.3 - - 2.9
Church 6.3 - 2.9
Shilpakala Samuha - 10.0 - 2.9
Upakar Group - - 11.1 2.9
Don’t know - 10.0 - 2.9
Total 100.0 100.0 100.0 100.0
Only 11.8 percent of the children from these families belonged to a club indicating a lesser
child participation in the community clubs. Most of these children are involved in youth club
and asha child club. The other clubs existing in these areas are triphali child club, pathivara
youth club, adolescent group, prayas Nepal, srijana youth club, church, and shilpakala samuha
and upakaar group.
47
7. Economic Status
Table 7.1: Types of Work Done By the Family Members during Life Time
Types of job already done in their life Kapan Shankhamul Tripureshwor Total
Labor 63.1 70.2 60.0 64.3
Agriculture 50.4 33.3 44.0 44.0
Business 24.8 21.4 29.3 25.0
House hold work 20.6 29.8 25.3 24.3
Government Job 9.9 11.9 5.3 9.3
Private company staffs 5.7 11.9 8.0 8.0
Driver 5.0 2.4 2.7 3.7
Work in foreign country 4.3 3.6 - 3.0
Carpenter 5.0 - 1.3 2.7
Player 2.1 1.2 - 1.3
Others work 1.4 1.2 1.3 1.3
Security 2.1 - - 1.0
Social work 0.7 1.2 1.3 1.0
Baidhya - - 1.3 0.3
Total 100.0 100.0 100.0 100.0
Percentage total may exceed due to multiple responses
Majority of the respondents (64.3 percent) had worked as a labor, whereas 44 percent had
worked in agricultural sector. The labour work mainly involved collecting bricks, sand,
cement, working in a carpet factory, working as porter, housing construction, working as
housemaid, carpenter and peeling soil/ sand.
Those involved in agriculture sector mostly do planting, harvesting and carrying production of
field although they worked in others’ land, as they do not have their own land. But some
families own the livestock and works for livestock raising, collect firewood and sell in
market.
Some of them had worked in various other sectors like household work, business,
government, private company, as a driver, in a foreign country, as carpenter, as a player, and
in security and social work. 0.3 percent had also worked as baidhya (homeopathic doctor).
During the survey, the adolescents were asked about their job preferences. 21.1 percent of
them prefer to do government job. 18.8 percent of the adolescents want to establish their own
business. Besides these two major choices, the adolescents also pointed out that they would
like to go for foreign employment, tailoring, Nurse, Driver, Teacher, Labor, Painting and for
private company.
The families were also asked about the type of job they would prefer the adolescents to take
it. It was found that 24.8 percent wanted them to take a job that is good and honorable,
whereas 24.1 percent of them wanted their adolescent members to join government services.
48
Some of them also expressed their desire for them to do business, to be Nurse,
Doctor/engineer, Tailoring, Foreign, Driver, Labor, Agriculture and Private Company staffs.
Table 7.2 Activities Done During Spare Time
Activities done during the spare time Kapan Shankhamul Tripureshwor Total
Watch TV/Read News paper 35.5 45.2 36.0 36.3
Do house hold work 51.8 22.6 22.7 20.3
Nothing 8.5 29.8 32.0 17.3
Talk/Visit 19.9 15.5 14.7 15.3
Do rest 10.6 22.6 16.0 9.3
Look after children 12.8 9.5 2.7 4.7
Business 7.1 3.6 1.3 1.7
Play 3.5 - - 1.7
Go for skill training 2.8 1.2 - 1.3
Others* 4.2 - 1.3 2.2
Total 100 100 100 100
*Make wine, search for work, Do social work, visit church. Percentage total may exceed 100 due to multiple
responses
Watching TV, reading newspaper, doing household work, talking and visiting neighbors,
resting, looking after children, playing, going for skill training, making wine etc are some of
the ways in which the respondents spend their leisure. However, majority of them prefer to
watch TV or read newspaper.
Table 7.3: Average Amount of Money Spent Daily Expenses for Food
Average Amount of money Kapan Shankhamul Tripureshwor Total

spent daily to buy food
Below 100 Rs 51.8 59.5 49.3 53.3
120 to 200 Rs 41.1 35.7 48.0 41.3
25 Rs and above 7.1 4.8 2.7 5.3
Total 100.0 100.0 100.0 100.0
Food is a daily necessity for survival. 53.3 percent of the respondents spend less than Rs. 100
per day for food, whereas 41.3 percent spend between Rs. 120–200 for the same purpose.
There were also families who spend Rs. 25 and above for their daily food expenses. The
spending on food is directly related to the income source of the family. Hence, people who
work as labor on daily basis usually spend less on food.
49
Table 7.4: Means of Transportation Used
Means of transportation Kapan Shankhamul Tripureshwor Total

Public transportation 100.0 96.4 93.3 97.3
Bicycle 7.1 31.0 12.0 15.0
Walking 7.8 20.2 10.7 12.0
Motorbike 2.1 7.1 5.3 4.3
Regarding the means of transportation, it was found that 97.3 percent of the respondents used
the public transport with 100 percent of the respondents from Kapan. Kapan is relatively
farther than other places and they used mostly the public bus. Usually, two ways travel by bus
cost 20 to 25 Rs. per day to travel within municipality in one route. There were few
respondents who owned bicycle and motorbike (15 percent and 4.3 percent) whereas the
remaining 12 percent traveled on foot.
Table 7.5: Money Taken (Borrowed) By the Families

Borrowed money (from friends/
relatives)
Yes 49.3 42.9 36.0 44.1
No 50.7 57.1 64.0 55.9
Total 100.0 100.0 100.0 100.0
Purpose for which money was
borrowed
Business 37.7 66.7 37.0 45.5
For the treatment of diseases 31.9 38.9 37.0 34.8
Maintenance 14.5 33.3 59.3 28.8
For food 34.8 16.7 29.6 28.8
School fees 20.3 5.6 22.2 16.7
To go foreign country 37.7 16.7 - 24.2
Others (Wedding, House hold, Make house, 23.2 22.2 14.8 21.2
for animal husbandry, to buy motor, to
purchase land)
Total 100.0 100.0 100.0 100.0
Amount of money borrowed
1000 to 10,000 43.5 36.1 33.3 39.4
11000 to 25000 23.2 19.4 22.2 22.0
26000 to 50000 17.4 27.8 37.0 24.2
51000 and more 15.9 16.7 7.4 14.4
Total 100.0 100.0 100.0 100.0
As indicated in the table, around 44.1 percent of the respondents had borrowed money from
friends and relatives. The reasons for borrowing were predominantly for business followed by
the medical treatment and maintenance. Such borrowings were highest among the families in
50
Shankhamul (66.7%) indicating the large number of business-oriented people in this area.
Similarly, the highest percentage of families in Tripureshwor borrowed money for the purpose
of maintenance indicating their high spending on machineries and appliances. Some also
borrowed money for food and for going to a foreign country. The borrowed money ranged
from maximum Rs 51,000 and more to a minimum of Rs.1000.
As per the NLSS report, the proportion of households borrowing some kind of loan has
increased from 61 percent in 1995/96 to 69 percent in 2003/04. The percentage of borrowing
from banks has decreased from 16 to 15 %, and that from moneylenders has decreased from
40 to 26 %. Interestingly, the borrowings from relatives increased from 41 to 55 %.
Table 7.6 Percentage Distribution of Period for Food Shortage
Period of food shortage Kapan Shankhamul Tripureshwor Total

During winter season 65.2 61.9 64.0 64.0
No scarcity 10.6 14.3 10.7 11.7
Don’t know 11.3 3.6 2.7 7.0
Every time 2.1 6.0 14.7 6.3
Nepal Bandha/no work available 2.8 9.5 5.3 5.3
Festival 5.0 4.8 - 3.7
During summer season 2.8 - 2.7 2.0
Total 100.0 100.0 100.0 100.0
Majority of the respondents (64%) expressed that they have a shortage of food during the
winter season for 2 to 3 months. Some also pointed out that there will be food shortages
during strike (Nepal bandhs) and during summer season when they are out of work. On the
other hand, 6.3 percent of the respondents expressed that they face shortage of food everyday,
whereas 11.7 percent of them do not have to face such kind of problems.
Table 7.7 Methods Used for Overcoming Economic Crisis
Methods used to overcome economic Kapan Shankhamul Tripureshwor Total

crisis
Borrow money (from friends / 47.5 51.2 64.0 52.7
relatives without interest)
Loan (from group, cooperatives with 34.8 40.5 17.3 32.0
interest 2%)
Control expenditure 7.1 3.6 - 4.3
Stay hunger 2.1 1.2 12.0 4.3
Begging 5.0 1.2 1.3 3.0
Chanda collection (donations) 2.1 - - 1.0
No economic crisis 0.7 1.2 1.3 1.0
Work as a labor 0.7 - 1.3 0.7
Do stock - - 2.7 0.7
Don’t know - 1.2 - 0.3
Total 100.0 100.0 100.0 100.0
51
During the times of economic crisis, majority of the families take loan to solve the financial
problem whereas some families live hunger without taking food, or decrease food amount,
sometimes beg or ask for donations as well. Only 1 percent of the families said that they never
had economic crisis. Some of them also keep things in stock, which they use during the times
of crisis.
8. Problems Faced By the Families
Table 8.1: Percentage Distributions of Main Problems felt in The Villages
Main problems felt in the village Kapan Shankhamul Tripureshwor Total

Employment 76.6 89.3 80.0 81.0
Housing 47.5 78.6 86.7 66.0
Hygiene 48.2 25.0 58.7 44.3
Education 38.3 36.9 62.7 44.0
Health 44.7 32.1 37.3 39.3
Drinking water 55.3 27.4 18.7 38.3
Incomes 37.6 39.3 32.0 36.7
Family harmony 17.0 15.5 17.3 16.7
Caste Discrimination 9.2 7.1 14.7 10.0
Drug / alcohol addict 7.8 2.4 - 4.3
Flood - 7.1 8.0 4.0
Violence 6.4 1.2 3.3
Toilet/Drainage 3.5 - 4.0 2.7
Force to move from this place 0.7 8.3 - 2.7
Malnutrition 1.4 6.0 - 2.3
Access to services 3.5 - - 1.7
Family planning 2.1 1.2 - 1.3
Transportation 2.8 - - 1.3
Road 2.8 - - 1.3
Robber 0.7 - - 0.3
Don’t know - 3.6 - 1.0
The respondents expressed that lack of employment is one of the major problems existing in
their villages. On the one hand, their literacy rate was very low, while the majority of them
did not have citizenship card, which make them further difficult to access any employment
opportunities. This is the reason majority of people work as a labor and involved in
agriculture. However, there are opportunities for business and better labor work through
vocational training for youth.
Apart from employment, the families living in these areas do not have proper housing. They
expressed that lack of proper drinking water is causing a lot of health problems. Similarly, the
families do not have proper access to health and education facilities. On the one hand, they do
not have a trust on the government services and on the other, they can not afford for education
in private schools and private health facilities. Discrimination on the basis of caste, addiction
to drugs and alcohol, flooding during rainy season are some of the problems faced by the
52
families living in these areas. Forceful migration from one place to other is also seen as the
problem prevailing in these villages.
Table 8.2 Percentage Distributions of Solutions to the Problems Faced
Solution for the problems felt Kapan Shankhamul Tripureshwor Total

Government should manage for 38.3 9.5 4.0 21.7
drinking water
Proper housing 7.8 16.7 32.0 16.3
Manage legal documents for land 7.1 32.1 12.0 15.3
Provide employment 5.0 11.9 8.0 7.7
Make clean and healthy 4.3 2.4 10.7 5.3
environment by joint efforts
Free education/free 4.3 2.4 9.3 5.0
treatment/open medical
To be employed by HMG 3.5 6.0 5.3 4.7
Establish factory 3.5 2.4 2.7 3.0
Stop alcohol 2.8 1.2 - 1.7
Throw dirty things in 2.1 1.3 1.3
municipality vehicle
To be manage by organization 2.8 - - 1.3
Decrease fee 2.1 1.2 - 1.3
Being united and no caste 2.1 - 1.3 1.3
discrimination
To be made privatization 2.8 - 1.3
Making toilet and dhal near .7 - 4.0 1.3
houses
Dam in the river - 3.6 1.3 1.3
Better to provide drinking water 2.1 - - 1.0
Activate to mother group/women 1.4 1.2 - 1.0
education
Stop quarrel/understand each 0.7 - 2.7 1.0
other
Search for income sources - - 2.7 0.7
To be manage by VDC 0.7 - 1.3 0.7
Hard work 1.4 - - 0.7
Focus program on target group - 2.4 - 0.7
Being public tab 0.7 - -- 0.3
Demand in ward being united 0.7 - - 0.3
Country should be develop - 1.2 - 0.3
Provide security benefit - 1.2 - 0.3
Don’t know 2.8 4.8 1.3 3.0
Total 100.0 100.0 100.0 100.0
The families’ opinions were sought on the solutions of problems they felt in the villages.
They expressed that the government should be responsible for the supply of proper drinking
water. Provisions for proper housing should be made along with the legal documents of the
53
land. They also expressed that possible areas of employment should be opened by HMG to
end the problem of unemployment faced by majority of the families. Provisions for free
education and free medical checkups will help to overcome the low education and poor health
status. They also feel that efforts to end discrimination should come as a joint effort from the
local level itself. They also pointed out the need of build enough toilets and proper drainage
system in the areas, since they tend to be affected by flood during the rainy seasons. Some of
the families have also put forth the idea that these villages should be assigned to private
organizations for development and resolving the problems.
Table 8.3 Ranking for the Problem of Drinking Water
Problem of drinking water Kapan Shankhamul Tripureshwor Total

First Priority 85.9 42.1 66.7 76.0
Second Priority 11.3 36.8 16.7 16.7
Third Priority 1.4 10.5 - 3.1
Fourth Priority 1.4 10.5 16.7 4.2
Total 100.0 100.0 100.0 100.0
Solution for the problem of
drinking water
Government should manage for 85.9 84.2 100.0 86.5
drinking water
To be manage by organization 5.6 5.3 - 5.2
Better to provide drinking 2.8 - 2.1
water
Being public tap 1.4 5.3 - 2.1
To be manage by VDC 1.4 5.3 - 2.1
Make clean and healthy 1.4 - - 1.0
environment by joint efforts
Demand in ward being united 1.4 - - 1.0
Total 100.0 100.0 100.0 100.0
Water is necessary for our survival and lack of proper drinking water can cause adverse effect
in people’s health. Accordingly, majority of families in all areas have given the first priority
to the problem of drinking water. Among them, Kapan has a highest percent (85.9%) of the
families to rate water as their first priority.
While asking about the possible solutions to this problem, a majority of (86.5%) of the
families expressed that the government should manage the problem of drinking water. Few
other families mentioned that it should be managed by private organizations, and VDC, by
building a public tap. Some also feel that there should be a joint effort from each corner to
solve this problem.
54
Table 8.4 Ranking Problem of Housing
Problem of Housing Kapan Shankhamul Tripureshwor Total

First Priority 42.6 57.9 61.5 53.5
Third Priority 16.4 17.5 17.3 17.1
Total 100.0 100.0 100.0 100.0
Solution for the problem of housing
Proper housing 47.4 36.4 66.7 50.4
Manage legal documents for land 42.1 63.6 33.3 46.5
To be made privatization 7.9 - - 2.4
Don’t know 2.6 - - 0.8
Total 100.0 100.0 100.0 100.0
The table 8.4 shows that 53.5 percent of the families have given first priority to the problem
of housing with a majority of 61.5 percent families from Tripureshwor. 20.6 percent of the
families have rated this problem as secondary.
Regarding the solution to the problem of housing, most of the families feel that there should
be proper housing as well as proper management and provision of legal documents for land.
Some have also suggested that private companies should be allowed to solve this problem.
Table 8.5: Ranking for the Problem of Employment
Employment Kapan Shankhamul Tripureshwor Total

First Priority 18.4 30.2 27.9 24.4
Third Priority 26.4 14.3 18.6 20.7
Total 100.0 100.0 100.0 100.0
N 87 63 43 193
Unemployment is a big problem in the present context of the country. Regarding this
problem, only 24.4 percent of the respondents from the three villages have given this problem
as a first priority. Most of the respondents from Shankhamul have given the problem of
unemployment as a first priority (30.2 percent). The highest percent of the respondents in all
areas has rated unemployment as a second priority.
Table 8.6: Ranking for the Problem Health And Hygiene
Health and hygiene Kapan Shankhamul Tripureshwor Total

First Priority 13.7 40.0 31.0 22.2
Third Priority 29.4 30.0 13.8 24.4
Fourth Priority 21.6 13.8 16.7
Total 100.0 100.0 100.0 100.0
55
Majorities of respondents (36.7%) find health and hygiene only as a secondary problem since
they were not much aware of family health and hygiene that has a great influence on every
aspect of economic and social development. Only 22.2 percent of the total respondents have
ranked this problem as the first priority.
The table below indicates that that violence and discrimination among girls and women are
pervasive in all the three villages. Beating by the husbands and alcohol abuse by using vulgar
words and scolding has been expressed as the major problems by 72 and 69.7% respondents
respectively. Early marriage is also prevalent in these villages along with multiple marriages.
Rejected wife, rape, sexual abuse, discrimination between son and daughter, divorce,
unwanted pregnancy, unemployment, husband play card, trafficking are some of the other
problems that the girls and women are facing as pointed out by the respondents. Only 2.3% of
the respondents expressed their unawareness about such problems.
Table 8.7: Problems Faced By Women and Girls In The Village
Main problems of girls and Kapan Shankhamul Tripureshwor Total

women
Beating by husband 72.3 69.0 74.7 72.0
Alcohol/badly scolding/using 61.0 76.2 78.7 69.7
vulgar sexy words
Early marriage 57.4 32.1 62.7 51.7
Multiple marriage 50.4 32.1 42.7 43.3
Rejected wife 29.8 20.2 25.3 26.0
Rape 30.5 13.1 26.7 24.7
Sexual abuse 18.4 17.9 29.3 21.0
Discrimination of son/daughter 11.3 13.1 14.7 12.7
Divorce 9.9 7.1 10.7 9.3
Unwanted pregnancy 12.8 1.2 2.7 7.0
Do not know 0.7 13.1 5.3 5.3
Others* 2.1 3.6 1.3 2.3
Don’t know 4.3 1.2 - 2.3
*Unemployment, husband Play card, trafficking and blame to women and girls (Percentage total may exceed
100 due to multiple responses)
56
Table 8.8 Solutions to the Problems Faced By Women And Girls In The Village
Solution Kapan Shankhamul Tripureshwor Total

Avoid bad company/ to educate 25.5 22.6 26.7 25.0
Control to drug achievement 7.1 25.0 21.3 15.7
Prosecution 9.9 4.8 10.7 8.7
Marriage at proper age 10.6 2.4 5.3 7.0
Stop/control alcoholism 5.7 6.0 4.0 5.3
Activate mother group 4.3 2.4 4.0 3.7
Need to education, health and 5.0 2.4 3.0
cleanness
Understand own self/ respect to others 5.0 1.2 1.3 3.0
Make strong law 3.5 2.4 1.3 2.7
Threatened to violet husband from 0.7 2.4 5.3 2.3
organization
Control own children by parents 2.1 1.2 2.7 2.0
Call police 1.4 3.6 - 1.7
Equal behavior/no discrimination 1.4 2.4 1.3 1.7
between son and daughter
Provide sexual education 1.4 1.2 1.3 1.3
United to women for legal aspect 2.1 - - 1.0
Improve his habits 0.7 1.2 1.3 1.0
Being united 0.7 1.2 1.3 1.0
Aware family about sexual abuse 1.4 - 1.3 1.0
Suggesting them by women group 2.1 - - 1.0
Marriage after employed - - 2.7 0.7
Provide training for daughter 1.4 - - 0.7
Manage for settlement - - 1.3 0.3
Act as children’s will - - 1.3 0.3
Don’t know 7.8 17.9 5.3 10.0
Total 100.0 100.0 100.0 100.0
Most of the respondents find that avoiding bad company and educating the girls and women
will help to resolve the problems they face. Control in drug and alcohol availability will also
help to lessen the domestic violence. Some of the respondents also expressed that activating
the mother’s group will largely help to overcome the problems related to women and girls.
Some of them opted for making the standard laws so as to take effective action against
violence and to penalize the culprits. Creating awareness about health issues, effects of early
marriages, sex education, importance of equal treatment to son and daughter as well as
between the members of the villages were some of the solutions given by the respondents to
solve the problems faced by the women and girls.
57
Table 8.9: Prioritizing the Problems of Women and Girls in the Village
Priority 1st 2nd 3rd 4th

Problems None Total
Priority Priority Priority Priority
Early marriage 24.7 9.0 4.7 2.7 59.0 100.0
Rape 6.7 7.3 2.3 2.0 81.7 100.0
Beating by husband 11.7 31.0 10.3 4.0 43.0 100.0
Multiple marriage 4.0 9.3 6.7 7.0 73.0 100.0
Divorce - 1.3 1.3 2.3 95.0 100.0
Unwanted pregnancy 1.3 0.3 1.3 1.3 95.7 100.0
Sexual abuse 1.7 3.0 3.7 2.7 89.0 100.0
Alcoholism/badly 37.7 19.3 4.7 1.3 37.0 100.0
scolding/using vulgar words
Rejected wife 3.0 4.7 4.7 3.7 84.0 100.0
Discrimination of 1.7 2.3 0.7 2.3 93.0 100.0
son/daughter
Never marriage - 0.3 - - 99.7 100.0
When prioritizing the problems for women and girls, the problems of alcoholism, badly
scolding and using vulgar words got the highest priority (37.7%) followed by the early
marriage (24.7%). Whereas, beating by husband was given second priority by the large
percentage of respondents (31%). It was surprising to know that very sensitive and gross
violation of rights like rape, multiple marriage, divorce, unwanted pregnancy, sexual abuse,
rejected wife and discrimination of son and daughter were given no priority by most of the
respondents. It may be because they take these problems as granted.
Table 8. 10 Solutions For The Problem Of Early Marriage
Solutions for the problems of Kapan Shankhamul Tripureshwor Total

early marriage
Avoid bad company 41.9 40.0 45.5 42.7
Marriage at proper age 34.9 20.0 18.2 28.0
Need to education 7.0 20.0 6.7
Control over children by parents 4.7 10.0 9.1 6.7
Activate mother group 7.0 - 4.5 5.3
Marriage after employed - - 9.1 2.7
Provide sexual education 10.0 4.5 2.7
Prosecution - - 4.5 1.3
Equal behavior/no discrimination 2.3 - - 1.3
between son and daughter
Provide training for daughter 2.3 - 1.3
Act as children will - - 4.5 1.3
Total 100.0 100.0 100.0 100.0
Early marriage has been a prioritized problem mentioned by all the respondents. Hence,
regarding the possible solutions to solve this problem, majority (42.7%) of the respondents
said that avoiding bad company would prevent this problem. A large segment of respondents
58
in Kapan mentioned that marrying at the right age is the solution, whereas need of education
was mentioned by a considerable number of respondents in Shankhamul. Some of the
respondents feel that the parents should control the children in order to prevent early
marriages. Activating the mothers groups, getting married only after being employed, sex
education, prosecuting the children who marry early, no discrimination between the son and
daughter, providing good trainings to daughter and acting according to children’s will are
some of the solutions pointed out by the respondents.
Table 8.11 Solutions for the Problem of Alcoholism
Solution of the problem of Kapan Shankhamul Tripureshwor Total
alcoholism
Control to drug achievement 25.0 50.0 48.4 41.3
Stop/control alcohol 16.7 9.5 9.7 11.9
Prosecution 8.3 4.8 9.7 7.3
Make strong law 8.3 - - 2.8
Understand own self 8.3 - - 2.8
Call police 2.8 2.4 - 1.8
Need to education 5.6 - - 1.8
Improve his habits - 2.4 3.2 1.8
Don’t know - 4.8 - 1.8
Total 100.0 100.0 100.0 100.0
The respondents have mentioned the alcoholism as one of the major problems in the survey
areas. Regarding the solutions for this problem, majorities (41.3%) have said that availability
of alcohol should be stopped. Some of them said that avoiding bad company will also help in
solving this problem. The respondents feel that persecuting the people taking alcohol, making
strong laws, understanding own-self, calling the police when required, activating the mother’s
groups, educating and improving habits are ways of solving the problem of alcoholism.
Table 8.12 Problems Faced By the Adolescents
Main problems of adolescent Kapan Shankhamul Tripureshwor Total

Not care what parent said 65.2 60.7 70.7 65.3
Drug addict 62.4 53.6 64.0 60.3
Do more expenses 33.3 31.0 26.7 31.0
Left home 25.5 16.7 20.0 21.7
No problems 12.8 13.1 12.0 12.7
Left school 3.5 7.1 9.3 6.0
Unemployment 4.3 8.3 - 4.3
Bad company/visit anywhere 2.8 1.2 2.7 2.3
Others* 4.3 3.6 - 3.3
Don’t know 6.4 8.3 4.0 6.3
*Quarrel, inter caste marriage, Play card, early marriage, no knowledge, Percentage total may exceed 100
due to multiple responses
59
Adolescence is a very crucial period in the life of every person. This is the time when the
children have chances of following the wrong path of life. The families in these villages also
expressed the various types of problems existed among the youth. The major problem pointed
out by 65.3 percent of the respondents was the adolescents not caring about the parents
guidance. Similarly, 60.3 percent of the respondents find drug addiction to be the existing
problems among the adolescents. Other problems pointed out by the respondents were
spending more, leaving home, dropping out of school, unemployment, bad company,
quarreling, inter caste marriage and early marriage. Surprisingly, 12.7 percent of the
respondents felt that there is no problem among the adolescents and few were unaware of
such problems.
A study of teenagers in Nepal by UNAIDS, UNICEF in 2001 found that more than one in ten
teenagers ( 13.1 % ) admitted to taking drugs. Of those, more than half of them took drugs by
smoking ( 56 % ), a quarter by inhaling ( 26 % ) and 5.4 % by injecting. In Kathmandu there
were 5.6 % of injected drug uses.
60
Table 8.13 Possible Solutions for the Problems Faced By Adolescents
Solution Kapan Shankhamul Tripureshwor Total

Band drug factory 4.3 13.1 12.0 8.7
Control from childhood 7.1 8.3 6.7 7.3
Call police/ give punishment 6.4 10.7 1.3 6.3
Avoid drug 7.1 1.2 4.0 4.7
Be aware of money 5.7 1.2 6.7 4.7
Prosecution 5.0 1.2 6.7 4.3
Provide appropriate education 3.5 3.6 5.3 4.0
Search for employment 4.3 3.6 1.3 3.3
Self learning/educate 4.3 2.4 1.3 3.0
Control oneself 0.7 2.4 1.3 1.3
Educate 0.7 1.2 2.7 1.3
Control and threatened - 1.2 1.3 0.7
Security check post 0.7 - - 0.3
Create healthy environment of the - - 1.3 0.3
house
Don’t know 22.7 22.6 17.3 21.3
Total 100.0 100.0 100.0 100.0
It was found that avoiding bad company has been given as the best solution to solve the
problems faced by the adolescents by 26.7 percent of the respondents. Avoiding and banning
of drugs, keeping strict control over them since childhood, giving punishments are the other
solutions proposed by the respondents. They have also suggested a need for proper education
and awareness on various issues as a problem solver along with a healthy home environment.
Table 8.14: Percentage of Drug Abusers Present In the Village

Drug abusers are present in the village
Yes 43.3 39.3 46.7 43.0
No 56.7 60.7 53.3 57.0
Total 100.0 100.0 100.0 100.0
If yes, number of abusers present
1-5 18.0 24.2 20.0 20.2
6-10 9.8 27.3 17.1 16.3
11-15 29.5 9.1 20.0 21.7
16 and above 42.6 39.4 42.9 41.9
Total 100.0 100.0 100.0 100.0
There were 43 percent drug abusers in the villages with a higher percentage in Kapan, and
Tripureshwor respectively. The maximum number of drug abusers was present among the age
group of 16 and above.
61
Table 8.15: Solutions for the Problem of Drug Abuse
Solution for the problem of drug Kapan Shankhamu Tripureshwor Total

abuse l
Band bad company 26.3 17.9 29.3 25.0
Band drug factory 7.9 28.2 22.0 16.7
Call police/ punishment 10.5 20.5 2.4 10.9
Control from childhood 10.5 10.3 9.8 10.3
Avoid drug 13.2 2.6 7.3 9.0
Prosecution 9.2 2.6 12.2 8.3
Provide appropriate education 6.6 2.6 4.9 5.1
Self learning/educate 5.1 5.1 2.1 4.3
Activate mother group 5.3 2.4 3.2
Control oneself 1.3 5.1 2.4 2.6
Search for employment - - 2.4 0.6
Control and threatened - 2.6 - 0.6
Security check post 1.3 - - 0.6
Be aware of money 1.3 - - 0.6
Create healthy environment of the - - 2.4 0.6
house
Don’t know 1.3 2.6 - 1.3
Total 100.0 100.0 100.0 100.0
Using drugs is a national problem at present especially among youngsters. The respondents
from the three villages have given some solutions to help control this problem. For instance,
banning bad company and banning the drug factory has been pointed out as the major method
to solve these problems. Involving the police for punishing the drug users, control over
children from childhood, provision of appropriate education, and activation of mother’s
groups. searching for employment, awareness regarding the use of money and creating a
healthy environment in the house are some of the solutions put forth by the respondents.
Table 8.16 Solutions for the Problem Of Not Care What Parents Said
Solutions Kapan Shankhamul Tripureshwor Total

Band bad company 42.9 75.0 75.0 61.2
Be aware of money 19.0 - - 8.2
Self learning/educate 14.3 - - 6.1
Control from childhood 9.5 6.3 - 6.1
Provide appropriate education - 6.3 16.7 6.1
Call police/ punishment 4.8 6.3 - 4.1
Control and threatened - - 8.3 2.0
Educate - 6.3 - 2.0
Don’t know 9.5 - - 4.1
Total 100.0 100.0 100.0 100.0
As indicated on the table, it was found that, 61.2 percent of respondents feel that banding bad
company is the major way to solve the problems of youngsters not listening to their parents.
Others feel that becoming aware about money, self learning, education, control over children
62
from childhood, providing appropriate education, punishing are all solutions to solve the
problems of not caring what parents say.
9. Support Received By the Families

Table 9.1 Services Received From Government/ Municipality/ VDC, Ward

The services of the local VDC,
authorities municipality/ward
Yes 29.8 33.3 9.3 25.7
No 70.2 66.7 90.7 74.3
Total 100.0 100.0 100.0 100.0
If yes support is given by
Ward 26.3 50.0 62.5 42.6
VDC 63.2 - - 21.0
Municipality 25.0 37.5 19.0
Local authority 5.3 10.0 9.0
Mother group 5.3 10.0 8.4
Total 100.0 100.0 100.0 100.0
If yes type of services received
Electricity 42.9 32.1 28.6 14.9
Recommend for citizenship card 47.4 10.0 25.0 27.7
Drinking water - 57.1 14.3 22.1
Health services 31.0 7.1 14.3 20.8
School 21.4 3.6 14.3 14.3
Waste 14.3 - 14.3 9.1
Road 4.8 10.7 - 6.5
Identity card 2.4 3.6 14.3 3.9
Public toilet 4.8 3.6 - 3.9
Settlement 4.8 - - 2.6
Eliminate alcoholism 5.3 - - 2.1
Economic support 2. 4 - - 1.3
It was found that only 25.7 percent of the total families use the services provided by the
municipality/ward. Among those using the services, families from Shankhamul were seen to
be making maximum utilization of the services (33.3 percent) followed by families in Kapan
(29.8 percent) and the families in Tripureshwor (9.3 percent) were least utilizing the available
services.
Among those families using the municipality services, majority of them (37.7 percent) used
electricity, followed by the use of water supply (22.1 percent) and health services (20.8%).
Other services such as waste, road, identity card, public toilet, settlement, economic support
and drinking water were used by very few families.
Informal discussions with the families also showed that the municipalities/wards provide
recommendations for the families to get birth registration/ citizenship and other government
services. The families from Shankhamul are found to be receiving almost all of the services
63
provided. The authorities mostly recommend to get the citizenship card along with other
services like drinking water, Electricity, Economic support, Toilet/Dhal, School established
Settlement, Eliminate alcoholism and Identity card. The ward, VDC and municipality are seen
to be providing most of the services to the families.
Table 9.2 Meetings Attended By Families

Families attend meetings
Yes 73.0 76.2 53.3 69.0
No 27.0 23.8 46.7 31.0
Total 100.0 100.0 100.0 100.0
If yes type of meeting
Mother group 57.3 39.1 25.0 45.4
Local authority 28.2 45.3 42.5 36.2
Local/Tole meeting 5.8 12.5 25.0 11.6
NGO 5.8 7.8 2.5 5.8
Landless people 6.8 - 7.5 4.8
Cooperative meeting 1.9 6.3 - 2.9
Religious 2.9 1.6 - 1.9
Club 1.0 - - 0.5
Shakti Samuha 1.0 - - 0.5
Child club - 1.6 - 0.5
The participation of the families in the meetings of various groups was found to be
significantly higher especially among the families in Kapan and Shankhamul (73.0 percent
and 76.2 percent). Majority of them participated in the meetings with the mother’s group and
local authority. Only a few percentages of the families attended the meetings of the local/tole,
NGO, landless people, cooperatives and religious activities (11.6 percent, 5.8 percent, 4.8
percent, 2.9 percent and 1.9 percent respectively). It was also found that meetings of the
clubs, Shakti Samuha were attended by very few families in Kapan and Shankhamul and the
child club meeting was attended by 0.5 percent families in Shankhamul only.
The table below indicates that only 39.5 percent of the families surveyed have received some
sort of services from the NGOs. Lumanti was found to be the main NGO that provided the
highest support (54.2%) to the families with a focus in Shankhamul and Tripureshwor. Apart
from this, German support, support from foreigner, Mahila Ekta, EDHAG, Japanese, NGO
and CWIN have also provided one off support services to these families. Majority of the
families have received support in the areas of Toilet and Education/Health. There is a
minimum support in other areas such as economic support, drainage, establishment of
cooperatives, sanitation, RH/HIV/AIDS, road, training, loan, formulation of women’s groups
and child clubs.
64
Table 9.3: Services Received From NGOs

Support is received from the
NGO
Yes 37.6 57.1 23.0 39.5
No 62.4 42.9 77.0 60.5
Total 100.0 100.0 100.0 100.0
If yes support is given by
LUMANTI 15.1 89.6 76.5 54.2
Children world 67.9 2.1 - 31.4
Foreigner 13.2 - - 5.9
Mahila Ekata - 6.3 11.8 4.2
EDHAG - 2.1 5.9 1.7
Japanese 1.9 - - 0.8
NGO 1.9 - - 0.8
CWIN - - 5.9 0.8
Total 100.0 100.0 100.0 100.0
If yes type of services received
Toilet 58.5 66.7 - 53.4
Education/Health 75.5 29.2 47.1 52.5
Economic support 5.7 2.1 41.2 9.3
Drainage 17.0 - - 7.6
Established cooperative 1.9 14.6 5.9 7.6
Sanitation 1.9 - 11.8 2.5
Reproductive Health /HIV/AIDS 3.8 - 5.9 2.5
Road 3.8 - 5.9 2.5
Training - 4.2 - 1.7
Provide loan - 4.2 - 1.7
Physical support - 2.1 - 0.8
Formulate woman group - 2.1 - 0.8
Formulate child club - 2.1 - 0.8
Total 100.0 100.0 100.0 100.0
What is Lumanti?
Lumanti Support Group for Shelter is a non-government organization dedicated to the

alleviation of urban poverty in Nepal through the improvement of shelter conditions. Lumanti
facilitate shelter upgrades, micro-finance, education and good governance, gender equity,
health awareness for the prevention of diseases and advocacy.
Lumanti works in 68 slums and squatter communities throughout Kathmandu, Lalitpur and
Thimi. The urban poor are living in improved shelter and socio-economic conditions, with
increased self-dignity.
65
Since the saving and credit groups have been transferred to cooperatives, the members have
found big benefits. In the saving groups, the maximum amount of loan for which they could
apply was Rs. 5,000, but the cooperatives now offer a maximum loan of Rs. 20,000, with 24
percent interest per annum and without any collateral. This has encouraged members and
built their confidence to undertake personal housing projects to maintain extend or build
houses. In the last 12 months, a number of individual housing projects have taken place in
several informal settlements.
Lumanti believes saving money is a key tool in empowering and developing poor, urban
communities. This is particularly so given that the urban poor are often considered a "risk"
by financial institutions and, therefore, find it difficult to access loans through Lumanti's
micro-finance programme, at least one woman from each household is encouraged to join
savings and credit group. The groups have an average of 18 members.
There is various type of saving which start from 5 Rupees to 100 Rupees. The saving can be
done on daily, weekly, or in every 15 days and on monthly basis which is entirely the decision
of women group and differs place to place.
At Present, Lumanti is working with 2400 women savers in more than 500 savings and credit
groups. These women manage their funds and groups themselves, however, Lumanti offers
organizational and accounting support and training where needed. Loans are then distributed
to members for housing improvements, health matters, emergencies and educational costs.
Despite high growth in the number of savings and credit groups, Lumanti found the very
poorest members of some communities were not joining the groups. These were the people
who were too poor to save few rupees a week. As a means of helping communities explore
solutions to this problem, Lumanti set up a revolving fund to extend special loan to the
poorest of the poor and community members identifying their poorest neighbors and working
out a business plan with the family which is then submitted to Lumanti.
The saving and credit program was initiated in 1996 in slum and squatter communities. It has
been able to reach 1953 households (as of Dec. 2002). Unless these informal saving groups
are financially sustainable, their replicable, outreach and life is limited. Hence, for the
sustainability and institutionalization of the saving groups, the women of the squatter
communities decided to embrace all saving groups into one formal institution-the
cooperative. But the effort to form a single cooperative did not materialize due a number of
legal restrictions and ultimately registered three cooperatives instead of one that was
originally intended. These cooperatives function as autonomous, member-controlled bodies.
66
Available Facilities / Resources in Ward No 10, 11 and 3
Education / Ward No 3 10 11 These facilities are

applied to all people
Pre- primary/ primary 4 24 12 Private
- 3 - public
Lower secondary 4 5 1 Private
- - - Public
Secondary 4 10 3 Private
1 1 1 Public
Higher secondary ( 10 + 2 ) 1 7 2 Private
Campus - 7 2 Public
Health Institution
Private hospital / Nursing home / 7( clinic in 1 5
clinic Pharmacy )
Poly clinic - 12 -
Community health Clinic - 2 -

Public hospital ( Families visited - - 2
other public hospitals as well which
are not under these wards )
Basic Infrastructure( In survey area
these facilities are public facilities
except electricity)
Electricity 9 9 9 All household
Drinking water 9 9 9 Public
Telephone 9 9 9 Public
Toilet 9 9 9 Public
Market access ( food, cloth, 9 9 9 Within 10 to 30

medicine general store, hardware ) minutes
Finance Company / co-operative 9 9 9
In survey areas, though they have private schools and private hospitals more than 90 % of
families use public services.
67
Existing structure and Groups in Survey Areas
S.NO NAME
1. Adolescent Group
2. Asha Child club
3. Children world – Focused on children’s education till 3 grade in
Kapan
4. Church
5. CWIN- provided education to street children in Tripureshwor area
6. LUMANTI- Support group for shelter, urban poverty, micro finance
7. Mahila Ekata Samaj-
8. Mother Group- saving, sharing , meeting
9. Municipality – Recommendation to access water, electricity, school
education, telephone, support social work, give ID,
10. Nepal Mahila Ekta Samaj ( Federation of women from squatter
families)
11. Pathivara Youth club
12. Prayas Nepal
13. Shilpakala Samuha
14. Sirjana Youth Club
15. Society for preservation of shelters and habitations in Nepal (
Federation of urban squatter families)
16. Tole Sudhar Samiti ( cluster improvement committee )
17. Tripahil Child Club
18. Upakar Group
19. VDC - Recommendation to access water, electricity, give ID,
telephone
20. Ward - Recommendation to access water, electricity, telephone, give
ID
21. Youth Club – Meeting and sharing feelings of youth
It found that there are basic structures, groups among urban poor families, and might have
opportunities to any organizations to work with them rather forming new group.
68
Health Facilities Available in Kathmandu
Health Facilities Available in Kathmandu Year2002/03

Total number of Public Hospitals ( Bir, Kanti, Thapathali maternity, Teaching hospital, Teku and Patan hospitals) 6
Total Number of Primary health Care centers 7
Total Number of Health posts 6
Total Number of Sub health posts 53
Total Number of PHC outreach clinic 199
Total Number of EPI clinic 254
Total Number of FCHVs 1,158
Total Number of Private Health Institutions 13
Multilateral Partners (National level) 3
UNFPA -focused on population and reproductive health integrated project
UNICEF- focused on CDD, ARI, EPI Safemother hood, deworming, prevention and control of vitamin A
deficiency
WHO- focused on prevention and control of TB, ARI, safe motherhood, Child and adolescent health, Mental
health
Bilateral Partners 7
USAID- focused on VCT, HIV / AIDS, FP, MCH
GTZ- focused on reproductive health, HIV AIDS, strengthening government health system, community drug
program
The German development Bank - focused on ORS, FP, Reproductive Health service and mobilization private
sectors
DFID -focused on safer motherhood in country side and assistance to the national TB. HIV /AIDS, Polio
eradication, FP
JICA -focused on TB control program, HIV /AIDS, MCH, Immunization, school and community health project,
support scholarship to produce trained health resources especially paramedics.
SDC -focused on women, children, adolescent and men’s health through empowerment
NFHP- focused on family planning, safe motherhood/ PAC, FCHV training program, vitamin A, BCC, child
health
Total Number of INGO / NGO / other private sector involvement in Health sector 30
UMN- run hospitals, integrated community health and development projects, HIV / AIDS, Mental health
SC /US- run health, population and nutrition, ECD, education, economic opportunity , HIV /AIDS
Marie Stopes International ( MSI ) / SPN- focused on FP, MCH services, sexual / reproductive health, STI, HIV/
AIDS, Safe abortion, CAC, PAC
BNMT – Focused Drug scheme program, Tuberculosis and Leprosy control program, Community Health
Development Program
INRUD, Nepal – promote the rational use of pharmaceuticals
NGOs
Nepal Red Cross Society- Focused on blood transfusion, Ambulance service, First aid service, Eye camp,
drinking water and sanitation, Non – formal education, Women empowerment for health and education
National Vitamin A Program- focused on Vitamin A distribution, training on Nutrition
Helping Hands - Health service delivery for poorest of the poor, porter group, transport workers
FPAN- focused on FP, MCH, sexual and reproductive health services, gender, youth, STD, HIV /AIDS, training
Ama Milan Kendra ( Mother’s Club ) -focused on peer education, advocacy, MCH, research, youth reproductive
health, maternal and neonatal health program
Nepal CRS company- HIV / AIDS, STI, MCH, BCC, Social marketing for FP devices, Mass media
communication
NFCC- focused on STI, VCT service, HIV / AIDS, Clinical Training Centre
Youth Vision – focused on IDUs, drug and alcohol counseling, VCT, HIV / AIDS, STI , referral services
General Welfare Pratisthan- focused on adolescents and Young Adults, transport workers, factory workers,
laborers
Community Welfare Center- Family health, child survival, environment, legal rights and education
AMDA- focused on Health care including VCT, HIV / AIDS and STI prevention, hospital operation, people of
reproductive age, elderly, general patients
Sources: Department of Health Service 2002/2003, working in partnerships FHI 2005
69
Ministry of Health, Department of Health Services
National Health Service Coverage Fact Sheet
Health Indicators Year2002/03
1. Total Fertility Rate 4.1%
2. Crude Birth Rate 33.58%
3. Neo Natal mortality Rate 39%
4. Infant Mortality Rate 64%
5. Child Mortality Rate below 5 years children 91%
6. Maternal Mortality Ratio ( Per 100,000 live birth ) 415
7. Crude Death Rate 9.96
8. Life Expectancy 58.95
9. Total Health Expenditure as % of national Government budget 5.20
Expanded Programme on Immunization
10. BCG 97%
11. DPT-3 Coverage 86%
12. Polio-3 Coverage 84%
13. Measles Coverage 80%
14. Women of child bearing age 15- 44 received Tetanus Toxoid 15%
Nutrition
15. Growth Monitoring coverage as % of below 3 years children New visits 51%
16. Proportion of Malnourished children ( weight / age – New visits ) 14%
Acute Respiratory Infection
17. Reported Incidence of ARI /1000 Below 5 yrs children – New visits 289
18. Annual reported Incidence of Pneumonia ( Mild + Severe ) /1000 among below 5 yrs children –New visits 117
19. Proportion of Severe pneumonia among new cases 3.3
Diarrhea diseases
20. Incidence of Diarrhoea /1000 below 5 years children 200
21. % of some dehydration among total new cases 41.4%
22. % of Severe dehydration among total New cases 3%
23. Diarrhoea deaths / 1000 0.04
24. Case Fatality rate /1000 0.20
Safe Motherhood
25. First Antenatal Visits as % of Expected Pregnancies 53%
26. Average No. of ANC Visits per pregnant woman 1.8%
27. Deliveries Conducted by TBAs as % of Expected Pregnancies 8.4%
28. Deliveries Conducted by Health workers as % of Expected Pregnancies 16.1%
Family Planning
29. Contraceptive Prevalence Rate( CPR) 37.8%
30. Condoms ( CPR Method Mix) 2.2%
31. Pills “ 2.5%
32. Depo Provera “ 10.2%
33. IUCD “ 0.7%
34. Norplant “ 0.9%
35. Sterilization “ 21.3%
36. Couple Years of Protection ( CYP ) by Method for New Acceptors 34.2
Tuberculosis Control Programme
37. Case Detection Rate 71%
38. New sputum +ve 14,348
39. Treatment Success Rate on DOTS 90%
40. Sputum Conversion Rate 85%
41. DOTS Coverage ( Population ) 94%
70
CHAPTER FOUR
4. ANALYSIS AND CONCLUSION

This study has reflected the socio-economic conditions of vulnerable families in Nepal, who
live by crisis at every stage of their lives. The survey was conducted with 300 vulnerable
families living in Kapan, Shankhamul, and Tripureshwor, focusing on their state of living and
the problems surrounded by them. These families in the three villages adjacent to the capital
city Kathmandu are mostly migrated from the rural areas of Nepal in search of better
opportunities for their families. However, as illegal residents in the riverside and slump areas
they have hardly managed to grasp the opportunities and services available in the city. In
absence of legal identification, majority of the household members in these areas work as
laborers for survival with an income range of Rs.1100-3000 per month. This level of income
represents very poor state of living of these families who can not take the full advantages of
being in the city like Kathmandu nor can they escape the living expenses at city.
Although most of these families have houses, they do not have legal documents for land,
which they use for building houses. They always live in fear that they might be displaced at
any times by the government authorities. The families have migrated to Kathmandu from
various parts of the country as well as from India following the dame trend since long in
Nepal. Tamang is the dominant caste in the villages followed by Brahmin, Chhetri, and
Newar. Only few families belong to the underprivileged and marginalized groups like the
Dalits, Rai, Magar, Limbu, and Tharu. They follow Hinduism with only few families inclined
towards Christianity and Kirat.
The family size among the families in three different areas ranged from minimum number of
1-3 to maximum number of 11 and more however, following a similar pattern (large number
of family size: 11 or more among the majority of families). The majority of the family
members are between the age group of 19 to 59 years, followed by members aged 6-18 years.
Only few members are less than 6 and above 60 years. The number of male members
dominates the household compared to that of females.
Occupation, land ownership, and income are the indicators of economic conditions. A
majority of the members of these families are indulged in some kind of work. As indicated
earlier labour on a daily waged basis is the major occupation of the working members of the
family. Apart from this, some of the families’ members do their own business, work as
domestic labour, and or also work in different private and government offices. Average
monthly income of these families falls between the range of Rs. 1100–3000. There are
families in these villages as well who make monthly household income of Rs 7600 and above
but these are only exceptions.
The families’ expenses are quite proportionate to their income. On an average majority of the
respondents, spend less than Rs 100 for food per day followed by Rs 120 – Rs 200. Majority
of them use public transport. Most of these families go through financial problems at one time
or the other. In order to resolve their financial problem, most of them take loans from families
and friends except some who look for donations or even beg or remain hungry. Most of the
time, the families use the loans to start business, and for medication. Sometimes they also
borrow the money for household maintenance, food, and school fees. Such borrowings range
from minimum of Rs. 1000 to maximum of Rs. 51000.
71
Although more than 50 percent of the family members fall under the age group of 19-59,
majority of the family members do not have a voter’s card or Identity cards. Moreover, there
are many family members who do not have citizenship card as well. The same trend can be
seen for the birth registration. Majority of the families have not registered their childbirth for
various reasons.
The house plot for the majority living in these areas ranges from less than an Ana to one or
more than one Ana. Since these families have clustered housing system, the hygiene and
sanitation status (inside and outside the house) is medium to worse in most of the cases.
Majority of these families has access to the basic household utilities and amenities like
furniture (bed, chair, radio, TV, stove) and electricity. There are also families who follow the
traditional life style such as firewood cooking, and kerosene/candle lighting due to their
inability to afford for electricity and or gas or other cooking appliances.
Piped water is the main source of drinking water for majority living in these villages.
However, there are families who use the natural tap water and water from wells for drinking.
Among the families who use water from well, majority use the water directly without making
it consumable. Some families use various means of purifying the water such as purified water
through sunlight, boiling and filtering, using filter, using medicine, and some only cover the
storage jar.
There is no systematic management of wastes/garbage in these villages. Most of the families

from these villages throw wastes in the river. Only few families throw the wastes in the
municipality’s truck or in the containers. Although less in number, there are families who do
not have access to proper toilets. Those having access to toilets have more collective toilets
than the individual toilets reflecting the higher possibility of communicable diseases.
However, there is a high level of awareness among the respondents regarding the diseases
transmitted by stool such as Diarrhea, Cholera and Dysentery.
Education and literacy rate are important determinants of the social and economic well being
of a household. Most of the family members have got only primary education and there is a
high drop-out rates among the children at primary level. This is even truer for the gild child.
The percentage of illiterates is higher than those of literates representing their limitations to
access socio-economic opportunities.
Although a number of clubs are available in these areas the participation of children in these
clubs are mostly limited to a youth club. The other clubs like triphali child club, pathivara
youth club and others do not seem to encourage the children to participate limiting their
strengths for community participation.
Majority of the mothers in these areas breast-feed to their children below 5 years old as the
most universal practice for healthy growing of their children. The frequency of feeding is 2 to
4 times a day depending on their availability. The women stop breastfeeding once milking is
stopped or after the child is 2-3 years old or after they became pregnant again. All the families
have immunized their children below 5 years with the necessary vaccines like BCG, DPT,
Polio, and Measles. Most of the families vaccinated the child in the public health centers and
hospitals. Some of them vaccinated the child during the visits of mobile health camps, in
private health centers, and in local committee and schools.
The infant mortality rate was found to be very high in these villages. The children had died
due to number of illness such as pneumonia, Jaundice, and malnutrition. The families in these
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areas were not properly aware of early childhood and development thus indicating high illness
among the infants. Majority of the female family members have experienced pregnancy more
than twice and most of the time with no birth spacing. Despite some awareness on the
importance of prenatal care for a woman and her child during pregnancy, not all pregnant
women in these villages go for regular check up during pregnancy. Majority of the deliveries
occurred at home, which were assisted by neighbors, family members and traditional birth
attendants (TBA). Only few percent of these women went to the hospitals for delivery of their
babies and again they rarely go for postnatal care indicating their least awareness on early
childhood development. Although majority of the respondents use various means of family
planning, it was mostly the temporary tools used by women.
As indicated earlier, lack of employment is one of the major problems in the entire three
villages. On the one hand, most of the people in these areas were not educated enough, on the
other, they did not have legal documents for the formal employment. Apart from employment,
the families living in these areas do not have proper housing equipped with power, water
supply (dinking water), and sanitation facilities indicating the large possibilities of water born
and transmissible diseases. The other problems prevalent in these areas are flooding during
rainy season leading to forceful migration from one place to other for relocation, caste-based
discrimination, and addiction to drugs and alcohol leading to violence.
Especially women and girls in these communities were highly affected by discrimination, and
violence due alcoholism. The men become wild after drinking alcohol and attack their women
counterparts using the vulgar words or beat them. In addition, early marriage and multiple
marriages are still profound in these communities again having the most negative impact on
girls and women. Similarly, trafficking and rapes, unwanted pregnancy, and gender-based
discrimination between sons and daughter were noticeable, which needs to be resolved. There
is an absolute lack of awareness among the people in these communities on the violence and
women’s and human right issues and the ill practices are continuously existed.
Municipalities and local bodies have not provided enough attention towards the solution of
the basic problems faced by these communities. Only few families were able to get the
services from municipalities regarding electricity and water supply. Although the people in
these communities highly participated in the community meetings organized by local groups,
they were mainly with mother’s groups and other local authorities such as ward and village
committee. There was a less representation in local NGOs, Clubs, cooperatives and other
religious organizations whose resources could be highly tapped for the betterment of these
communities.
Overall, the vulnerable families in Nepal live in extreme poverty indicating multiple
implications on their livelihood. They do not only strive for basic needs but also look for
better opportunities for their future generation. Hence, there is a need for cooperation and
coordination from local authorities and organizations to strengthen the capacities of these
communities by delivering the appropriate support and services thus enabling them to
improve their livelihood.
As poverty increasingly displays urban characteristics, the challenge is to work with people to
improve the quality of life in poor urban communities. Working with the urban poor is the
challenge, however, does not mean "doing it for them". It means recognizing that the urban
poor are valuable citizens, that they have insights, skills and experiences that need to be
included and recognized if our cities are to be sustainable developed. For this development to
occur, all urban actors must recognize the role they have to play.
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CHAPTER FIVE
5. RECOMMENDATIONS
As indicated earlier, the vulnerable families are surrounded by overwhelming problems due to
the extreme poverty. Despite these problems, the people in these communities have enormous
strength and capacities to improve their situations if external agencies are willing to support
them by facilitating the process of development and their empowerment. This study has been
able to reflect the real situations, problems, and the socio-economic condition of the
families/households surveyed. Based on the findings of this survey, the following strategies
and recommendations have been suggested for taking actions.
1. Create Conducive Environment to enhance the capacities of Poor Families
• The people in these communities were surveyed by many other agencies however,
their information was only limited to the reports without urging for real actions. They
are not supported enough for resolving their problems and increasing their self-esteem.
They are under valued and ignored either in public or private spaces. Therefore, it is
necessary to create a climate of confidence by listening to these poor families and
discovering their strengths and values and inspiring them for participations and
actions. The local organizations such as local NGOs should facilitate their active
participation in existing groups and structures, that can also help them to build their
collective strengths and increase their self-esteem.
• Existing women’s group and mothers’ group should be strengthened and used as a role
model, and encourage to establish new other new groups (children, women, and men)
and illustrate how the group strengths can help to reduce violence, accessing resources
and opportunities.
• The rights and hopes of poor families and their achievements should constantly be
focused and in the agenda of all authorities especially in the municipality and wards
and local organizations, women’s groups, NGOs, youth groups and other local level
user committees.
• Involve families in the decision making process and include them as full and active
partners in identifying their own issues and problems and in designing, planning,
implementing, and assessing programs for their sustainable livelihood.
2. Identifying And Linking Services To Poor Families:
• It has been found that access to services is very challenging for the poor families. They are
struggling with various problems for fulfilling their basic needs, such as access to drinking
water, lack of health and education facilities, inadequate resources and information, fear of
displacement by government, lack of support mechanism, uncertainty about employment
and uncertain about children’s education and their future. Therefore, there should be a
74
program to make them aware of the resources and services available in those communities,
to link with those resources, and make access to the social support from various service
agencies.
• Do social support resource mapping and discuss together with those families to
identify and locate where real resources are available to meet the physical, health,
economic, social problems identified in the survey.
• Networking among various groups should be initiated and various resources and support
services provided by government and different NGOs should be explored. These services
should be made available to the communities through organizing community meeting with
social group, local leaders, and local organizations. Strengthen existing groups for:
- Income generating activities

- Community development fund
- Resource mobilization
- Sharing information
3. Raising Awareness
As parents are nor aware on many issues; a strategy to raise awareness amongst parents, men,
women and children should be developed to address issues like:
a) Health and hygiene

b) Gender discrimination between girls and boys, gender roles and
responsibilities within the family
c) Children and women’s rights
d) Sexual abuse and trafficking
e) Awareness about the existing services available and how the families can
access those services
f) Family violence (such as drinking alcohol), beating wife and its effects to
children and family itself.
g) Women’s health including reproductive health (prenatal and postnatal care),
STI.
h) Social and legal awareness on children rights, women rights, sexual abuse,
domestic violence.
i) Early child marriage, reproductive health and its impact on girls.
j) Importance of protection of children and women from any kind of violence
k) The importance of education in general and for girls in particular
l) Awareness on Drug abuse, its impact and HIV/AIDS,
m) Caring of children, child development, and nutritional value of the food.
¾ Along with awareness, there should be a movement to stop violence and a holistic
program (legal, psychosocial, economic, and medical support for the victims)
against domestic and sexual violence should be initiated to protect girls and women
from violence.
¾ Where culture and tradition dominate the living practices, community-based
awareness program that target family members especially mother in law, husbands,
women and men groups and children will be critical. Raising awareness and
knowledge against violence, educating communities about the cost and
consequences of violence, risks and problems related to health, early pregnancy and
75
child birth about common problems during pregnancy, delivery and the postnatal
period will be important to enable family members and the community to identify
and respond to the problems in a timely and appropriate manner.
4. Education
¾ Non-formal education classes should be conducted for the children who are not
attending school or have dropped out. Similarly, adult literacy classes are also
required for adults who are illiterate making them aware on different issues such as
early child hood care and development, girls and women’s rights, violence and its
consequences, family health and hygiene and other social activities.
5. Child Development Program for Children Below 5 Years
¾ The infant mortality rate is very high especially the percent of deceased children
below 1 years old (46.7 percent and 75.9 percent for boys and girls respectively).
Hence, intervention is required to prevent infant mortality by providing regular
health checkups and awareness.
¾ In survey areas parents are quite busy and they do not have enough time to look after
their children properly. There is a felt need for a day care centre for children under
five years. It will be very helpful for the children and parents especially when both
parents are not available during the daytime. It is recommended that there is an
urgent need for establishment of ECCD program for 3 to 5 years and home based
ECCD program for below 3 years.
¾ ECCD centers should be established in own community to increase community

participation. If centers are based in community, parents have time to see ECCD
activities, create interest, attract from ECCD activities and motivate to support
continuously in future for their child development which address sustainability part
too.
¾ Survey shows that keeping child under strict control since childhood, giving
punishments is one of the solutions to keep discipline for the children. So it is quite
important for the parents to understand the concept of ECCD because many parents
are still expecting to discipline their children through giving punishment rather than
thinking a holistic approach of child development. According to research, the high
level of parental participation leads to a stimulating environment that especially
favors the cognitive development of children living in difficult conditions.
¾ To increase community participation ECCD center should not be run in isolation, it

has to link with other educational activities, such as parenting education, non formal
education program, women group program, out of school education program and
other educational related activities, health and nutritional activities.
¾ Families are required to sensitize about the value and necessity of child
development, health, and hygiene, caring of children, feeding. In developing a new
leadership culture the early childhood field has much to gain from listening to,
reflecting on and responding to parent’s / family’s stories.
76
¾ Parents should be made aware that play does not prevent children from learning
reading and writing. There should be enough evidences of learning drawn from the
play activities of children in the centre. They should be made aware of child center
learning.
6. Health and Nutrition:
It seemed that most of the children are suffering from diarrhea due to un-hygienic condition
and has caused malnutrition. There is relation between Diarrhea and malnutrition too.
Malnutrition is generally caused as a result of combination of inefficient nutrition and
infection. Among 3 to 5 years children there is high chance of malnutrition and diarrhea. So it
is recommended that;
¾ The program needs to focus to this aspect in early childhood program, which is a
major component. Health and Nutrition issue can be easily done with linkages to the
health sector and nutrition program.
¾ There should be routine health check up of those children at least in every two month
and as per necessary if there are infections.
¾ If ECCD center will establish and consider focal place for Vitamin A distribution, De-
worming program or immunization program at village for below 5 years, then many
parents visit to take those service for their children and thus ECCD has an attraction
for parents to increase their participation for their children in ECCD centers. This can
be done very easily by coordinating with DHO at district level or community health
centers at municipality. This also helps to benefit the health sector as a whole, and
could achieve target of below 5 years children without big difficulties.
7. Employment Opportunities
¾ Unemployment has been seen as the major problem prevailing in these villages.
Hence, possible employment areas should be explored and provisions for
apprenticeship trainings and vocational trainings should be made to help solve the
problems of unemployment.
8. Wastage Management
¾ Proper management of wastes is lacking in these villages. Hence, it is urgent to

effectively activate and mobilize the community members, provide them with good
orientation on their roles and responsibilities to mange wastage and jointly plan
activities to manage the wastes properly and to improve environmental hygiene.
9. Increase Access Services For Poor Families
¾ Identify means of providing free health check up and free treatment for poor families
as most of them have low financial status. Furthermore, provision for prompt
medical treatment and other care and support services are also required.
77
¾ Facilitate poor families to discover meaning in life, build self-esteem and sense of
humor. Develop skills and linkages for economic opportunities.
10. Partnerships and Networking
¾ E & D along with partners should organize meetings at national level with
organisations that are involved with the needs of vulnerable families. At the same
time, it is necessary to seek strong commitment from all I/NGOs and government to
address the specific needs of vulnerable families.
¾ A common coordination forum with the representation from concerned local

organization, representative of vulnerable families, women, youth and children
group should be established for advocacy purposes, sharing of experiences to foster
understanding on practical issues related on vulnerable families and for increasing
efficiency of the activities being implemented in their areas.
¾ E & D along with partners should do a mapping of “who is doing what” to address
the needs of vulnerable families and do collaborative work with different agencies in
order to ensure the minimum standard of those families.
78
Bibliography:
a. A survey of teenagers in Nepal, 2001 for life skills development and HIV / AIDS
prevention, UNAIDS, UNICEF
b. DOH, 2002 /2003 Annual report, HMG of Nepal, MOH, Kathmandu supported by
UNFPA.
c. Child Labour in Restaurants and Tea Shops in Nepal, 2003, A National Survey
conducted by CONCERN – Nepal.
d. Existing Practices of Caste – Based un-touchability in Nepal and strategy for a

Campaign for its Nepal, 2003, Action Aid
e. Health Seeking Behaviour of Women in Five Safe Motherhood Districts in Nepal,

1998, UNICEF.
f. Nepal Living Standards Survey, 2003/04, Statistical Report Volume I, II Central

Bureau of Statistics National Planning Commission Secretariat His Majesty’s
Government of Nepal.
g. School Level Educational Statistics of Nepal, 2004, Flash Report I, HMG of Nepal,
Ministry of Education and Sports, DOE, Sanothimi, Bhaktapur.
79
ANNEXES
ANNEX I: Key Indicators of Kathmandu

(Source: CBS 1991 census)
Country NEPAL
Capital KATHMANDU
Map Kathmandu Metropolitan City Map
Longitude 850 20' East
Latitude 270 42’ North
Elevation 1350 m
City area 5067 ha (50.67sqkm)
Population 701 962 (Census 2001)
Household 1 716 912
Average Household size 5.2
Built up area 3844.56 ha
Average pop-density 175.7per/ha
Per capita income 360 US$
Summer 190C - 270C
Winter 20C - 200C
Annual Growth rate 6%
Average of the annual humidity 75%
Rainfall average 1306.75 mm (heavy concentration at June to August)
Climate Sub-tropical cool temperate
City road network 219.5 km
National Highway - 17km
Feeder Road - 0.4km
District Road - 9 .7km
Urban Road - 273km
Major industry Tourism, Handicrafts, Garments & Cottage Industries
Principal Language Nepali, Newari & English
Main Rivers Bagmati, Bishnumati & Dhobikhola
80
ANNEX II: Survey Team
1. Irada Parajuli Gautam (Team Leader)
Supervisors:
2. Tek Bahadur Khadka

3. Kamal Sharma
Secretariats for Encoding, Data Entry Operators, Tabulation
4. Mr. Nagendra Luitel

5. Mr. Yubaraj Dahal
6. Mr Hari Bahadur Gharti
Surveyors:
7. Ms. Bimala Panta

8. Mr Bishnu KC
9. Mr. Homnath Dahal
10. Mr. Krishna Lal Joshi
11. Ms. Pabitra Giri
12. Ms. Sandhya Khanal
13. Ms. Sangita Rai
14. Ms. Tara BK
15. Mr. Madhav Dhakal
16. Mahendra Gyawali
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ANNEX III: Survey Questionnaire
Survey Questionnaire of Vulnerable Families in Kathmandu
1. Administrative Information
Municipality ward number VDC
Address:
District Village Street House

number
Name of the investigator:
2.1. Mother’s name 2.2.Father’s name:
2.3. Number of families living in the house: 1.No of adult: 2.No of children:
2.4. Do all adult have citizenship: 2.5.Do all children have birth registration
2.6. Interrogated persons: 1.mother 2.father 3.both 4.others heads of the

household
2.7.Family situation: 1.Married 2.Divorced 3.Separate 4.Widow 5.Alone with children 6.Single
without children
2.8.Number of children below 5 years:
2.9.Religion: 1. Buddhists 2. Hinduisms 3.Christians 4. Muslims 5. Others
2.10. Presence of the family:
2.10.1 Both parents are present everyday in the area all day
2.10.2 Only one of the parents is present everyday all day
2.10.3 Another person than the parents takes care of the children in the area during the day.
If yes which one
2.10.4 The members of the family go back home only in the evening
2.10.5 The children remain alone in the area all day
2.10.6 The family returns in the area only once a week.
3. HOUSING INFORMATION
3.1 Previous place of residence:
3.2 How many years or month of entrance in the house:

3.3 Surface of the plot: Ropani Ana
82
3.4 Hygiene / sanitation: 1 good 2. Medium 3.bad
3.5 Furniture and materials: 1.bed 2.Chairs 3.Radio 4.Stove 5.Table

6.TV
3.6 Outer kitchen: 1.yes 2. No
3.7 Lighting: 1oil 2.candle 3.electricity 4.others
3.8 Is the house flooded during the rain season: 1.yes 2.no
4. HEALTH OF THE CHILD / Family
4.1 Yesterday, how often could you feed your children under 5 years old?
1. One time 2. Two-time 3. Three time 4. More than 4 times
4.2 How often do you think it is necessary to feed a child under 5 years old?
1. One time 2. Two-time 3. Three time 4. More than 4 times
4.3 When did you stop breast-feeding your last-born child?
1. When pregnant again 2. When the child is 1-year-old 3. When I have no more milk
4. Other
4.4 According to you, when is it better to stop breast-feeding?
1. When you are again pregnant 2. When the child is 1 year 3. When I have no more milk
4.other
4.5 Did you give bottle milk to your child before 4 months? 1.Yes 2.No
4.6 What kind of food do you give to your children under 5 years old?
1.Rice 4.Beans 7.Eggs

2.Soya 5.Fish 8.Sweets
3.Vegetables 6.Fruits 9.Other
4.7 What do you think that is suitable to give to eat to a child?
1.Rice 4.Beans 7.Eggs

2.Soya 5.Fish 8.Sweets
3.Vegetables 6.Fruits 9.Other
4.8 What do you do before feeding the child?
1.Wash your hands 2. Wash the utensils 3. Others
4.9 Do you masticate the food before to giving it to your child? 1.Yes 2. No
4.10Did your child have already had accident? 1. Yes 2. No
4. 10.1. If yes what kind of accident?
4. 11 what did you do after that to anticipate, this kind of accident?
4. 12. Are there drug problems in your village? 1.yes 2.No
83
4. 12.1 If yes what numbers?
4.13 Does members of your family suffer from chronic diseases? 1.Yes .2 No
4.13.1 If yes which one?
4.14Does a member of your family has a handicap? 1.Yes 2.No
4.14.1 If yes which one? 1.Physical 2. Mental
4.15 What you did last time that your child had:
1- Fill up per child:
1.Public 2.Private health 3. Doctor 4.Self 5.Others 6.Nothing

health centre centre medical
treatment
a. Diarrhoea
b. Fever
c. Typhoid
Fever
d. Parasites
e. Accident
5. VACCINATION
Name Age BCG Polio 1, 2,3 DPT 1, 2,3 Measles Hepatitis B
5.1 Where do you vaccinate the children?
1.Private Health Center 2. Public Health Center 3. Hospital 4.

Others
5.2 When do you start to vaccinate your children?
1.Just after birth 2.Not before one month after birth
5.3 Which is the best time to begin to vaccinate the child?
1.Just after birth 2. Not before one month after birth 3. Do not know
5.4 How much do you pay for a vaccination? 1. 10 Rs 2.20 Rs 3.50 Rs

4. Others
6. FAMILY PLANNING, Pregnancy and Delivery
6.1 How often have you been pregnant in your life? 1. Non 2. Once 3. Twice 4. More than
twice
6.2 Number of living children: 1 girls 2.boys
84
6.3 Number of children died before 5 year of life
1.Causes? 2.Which age? 3.Which

Year?
6.4 Have you been looked after during your last pregnancy?
1.Yes 2. No.
6.4.1 If yes, where?
6.5 Have you been looked after, after your last pregnancy? 1.Yes 2 No.
6.5.1 If yes, where?
6.6 Where did you give birth: 1.In house 2.Hospital 3.Others
6.6.1 if in house by whom?
6.7 Do you use family planning method? 1.Yes 2.No
6.7.1 If yes which method 1. Permanent 2. Temporary
6.8 According to you, how long should you wait to be pregnant again?
1.6 months 2.1 year 3.2 years 4. Do not know
7. HYGIENE / SANITATION
7.1 Where did you get your drinking water this week?
1.Well 2. Protected well 3. Purchase of water 4.Tap water 5. River 6.Natural

Tap water
7.1.1 if you paid: how much did you pay for the water?
7.2 If you drew the water from a non-protected well, what did you do to make the water
consumable?
1.Nothing 2. Boil and filter the water 3. Cover the storage jar 4. Others
7.3 Where do you store the water for drinking?
1.Clay jars 2. Iron jar 3. Plastic bucket 4. Earthenware jars 5. Others
7.4 Where do you put your waste?
1.Burn 2. In a hole 3. Anywhere
7.5 Do you have latrines? 1.Yes 2.No
7.5.1 if yes are the latrines: 1. `Collective 2. Individual
7.5.2 if yes are the latrines: 1. Dry 2. Damp
7.6 Do you know the diseases transmitted by stool? 1.Yes 2.No
7.6.1 If yes 1.Cholera 2.Diarrhea 3.Dysentery 4.Typhoid fever 5.others:
85
7.7 Is the surroundings clean?
7.7.1.Floor: 1. Yes 2.no
7.7.2.Dishes: 1.yes 2. No
7.7.3.Inside house: 1.yes 2. No
8. SCHOOL ATTENDANCE/PRESCHOOL ATTENDANCE
8.1 Children from 6 – 14 years who do not attend to school what they do:
8.2 Children having given up school:
8.2.1. 1 At what age? 2 In which school? 3 Why?
8.3 Does one of your children go to a nursery school? 1. Yes 2. No
8.3.1 If not why? 1 No money 2.No time 3.others
8.4. If you could, will you send your child to a nursery school? 1.Yes 2. No
8.5 How much are you ready to pay per month for the school?
8.6 Does one of your children belong to a Club? 1. Yes 2. No
8.6. 1 If Yes which club
9. ECONOMY
9.1 For families having young people aged 16 to 25 years:
9. 1.1Which kind of work he would like to do?
9.1.2 Which kind of work you would like him (her) to do?
9.2 What kind of different jobs did you already have in your life?
9.3 How much money do you have on an average per day to buy food?
9.4 What means of transport you use? 1. Motorbike 2. Bicycle 3.Public transport 4.
Walking
9.5 How much do you spend for the education of your children?
9.5.1.Primary school: per Month
9.5.2.Secondary school: per Month

9.6 What do you do during your spare time?
9.7 Did you borrow money? 1.Yes 2. No.

9.7.1 If yes how much?
9.7.2 What for? : 1.Business 2. Diseases 3.Maintenance 4.Food 5.School fees 6.Wedding
7.Others
10 PROBLEMS
10.1 In your views, what are the main problems are: (to classify from 1 to 4)
86
1.Family harmony 7.Family planning
2.Health 8.Incomes
3.Housing 9.Malnutrition
4.Education 10.Transportation
5.Employment 11.Hygiene
6.Caste Discrimination 12.Others
10.1.1 How is the caste discrimination in your area (access drinking water, schooling,
public festival, religious work and other public services).
10.2 For the 2 main problems, which kind of solutions do you see?
10.2.1 Problem N° 1 Solution

10.2.2 Problem N°2 Solution
10.3 In your views what are the main problems of girls and women?
1.Early marriage 6.Unmarried pregnancy

2.Rape 7.Sexual abuse, exploitation and trafficking
3.Beating by husband 8.Alcoholism, badly scolding, using vulgar words
4.Multiple marriage 9.Rejected wives
5.Divorce 10.Discrimination of son / daughter

10.5 In your views what are the main problems of teenagers?
1. Drug addict 2. Left home 3. not care what parents said 4. do more expenses
5.others

11 MISCELLANEOUS
11.1 Do you use the services of the municipality, ward? 1. Yes No 2
11.1.1 If yes which one 1.Health Centre 2.School 3.Purchase of water 4.Well
5.Others
11.2 Do you attend meetings? 1.Yes 2. No
11.2.1.If yes: meeting with whom 1.local authorities 2. NGO 3.Others
11.3 Do you receive support from the local authorities? 1.Yes 2. No
11.3.1. If yes, by who? Which kind of support?
11.4 Do you receive support from the NGO? 1.Yes 2. No
11.4.1 If yes, by who? which kind of support?
87
Thank you very much
Family situation / Plan of the area
Plan per area (see annex)
COMMENTS OF THE INTERVIEWER
RECOMMENDATIONS
Technical Note
Please mark this sign | only. You can put this sign |more than one box for certain questions
88
SN Inco ID
Name Caste Age Sex Birthplace Relation Activity me Education Voter Citizenship Card
Card card
Per Per
day Month
89

Survey of Family in Kathmandu Final

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Survey of Vulnerable Families

July / August 2005

II. ABBREVIATIONS _________________________________________________________ 4

III. LIST OF TABLES _________________________________________________________ 6

1. Family Information ________________________________________________________ 6

II. EXECUTIVE SUMMARY ____________________________________________________ 9

CHAPTER ONE ______________________________________________________________ 11

CHAPTER TWO _____________________________________________________________ 14

CHAPTER THREE ___________________________________________________________ 17

RESULTS AND DISCUSSION _________________________________________________ 17

4. ANALYSIS AND CONCLUSION _____________________________________________ 71

CHAPTER FIVE _____________________________________________________________ 74

ANNEX I: KEY INDICATORS OF KATHMANDU ______________________________________ 80

I would like to extend my heartfelt gratitude to Ms. Daniele, Cheysson

My sincere gratitude goes to the local organizations, which allowed us to

Irada Parajuli Gautam

AIDS Acquired Immuno Deficiency Syndrome

AMDA Association of Medical Doctors of Asia

ANC Antenatal Care

ARI Acute Respiratory Infection

BCC Behaviour change communication

BNMT Britain Nepal Medical Trust

CAC Comprehensive abortion Care

CDD Control Diarrhoeal Diseases

CHD Child Health Division

CWIN Child workers in Nepal

DHO District Health Office

DOE Department of Education

DPT Diphtheria, Polio and Tetanus

E&D Enfants and Development

ECCD Early child hood care and development

EDHAG Environment Health Development Advisory Group

FPAN Family Planning Association of Nepal

HIV Human Immuno Deficiency Virus

HMG His Majesty of Government

IAISP Intensification of Antenatal Iron Supplementation Program

INGO International Non Government Organisation

IUD Intra Uterine Devices

MCH Maternal and Child Health

NER Net Enrolment Rate

NFE Non Formal Education

NGO Non Governmental Organisation

NLSS National Living Standard Survey

OPD Out Patient Department

PAC Post Abortion Care

PPS Pre-primary School

SIP School Improvement Plan

SPN Sunaulo Parivar Nepal

STI Sexually transmitted Infection

TBA Traditional Birth Attendants

VCT Voluntary Counselling and Testing

VDC Village Development Committee

VOC Voice of Children

1.1 Percentage distributions by Types of Respondents

1.10 Percentage distribution of Family members with voter card

2.1 Duration of living in the current place

3. Health Status of children under 5 yrs of age

3.1 Percentage Distribution Breast feeding practices for children

4. Status of Family Planning, Pregnancy and Delivery

4.1 Number of Pregnancy in Life

5. Status of Hygiene and Sanitation

5.1 Distribution practices of sources of drinking water

6. Status of Preschool and School Attendance

6.1 Level of education among children aged 5 and above