Disruptive Innovations Bringing Nepal Closer to Ending Extreme Poverty

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

In the maternity ward of a USAID-supported hospital in Dhulikhel, a town on the eastern rim of the Kathmandu Valley in Nepal, I watched a nurse apply a disinfectant gel to the umbilical cord of a newborn baby. That tube of the antiseptic chlorhexidine — worth under 15 cents — has been shown in a randomized control trial, to reduce neonatal mortality by a remarkable 34 percent in Nepal.

All around the country, more than 50,000 female community health volunteers are sharing this innovation and saving thousands of lives in the process.

Thanks to simultaneous advances in health, education, nutrition and access to energy, Nepal stands at the edge of its prosperity. On the path to overcoming the remnants of internal conflict and transitioning to democracy, the Nepalese have cut extreme poverty by 50 percentage points in the last two decades.

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns. / Thomas Cristofoletti for USAID

Innovative programming like chlorhexidine application is growing more common in Nepal and around the world. USAID is also supporting creative community-based approaches to countering human trafficking, including a novel effort to criminalize organ sales that has won landmark court cases, setting new precedent in Nepalese law for holding traffickers accountable.

Suaahara, a comprehensive nutrition program that translates to “good nutrition,” teaches skills for nutrient-rich backyard vegetable farming, raising poultry, improving sanitation and hygiene, and controlling pests through demonstration farms and new mothers’ discussion groups.

A focused effort to improve early-grade reading is supporting the Ministry of Education’s School Sector Reform Plan by strengthening curricula and training teachers, school committee members, parents and technical support staff in more than 27,000 Early Childhood Education Development centers across the country. Just a 10 percent increase in the share of students with basic literacy skills can boost a country’s economic growth by 0.3 percentage points, while laying the foundation for their later learning.

We need these kinds of disruptive innovations to help bend the curve toward increased child survival, better access to justice, lower malnutrition, greater literacy and skills, and, ultimately, the end of extreme poverty. Solutions like these will drive broader development progress and elevate our efforts to realize transformative change, and now, 2015, is the time to do it.

This year will be a pivotal year for international development. In Addis Ababa this summer, leaders will come together at the third Financing for Development conference to agree on a new compact for global partnership.

In the fall at the U.N. General Assembly in New York, heads of states will ratify a post-2015 development agenda, a universal, more comprehensive, more ambitious follow-on to the Millennium Development Goals, outlining a vision for the next 15 years of development progress. And in Paris next December, member states will adopt a new agreement to combat global warming at the 21st Conference of Parties to the U.N. Framework Convention on Climate Change.

Substantial challenges lie ahead for Nepal. Tensions from the recent conflict remain, simmering below the surface. The government has set a January 2015 deadline to approve a constitution – after a failed attempt in 2012 – to be followed by local elections, which haven’t been held in 16 years. And a quarter of Nepal’s population still lives on less than $1.25 a day.

Based on current projections, Nepal is likely to eradicate extreme poverty before 2030. If Nepal can navigate the pitfalls ahead, it is well-positioned to see long-term, sustainable growth by developing its immense hydropower potential, exploiting its unparalleled tourist draw, and producing goods and services for the growing middle class on its doorstep – the belt from eastern Pakistan through northern India to Bangladesh that constitutes the most densely populated area on earth.

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third. / Thomas Cristofoletti for USAID

While the solution to a vexing challenge like neonatal mortality may seem as simple as applying a bit of antiseptic ointment at the right time, this breakthrough came only after a dedicated and concerted effort to hammer away at the problem. USAID worked in partnership with academic researchers, government service providers, community extension workers, private-sector drug manufacturers and others to rigorously pilot, test and scale the Chlorhexidine project.

One particular obstacle, for instance, was that in much of Nepal mothers traditionally rub substances like cooking oil, ash, or even cow dung, on their babies’ umbilical stumps. For widespread adoption to be viable, USAID and its partners had to develop a gel that could be applied similarly to traditional salves, and spend as much effort on behavior change and institutional strengthening as on the technology.

By focusing our efforts on disruptive innovations such as Nepal’s successful chlorhexidine project and using the U.S. Global Development Lab to design, test and scale similar interventions around the world, USAID will help bend the curve towards the end of extreme poverty.