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=== Maternal Health ===
=== Maternal Health ===
Nepal has made significant progress in improving the health of women and children and is on track in 2013 to achieve Millennium Development Goals (MDGs) 4 (to reduce child mortality) and 5A (to reduce maternal mortality). This review provided an opportunity for the MoHP and other stakeholders in Nepal to synthesize and document how these improvements were made, focusing on policy and programme management best practices.
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Nepal is one of a country where the goal of MDG 5A is on track . Nepal has made significant progress in improving maternal health. [[Maternal death|Maternal mortality rate]] was reduced from 748 per 100 000 live birth in 1990<ref>{{Cite web|url=https://www.gapminder.org/tools/#_chart-type=bubbles&state_time_value=1991&end=2013&startSelected=1980&endSelected=2013;&entities_select@_geo=npl&trailStartTime=1991;;;&marker_axis%2F_y_which=maternal%2F_mortality%2F_ratio%2F_per%2F_100000%2F_live%2F_births&domainMax:2680&zoomedMin:1&zoomedMax:2680&scaleType=log;&axis%2F_x_which=time&domainMin=1800&domainMax=2015&zoomedMin=1800&zoomedMax=2012&scaleType=time|title=Gap minder : Maternal mortality rate 1991 Nepal|last=|first=|date=|website=|publisher=|access-date=04/09/2016}}</ref> to 190 per 100 000 live birth on 2014. since 1991 to 2013.<ref name=":0">{{Cite web|url=http://dohs.gov.np/wp-content/uploads/2014/04/Annual_Report_2070_71.pdf|title=Annual Report 2013/2014|last=|first=|date=|website=|publisher=|access-date=04/09/2016}}</ref> Nepal has also made some progress on reducing [[total fertility rate]] (TFR), from 5.3 1991<ref>{{Cite book|title=Nepal fertility, family planning and health survey: (NFHS, 1991)|last=|first=|publisher=|year=1993|isbn=|location=Kathmandu Nepal|pages=|via=}}</ref> to 2.3 in 2014.<ref name=":0" />

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Nepal has made significant progress in improving maternal health. [[Maternal death|Maternal mortality rate]] was reduced from 748 per 100 000 live birth in 1990<ref>{{Cite web|url=https://www.gapminder.org/tools/#_chart-type=bubbles&state_time_value=1991&end=2013&startSelected=1980&endSelected=2013;&entities_select@_geo=npl&trailStartTime=1991;;;&marker_axis%2F_y_which=maternal%2F_mortality%2F_ratio%2F_per%2F_100000%2F_live%2F_births&domainMax:2680&zoomedMin:1&zoomedMax:2680&scaleType=log;&axis%2F_x_which=time&domainMin=1800&domainMax=2015&zoomedMin=1800&zoomedMax=2012&scaleType=time|title=Gap minder : Maternal mortality rate 1991 Nepal|last=|first=|date=|website=Gapminder|publisher=|access-date=04 September 2016}}</ref> to 190 per 100 000 live birth on 2014. since 1991 to 2013.<ref name=":0">{{Cite web|url=http://dohs.gov.np/wp-content/uploads/2014/04/Annual_Report_2070_71.pdf|title=Annual Report 2013/2014|last=|first=|date=|website=|publisher=|access-date=04/09/2016}}</ref> Nepal has also made some progress on reducing [[total fertility rate]] (TFR), from 5.3 1991<ref name=":1">{{Cite book|title=Nepal fertility, family planning and health survey: (NFHS, 1991)|last=|first=|publisher=|year=1993|isbn=|location=Kathmandu Nepal|pages=|via=}}</ref> to 2.3 in 2014.<ref name=":0" />


Despite of other indicator related to maternal health, the health indicator of contraceptive prevalance rate is showing its dereasing trend 2006 (44.2%) and 2011 (43.2%),<ref>{{Cite web|url=http://dhsprogram.com/pubs/pdf/FR257/FR257%5B13April2012%5D.pdf|title=Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population (MoHP), New ERA and ICF International, Calverton, Maryland; 2012.|last=|first=|date=|website=|publisher=|access-date=}}</ref> and has been attributed to high rates of spousal separation due to migration to other countries for employment (three fourths of youth in rural areas). The use of maternal health services has improved since 1996, with increases in the coverage and number of ANC visits (59% for four ANC visits) in 2014,<ref name=":0" /> rates of institutional deliveries as well as deliveries attended by a SBA (50%).<ref name=":0" />
Despite of other indicator related to maternal health, the health indicator of contraceptive prevalance rate is showing its dereasing trend 2006 (44.2%) and 2011 (43.2%),<ref>{{Cite web|url=http://dhsprogram.com/pubs/pdf/FR257/FR257%5B13April2012%5D.pdf|title=Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population (MoHP), New ERA and ICF International, Calverton, Maryland; 2012.|last=|first=|date=|website=|publisher=|access-date=}}</ref> and has been attributed to high rates of spousal separation due to migration to other countries for employment (three fourths of youth in rural areas). The use of maternal health services has improved since 1996, with increases in the coverage and number of ANC visits (59% for four ANC visits) in 2014,<ref name=":0" /> rates of institutional deliveries as well as deliveries attended by a SBA (50%).<ref name=":0" />


=== Child Health ===
=== Child Health ===

The under-5 mortality rate per 1,000 births is 51 and the neonatal mortality as a percentage of under 5's mortality is 55. In Nepal, the number of midwives per 1,000 live births is 4 and the lifetime risk of death for pregnant women 1 in 80.<ref name="SOWMY">{{cite web|url=http://www.unfpa.org/sowmy/report/home.html|title=The State Of The World's Midwifery|publisher=United Nations Population Fund|accessdate=August 2011}}</ref>
Nepal is also on track to achieve MDG 4 having attained a rate of 35.8 under 5 child deaths per 1000 Live birth in 2015<ref name=":2">{{Cite web|url=http://data.worldbank.org/country/nepal|title=World Development Indicators [online database]. Washington DC: The World Bank; 2015|last=|first=|date=|website=World Development Indicators [online database].|publisher=|access-date=06 September 2016}}</ref> from 162 in 1991<ref name=":1" /> according to national data. Global estimates indicate that the rate has reduced by 65% from 128 to 48 per 1000 live births between 1991 and 2013.<ref>{{Cite web|url=https://www.gapminder.org/tools/#_chart-type=bubbles&state_time_value=2011&start=1931&end=2011&startSelected=1949&endSelected=2011;&entities_select@_geo=npl&trailStartTime=2011;;;&marker_axis%2F_y_which=under%2F_five%2F_mortality%2F_from%2F_cme%2F_per%2F_1000%2F_born&domainMin:1.8&domainMax:492.8&zoomedMin:1.8&zoomedMax:492.8&scaleType=log;&axis%2F_x_which=time&domainMin=1931&domainMax=2011&zoomedMin=1931&zoomedMax=2011&scaleType=time|title=Gapminder Under five mortality from 1991 to 2011|last=|first=|date=|website=Gapminder|publisher=|access-date=06 September 2015}}</ref> Nepal has successfully improved coverage of effective interventions to prevent or treat the most important causes of child mortality through a variety of community-based and national campaign approaches. These include high coverage of semiannual vitamin A supplementation and deworming; CB-IMCI; high rates of full child immunization; and moderate coverage of exclusive breastfeeding of children under 6 months. However, in the past few years the NMR has remained stagnant at around 22.2 deaths per 1000 Live Birth in 2015 . This compares to a rate of 27.7 in India (2015) and 45.5 in Pakistan (2015).<ref name=":2" />

The NMR is a serious concern in Nepal, accounting for 76% of the infant mortality rate (IMR) and 58% of the under 5 mortality rate (U5MR) in 2015 and is one of its challenges going forward<ref name=":2" />. Typically, a history of conflict negatively affects health indicators. However, Nepal made progress in most health indicators despite its decade-long armed conflict. Attempts to understand this have provided a number of possible explanations including the fact that in most instances the former rebels did not purposely disrupt delivery of health services; pressure was applied on health workers to attend clinics and provide services in rebel base areas; the conflict created an environment for improved coordination among key actors; and Nepal’s public health system adopted approaches that targeted disadvantaged groups and remote areas, particularly community-based approaches for basic service delivery with a functional community support system through female community health volunteers (FCHVs), women’s groups and Health Facility Operational Management Committees (HFOMCs).<ref>{{Cite journal|last=Devkota|first=Bhimsen|date=1 December 2010|title=Understanding effects of armed conflict on health outcomes: the case of Nepal|url=http://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-4-20|journal=BioMed Central Ltd. 2010|volume=|issue=|doi=10.1186/1752-1505-4-20|pmid=|access-date=06 September 2016|via=}}</ref>


==References==
==References==

Revision as of 12:45, 6 September 2016

Health care services in Nepal are provided by both the public and private sector and fare poorly by international standards. Disease prevalence is higher in Nepal than it is in other South Asian countries, especially in rural areas.Moreover, the country’s topographical and sociological diversification helps to promote periodic epidemics of infectious diseases, epizootics and natural hazards like floods, forest fires, landslides and earthquakes. Millions of people are at risk of infection and thousands die every year due to communicable diseases, malnutrition and other health-related events which particularly affect the poor living in rural areas. However, Some improvements in health care have been made, most notably significant progress in maternal-child health. For example, Nepal’s Human Development Index (HDI) was 0.458 in 2011[1] up from 0.291 in 1975.[2] Other improvements include:[3]

Health Indicators[9][10][11]
Population growth 1.28
Life expectancy 67
Infant mortality 39
Fertility 2.64
Total expenditure on health per capita (Intl $, 2009) 69
Total expenditure on health as % of GDP (2009) 5.8

Health care expenditure

In 2002, the government funding for health matters was approximately US$2.30 per person. Approximately 70% of health expenditures came from out-of-pocket contributions. Government allocation for health care was around 5.8% of the budget for 2009.[12] In 2012, the Nepalese government decided to launch a pilot program on universal health insurance in five districts of the country.[13]

Health care infrastructure

Health care facilities, hygiene, nutrition and sanitation in Nepal are of poor quality, particularly in the rural areas. Despite that, it is still beyond the means of most Nepalese. Provision of health care services are constrained by inadequate government funding. The poor and excluded have limited access to basic health care due to its high costs and low availability. The demand for health services is further lowered by the lack of health education. Reproductive health care is neglected, putting women at a disadvantage. In its 2009 human development report, UN highlighted a growing social problem in Nepal. Individuals who lack a citizenship are marginalized and are denied access to government welfare benefits.[14] Traditional beliefs have also been shown to play a significant role in the spread of disease in Nepal.[15][16]

These problems have led many governmental and nongovernmental organizations (NGOs) to implement communication programs encouraging people to engage in healthy behavior such as family planning, contraceptive use, and spousal communication, safe motherhood practices, and use of skilled birth attendants during delivery and practice of immediate breastfeeding.[17]

Nutritional status of Nepalese children under 5 years of age[18]
Urban areas Rural areas Overall
Stunted 37% 52% 51%
Wasted 8% 10% 10%
Underweight 33% 49% 48%

Geographical constraints

Much of rural Nepal is located on hilly or mountainous regions. The rugged terrain and the lack of proper infrastructure make it highly inaccessible, limiting the availability of basic health care.[19] In many villages, the only mode of transportation is by foot. This results in a delay of treatment, which can be detrimental to patients in need of immediate medical attention.[20] Most of Nepal's health care facilities are concentrated in urban areas. Rural health facilities often lack adequate funding.[21]

In 2003, Nepal had ten health centers, 83 hospitals, 700 health posts, and 3,158 "sub-health posts", which serve villages. In addition, there were 1,259 physicians, one for every 18,400 persons.[12] In 2000, government funding for health matters was approximately US$2.30 per person, and approximately 70 percent of health expenditures came from out-of-pocket contributions. Government allocations for health were around 5.1 percent of the budget for fiscal year 2004, and foreign donors provided around 30 percent of the total budget for health expenditures.[2]

Political influences

Nepal’s health care issues are largely attributed to its political power and resources being mostly centered in its capital, Kathmandu, resulting in the social exclusion of other parts of Nepal. The restoration of democracy in 1990 has allowed the strengthening of local institutions. The 1999 Local Self Governance Act aimed to include devolution of basic services such as health, drinking water and rural infrastructure but the program has not provided notable public health improvements. Due to a lack of political will,[citation needed] Nepal has failed to achieve complete decentralization, thus limiting its political, social, and physical potential.[14]

Health status

Life expectancy

In 2010 with the average Nepalese lived to 65.8 years.[12]

Diseases

Leading diseases and illnesses include diarrhea, gastrointestinal disorders, goiter, intestinal parasites, leprosy, visceral leishmaniasis and tuberculosis.[2]

HIV/AIDS

Main article: HIV/AIDS in Nepal

As of December 2007, the Government of Nepal reported 1,610 cases of AIDS and 10,546 HIV infections, which has grown to 13,000 infections by World AIDS Day 2008.[22] UNAIDS estimates from 2007 indicate that approximately 75,000 people in Nepal are HIV-positive, including all age groups. The Government of Nepal's National Center for AIDS & STD Control (NCASC) estimated that number to be closer to 70,000 in December 2007.[23] NCASC (2010) reports that estimated number of HIV infections by risk groups is 59,984 [24]

The epidemic in Nepal is driven by injecting drug users, migrants, sex workers and their clients, and MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in Kathmandu, Pokhara, and East and West Terai indicate that the highest prevalence rates have been found among urban IDUs, 6.8 percent to 34.7 percent of whom are HIV-positive, depending on location. In terms of absolute numbers, Nepal's 1.5 million to 2 million labor migrants account for the majority of Nepal’s HIV-positive population. In one subgroup, 2.8 percent of migrants returning from Mumbai, India, were infected with HIV, according to the 2006 IBBS among migrants.[23]

As of 2007, HIV prevalence among female sex workers and their clients was less than 2 percent and 1 percent, respectively, and 3.3 percent among urban-based MSM. HIV infections are more common among men than women, as well as in urban areas and the far western region of Nepal, where migrant labor is more common. Labor migrants make up 41 percent of the total known HIV infections in Nepal, followed by clients of sex workers (15.5 percent) and IDUs (10.2 percent).[23]

Maternal Health

Nepal has made significant progress in improving the health of women and children and is on track in 2013 to achieve Millennium Development Goals (MDGs) 4 (to reduce child mortality) and 5A (to reduce maternal mortality). This review provided an opportunity for the MoHP and other stakeholders in Nepal to synthesize and document how these improvements were made, focusing on policy and programme management best practices.

Nepal has made significant progress in improving maternal health. Maternal mortality rate was reduced from 748 per 100 000 live birth in 1990[25] to 190 per 100 000 live birth on 2014. since 1991 to 2013.[26] Nepal has also made some progress on reducing total fertility rate (TFR), from 5.3 1991[27] to 2.3 in 2014.[26]

Despite of other indicator related to maternal health, the health indicator of contraceptive prevalance rate is showing its dereasing trend 2006 (44.2%) and 2011 (43.2%),[28] and has been attributed to high rates of spousal separation due to migration to other countries for employment (three fourths of youth in rural areas). The use of maternal health services has improved since 1996, with increases in the coverage and number of ANC visits (59% for four ANC visits) in 2014,[26] rates of institutional deliveries as well as deliveries attended by a SBA (50%).[26]

Child Health

Nepal is also on track to achieve MDG 4 having attained a rate of 35.8 under 5 child deaths per 1000 Live birth in 2015[29] from 162 in 1991[27] according to national data. Global estimates indicate that the rate has reduced by 65% from 128 to 48 per 1000 live births between 1991 and 2013.[30] Nepal has successfully improved coverage of effective interventions to prevent or treat the most important causes of child mortality through a variety of community-based and national campaign approaches. These include high coverage of semiannual vitamin A supplementation and deworming; CB-IMCI; high rates of full child immunization; and moderate coverage of exclusive breastfeeding of children under 6 months. However, in the past few years the NMR has remained stagnant at around 22.2 deaths per 1000 Live Birth in 2015 . This compares to a rate of 27.7 in India (2015) and 45.5 in Pakistan (2015).[29]

The NMR is a serious concern in Nepal, accounting for 76% of the infant mortality rate (IMR) and 58% of the under 5 mortality rate (U5MR) in 2015 and is one of its challenges going forward[29]. Typically, a history of conflict negatively affects health indicators. However, Nepal made progress in most health indicators despite its decade-long armed conflict. Attempts to understand this have provided a number of possible explanations including the fact that in most instances the former rebels did not purposely disrupt delivery of health services; pressure was applied on health workers to attend clinics and provide services in rebel base areas; the conflict created an environment for improved coordination among key actors; and Nepal’s public health system adopted approaches that targeted disadvantaged groups and remote areas, particularly community-based approaches for basic service delivery with a functional community support system through female community health volunteers (FCHVs), women’s groups and Health Facility Operational Management Committees (HFOMCs).[31]

References

  1. ^ "gapminder world". gapminder.org. Retrieved 6 September 2016.
  2. ^ a b c Nepal country profile. Library of Congress Federal Research Division (November 2005). This article incorporates text from this source, which is in the public domain.
  3. ^ Nepali Times Issue #561 (8 July 2011 – 14 July 2011)
  4. ^ "gapminder world". gapminder.org. Retrieved 6 September 2016.
  5. ^ "gapminder world". gapminder.org. Retrieved 6 September 2016.
  6. ^ "gapminder world". gapminder.org. Retrieved 6 September 2016.
  7. ^ "gapminder world". gapminder.org. Retrieved 6 September 2016.
  8. ^ HDI 2010 index from article Let's Talk Human Development - Data challenges in estimating the HDI: The cases of Cuba, Palau and the Occupied Palestinian Territory
  9. ^ UNICEF Nepal statistics
  10. ^ Health Organisation Data from the Global Health Observatory
  11. ^ Health Profile World Health Organisation data (2010)
  12. ^ a b c Nepal Health Profile World Health Organisation data (2010)
  13. ^ "Health for all". My Republica. Retrieved 14 November 2012.
  14. ^ a b Nepal human development report 2009-State transformation and human development by United Nations Development programme
  15. ^ Beine, David. 2001. "Saano Dumre Revisited: Changing Models of Illness in a Village of Central Nepal." Contributions to Nepalese Studies 28(2): 155-185.
  16. ^ Beine, David. 2003. Ensnared by AIDS: Cultural Contexts of HIV/AIDS in Nepal. Kathmandu, Nepal: Mandala Book Point.
  17. ^ Karki, Yagya B.; Agrawal, Gajanand (May 2008). "Effects of Communication Campaigns on the Health Behavior of Women of Reproductive Age in Nepal, Further Analysis of the 2006 Nepal Demographic and Health Survey" (pdf). Macro International Inc. Retrieved 14 November 2012.
  18. ^ NDHS Fact Sheet, 2001
  19. ^ International Fund for Agricultural Development (IFAD) retrieved 20 September 2011
  20. ^ United Methodist Committee on relief; retrieved on 20 September 2011
  21. ^ Shiba Kumar Rai, Kazuko Hirai, Ayako Abe,Yoshimi Ohno 2002 "Infectious Diseases and Malnutrition Status in Nepal: an Overview"
  22. ^ Nearly 13,000, The Hindu, "Nearly 13,000 HIV/AIDS cases recorded in Nepal", December 8, 2008, retrieved April 28, 2011.
  23. ^ a b c "Health Profile: Nepal". United States Agency for International Development (March 2008). Accessed August 25, 2008. Public Domain This article incorporates text from this source, which is in the public domain.
  24. ^ http://www.ncasc.gov.np/
  25. ^ "Gap minder : Maternal mortality rate 1991 Nepal". Gapminder. Retrieved 04 September 2016. {{cite web}}: Check date values in: |access-date= (help)
  26. ^ a b c d "Annual Report 2013/2014" (PDF). Retrieved 04/09/2016. {{cite web}}: Check date values in: |access-date= (help)
  27. ^ a b Nepal fertility, family planning and health survey: (NFHS, 1991). Kathmandu Nepal. 1993.{{cite book}}: CS1 maint: location missing publisher (link)
  28. ^ "Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population (MoHP), New ERA and ICF International, Calverton, Maryland; 2012" (PDF).
  29. ^ a b c "World Development Indicators [online database]. Washington DC: The World Bank; 2015". World Development Indicators [online database]. Retrieved 06 September 2016. {{cite web}}: Check date values in: |access-date= (help)
  30. ^ "Gapminder Under five mortality from 1991 to 2011". Gapminder. Retrieved 06 September 2015. {{cite web}}: Check date values in: |access-date= (help)
  31. ^ Devkota, Bhimsen (1 December 2010). "Understanding effects of armed conflict on health outcomes: the case of Nepal". BioMed Central Ltd. 2010. doi:10.1186/1752-1505-4-20. Retrieved 06 September 2016. {{cite journal}}: Check date values in: |access-date= (help)CS1 maint: unflagged free DOI (link)

External links

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