Public Health in Nepal

 

Snap of NEPAL

Nepal is a relatively small (population around 26.5 million) land-locked country, bordered by the two biggest countries in the world, India and China. Its renowned physical beauty makes it very fragmented and many parts are inaccessible by modern transport and communication facilities. There are few cities and 86% of the population lives in rural areas. The country is divided into 5 development regions, 14 zones and 75 districts. Despite its richness in biodiversity, natural resources and cultural multiplicity, Nepal has still remained a developing country where more than 24 percent of the people live under the poverty line. The impact of the poverty is manifest in all other sectors like health and hygiene, education, disaster and conflict preparedness, access to and distribution of resources, gender equity, as well as respect for humanitarian values. The transitional period of developmental change in the legal, political, financial and diplomatic scenario indicate that the country needs more efforts in the fields of social reformation, rehabilitation and development. 


Public Health Scenario of Nepal

The Government of Nepal has recognized health care, reproductive right, women right, safe environment right, as a basic fundamental right, as acknowledged in the Interim Constitution of Nepal 2063 (2007), and has declared that it’s the state's responsibility to ensure people's health. The vision of an inclusive society, where people of all races and ethnic groups, genders, castes, religions, political beliefs, and socioeconomic status live in peace and harmony, and enjoy equal rights without discrimination, as outlined in the Interim Constitution, is the guiding principal for all policies, plans and programmes of Ministry of Health and Population (MoHP). This has placed increasing pressure on the government to improve the delivery of health services, quantitatively and qualitatively, down to the grassroots levels. 

WHO advocate, 5% budget from total GDP and 10% budget from total budget should be allocated for health budget. There is growing debate on public health service in the world. In FY 066/67, the Government of Nepal has allocated Rs. 24.51 billion for the health sector, which is 7.25 per cent of the total budget and 5.6 percent of GDP.  The government aims at making free health services more accessible and conducts a feasibility study on health insurance. In Nepal, there has been an increment of 31.28 per cent in the health budget; however, it is still not 10 per cent of the total budget as promised by the then government in 1991. More than that, the allocation also is not enough to provide free medical services to the poor as spelled out in the interim constitution. 

However, the country is going through demographic and epidemiological transitions. Now country endorsed the new Nepal Health Sector Programme Implementation Plan (NHSP-IP II) and comparatively high emphasizes on the essential services package. The health sector is heavily dependent on external resources. At the same time, people spend a significant amount of money on health care from their pocket. The private sector is growing without much regulation and supervision from the Ministry of Health. 

The key areas identified where we need to promote health service in area of : equitable health care financing; increased access of the underprivileged to services; integrated disease surveillance; prevention and control of communicable and chronic diseases; rationalization of human resource development and management; reduction of maternal and neonatal mortality (safe motherhood); promotion of healthier physical environment; and health system capacity building for emergency preparedness and response. Emphasis is also placed on facilitating the process of decentralization of health services, and supporting development of a strategy for effective public/private/ NGO collaboration. Support for mobilizing additional resources for the health sector and to better harmonize its work with those of other UN agencies and external development partners will also be considered. Cross-cutting issues such as health equity, health as a human right, people’s empowerment, Community health insurance and the health system’s responsiveness to people’s needs. 


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. Provisions 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. Traditional beliefs have also been shown to play a significant role in the spread of disease in 


Health Politics

Health care issues are largely attributed by the fact that its political power and resources are mostly centered in its capital, resulting in the social exclusion of other parts of Nepal. The restoration of republican in 2006 has allowed the strengthening of local institutions, inclusive, identity, decentralization and health right etc. 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 clear in political vision to promote health issues  Nepal has failed to achieve complete target of SLTHP, MDG and many more. 


Policy Strategy

Beside the major indicator of health sector, a major goal of NHSP-IP II (2010-2015) is to sustain and build on a program delivering excellent results. Gender and social exclusion issues came into greater prominence during the implementation of NHSP-IP II, particularly with the extension of free services, focus on improving the health of poor and marginalized groups. NHSP-IP II also aims to reconsider how best to achieve improved efficiency and accountability in order to sustain government and external development partner (EDP) support and make the best use of limited resources. Recently, the Population Perspective Plan (PPP) 2010-2031 was formulated based on a multidisciplinary approach in order to integrate population aspects with relevant economic and social sectors. It also provides a thematic focus on three aspects: poverty reduction, gender mainstreaming, and social inclusion including poverty alleviation and sustainable development.

For achieving this right, the civil society, professional organization has been playing the role of vanguard to pressurize the government to make sure that it comes up with progressive improvement and implemented one after another. Effective incited by the pressure of the professional society, it has started to emphasize on transparency, accountability, decentralization, accessibility, affordability, equality service, equity as per necessary, public private partnership. In this context, Nepal Public Health Association now focus on the areas of basically advocacy and lobbying for development of community based health policy, necessary research, training, and conduct public health action. Hence, NEPHA is dedicated to strengthening its organization, expanding of committee, defining its priority and moving ahead related to public health with further programmes for wider outreach. 


Public Health Indicator in Nepal 

Indicator

Measure

 Nepal Demographic Indicator

Total area

147181 Sq.km

Total population

26,494,504

Population density per Sq Km

180

Working age population

57 Percent

GDP

$ 18,884, 495, 628

GDP growth

3.8 %

Population growth rate per annum

1.35

Population below poverty line (NPC)

25

No. of house hold

56,59,984

Family size

4.7

Per Capita Income

US$735

HDI rank out of 187

157

Literacy rate

65.9

Literacy rate

Male

75.1%

Female

57.4%

Life Expectancy

66.51 

Life Expectancy

Male

65.26 years 

Female

67.82

Total male population

48.56

Total female population

51.44

Sex ratio

94.2

Gender Inequality Index

0.558

 Major Health Indicators

CBR

28 births/1,000 population

CDR

8 deaths/1,000 population

Infant mortality rate

46 deaths/1,000 live births 

under-five mortality rates

54 deaths/1,000 live births 

Neo natal mortality rate

33 deaths/1,000 pregnancy 

Perinatal mortality rate

37 deaths/1,000 live births 

Maternal mortality rate

224 per 100000 live birth

EPI (2011)

BCG

96.2

OPV

94

DPT-Hep, B-Hib

94

Measles

87.7

Malnutrition Child (Percent of total GMC)

3.4 %

Prevalence of underweight children under five years of age

 

28.8

CPR

43 %

TFR

2.6

First ANC Visit

85%

Four times complete ANC visit

50.1

Un meet need of FP

27 %

Birth Attendance SBA

36 %

Institutional based delivery

35 %

CEOC service available

60 District

CEOC Site Number

99 sites

BEOC service providing PHCC

80 %

Birthing facility in health post

70%

Safe Abortion between 2010 to 11

95306 in No

Aware about legal abortion service in Nepal

38 percent

Experience of physical violence (Ever)

33.6

People living with HIV and AIDS (Est. 2012))

52200

Percentage of population using an improved drinking water

Source

88.6 %

Percentage of population with access to improved sanitation

39.5 %

 Government Health Facility indicator

Public Hospital

95

Regional Hospital

3

Sub Regional Hospital

2

Central Hospital

8

Zonal Hospital

10                                          

District Hospital

65

DHO

60

DPHO

15

Regional Training Center

5

Regional Medical Store

5

Regional TB Center

5

PHCC

209

HPs

676

SHPs

3129

PHC/ORC

12790

EPI Clinics

16579

FCHV

48680

Source:

Census report 2011

Nepal Population Report 2011

National Demographic Health Survey 2011

National Planning Economic Report 2011

Annual Report 2011, DHS

 

Contact

Nepal Public Health Association
Jeet Jung Marg, Thapathali Height

Kathmandu-11, Nepal
Phone: 01-4248513, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Url: www.nepha.org.np

Affiliations