Public Health Status and

challenges of Nepal

Prepared by
Sagar Prasad Ghimire
MPH, Institute of Medicine, Nepal
China
Nepal’s Population
Pyramid 2003
Basic Information
 AREA: 1,47,181 Sq.Km

 HIGHEST MOUNTAIN: Mount Everest

 POPULATION: 24.6 million

 REGION: 5

 ZONE: 14

 DISTRICT: 75
 Major Indicators
CBR (per 1000 population) 33.1
CDR (per 1000 population) 9.6
TFR 4.1
IMR (per 1000 live birth) 64.4
U5MR (per 1000 live birth) 91.2
Life expectency 59.7 years
Mean age at marriage 21.9 (M),19.5 (F)
MMR (per 100000 live birth) 539*
PGR 2.24
Literacy Rate 54.1
Urban Population 14.2 %
(Source: Census, 2001* NDHS 1996)
 Diseases status
Ten Leading Outpatient
Top Reasons for Hospitalization, Diseases, 2003/04
2003/04
(dominated by infectious
 Spontaneous Delivery diseases)
 Diarrhea and Gastroenteritis  Skin Diseases
 Pneumonia  Diarrhea Diseases
 Typhoid  Acute Respiratory Infection
 Other Chronic Obstructive Pulmonary
 Intestinal Worms
 Unsuspected Acute Lower Respiratory
 Injury of unspecified body region  Pyrexia
 Unspecified Abortion  Gastritis
 Single Delivery by Caesarean Section  Ear Infection
 Fever of Unknown Origin
 Chronic Bronchitis

 Abdominal Pain

 Sore Eye and Complaints

Some related facts:
 proportion of HH, who have access to safe drinking
water:79.9% (92.3% urban and 78.1% rural)

 Proportion of HH with any type of toilets was 33.2%

but the proportion with safe toilets was only 29.4%

 39.8% of them had at least one ANC check-up during

their last pregnancy

 About 13% of deliveries took place under the

guidance of medically trained persons
(a Survey by CBS-Nepal 2000)
 Health Service Coverage Fact Sheet
2001/2002 2002/2003 2003/2004

EXPANDED PROGRAMME ON IMMUNIZATION

BCG Coverage 94 % 97 % 96 %
DPT-3 Coverage 80 % 86 % 90 %
Polio-3 Coverage 80 % 84 % 90 %
Measles Coverage 76 % 80 % 85 %
Nutrition
Growth Monitoring Coverage as % 41 % 51 % 55 %
of <3 Children New Visits
Proportion of Malnourished Children 16 % 14 % 12 %
(Weight/Age)
 Health Service Coverage Fact Sheet contd.

2001/2002 2002/2003 2003/2004

ACUTE RESPIRATORY INFECTION

Reported Incidence of ARI/1,000 <5 229 289 344
Children New Visits
Annual Reported Incidence of 97 113 131
Pneumonia (Mild+Severe)/1,000
among <5 Children New Visits
DIARRHOEAL DISEASES
Diarrhoeal Deaths/1,000 117 200 222
Diarrhoeal Deaths/1,000 0.04 0.04 0.05
Case Fatality Rate/1,000 0.22 0.20 0.25
 Health Service Coverage Fact Sheet contd.
2001/2002 2002/2003 2003/2004

SAFE MOTHERHOOD
Antenatal First Visits as % of 43 % 53 % 66 %
Expected Pregnancies
ANC Four Visits among 1st Visit 37.8 % 36.8 % 43.6 %
Average No. of ANC Visits per 1.9 1.8 2.1
Pregnant Woman
Deliveries Conducted by Health Workers 7.9 % 16.1 % 18.3 %
as % of Expected Pregnancies
Deliveries Conducted by TBAs as % 7.1 % 8.4 % 11.3 %
of Expected Pregnancies
PNC First Visits as % of Expected 14.4 % 18.1 % 28.3 %
Pregnancies
 Health Service Coverage Fact Sheet contd.
2001/2002 2002/2003 2003/2004

FAMILY PLANNING
Contraceptive Prevalence Rate 37.4 % 37.8 % 40.2 %
(adjusted)
MALARIA CONTROL PROGRAMME
Blood Slide Examination Rate per 0.6 % 0.6 % 0.8 %
100 Malarious Area Population
Slide Positivity Rate (SPR) 9.2 % 8.1 % 4.3 %
LEPROSY CONTROL PROGRAMME

New Case Detection Rate/10,000 5.73 3.24 2.84

Prevalence Rate/10,000 4.41 3.04 2.41
 Health Service Coverage Fact Sheet contd.
2001/2002 2002/2003 2003/2004

TUBERCULOSIS CONTROL PROGRAMME

Case Detection Rate 70 % 71 % 71 %

Treatment Success Rate on DOTS 89 % 90 % 88 %

Sputum Convertion Rate 84 % 85 % 86 %

DOTS Coverage (Population) 89 % 95 % 96 %

Health Services Coverage Fact Sheet:

Source: Annual Report, Department of Health Services
(2003/2004)
 Cumulative HIV/AIDS Situation of Nepal

As of October 31, 2005

New Cases
in
Condition Male Female Total
October
2005
HIV Positives (Including
AIDS) 4042 1522 5564 99

AIDS (out of total HIV) 671 258 929 22

Death 273 (10*)

* In oct 2005
 Ministry of Health

Department of Health Services

D I V I S I O N S C E N T R E S

NHEICC

NCASC
EDCD

NHTC

NPHL
LMD
CHD

LCD
FHD

NTC
MD

CE NT RA L
LEVEL C ent ral H os pit als - 5

Regional Health Directorate - 5

Regional Training Centre (5)

Regional Medical Store (5)

Regional Laboratory (1)

Regional TB Centre (1)

Regional Hospital (1)

REGIONAL
LEVEL (5)

ZONAL
Zonal Hospi tal - 11
LEVEL (14)

DISTRICT Di stri ct Publ i c Di stri ct Hospi tal Di stri ct Heal th Offi ce

LEVEL (75) Heal th Offi ce - 14 62 61

ELECTORAL Pri mary Heal th Care Centre/

CONSTITUENCY Heal th Centre - 188
(205)

Heal th Post - 698

VDC LEVEL (3,995) Sub Heal th Post - 3,129

COMMUNITY FCHV T BA PHC ORC Clinic EPI Outreach Clinic

48,307 15,553 14,769 15,833
LEVEL
 Health Problems
 Major health concerns
 Maternal Health
 Malnutrition / anemia
 New and re-emerging conditions
 Sexually Transmitted Infections
 HIV
 Vector-borne diseases
 Malaria

 Kala-azar

 Japanese Encephalitis

 Infectious diseases
 Acute respiratory Infection
 Tuberculosis
 Diarrhea
 Why is Health Delivery System Failing?

 Insecurity and conflict

 Lack of human resources (high vacancy rates in rural
locations)
 Lack of supplies and equipment at rural facilities
 Lack of sufficient infrastructure inputs
 Mismanagement of ‘poor funds’ and subsidies
 Mistrust and fear of government services
 Poor perceived quality of care and provider behavior
 Supply and demand centralized
 Inaccessibility
 Health Financing

 WHO target is US$12 (NRs.850) public spending per

person
 Nepal official spending only US$3.10 (NRs.220) per person
 Development Budget
 7.28% earmarked for health (9th Plan); only 3.8% received
 Escalation of conflict reducing budget for military spending
 Donors
 Provide for majority of current health budget
 Consider health a ‘safe’ and necessary sector
 Will continue to pursue even in conflict
 Public Health Challenges
 Resource Gap current 30 % : How to fulfill ?, Issue of Debate.
 Privatization of health services: increase quality in urban areas but
challenging for remote and far people.
 Epidemiological transition: Still facing huge burden of communicable
disease(Diarrhoea, ARI) with newly emerging Non-communicable
disease along with some new concentrated epidemic (HIV/AIDS)
 Internal conflict: Negative impact on overall social development
(Death, Violence, Handicapped, Disabled, migration, Rape)
 WTO, Membership: Lacking preparation and capacity to promote
national interest.
 Human Resource for health: Urban centered highly skilled manpower
 Globalization:
Commercialization (Safe Delivery kit, ORS, FP devices)
Privatization (Quality increase but accessibility and affordability)
Introduction of user’s fee in public health facilities: Affordability for poor
people