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
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AREA:
1,47,181 Sq.Km
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HIGHEST MOUNTAIN:
Mount Everest
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POPULATION:
24.6 million
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REGION:
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ZONE:
14
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DISTRICT:
75
5
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
Top Reasons for Hospitalization,
2003/04
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Spontaneous Delivery
Diarrhea and Gastroenteritis
Pneumonia
Typhoid
Other Chronic Obstructive Pulmonary
Unsuspected Acute Lower Respiratory
Injury of unspecified body region
Unspecified Abortion
Single Delivery by Caesarean Section
Fever of Unknown Origin
Ten Leading Outpatient
Diseases, 2003/04
(dominated by infectious
diseases)
 Skin Diseases
 Diarrhea Diseases
 Acute Respiratory Infection
 Intestinal Worms
 Pyrexia
 Gastritis
 Ear Infection
 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)
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Proportion of HH with any type of toilets was 33.2%
but the proportion with safe toilets was only 29.4%
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39.8% of them had at least one ANC check-up during
their last pregnancy
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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 %
Growth Monitoring Coverage as %
of <3 Children New Visits
41 %
51 %
55 %
Proportion of Malnourished Children
(Weight/Age)
16 %
14 %
12 %
Nutrition
Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003
2003/2004
Reported Incidence of ARI/1,000 <5 229
Children New Visits
289
344
Annual Reported Incidence of
Pneumonia (Mild+Severe)/1,000
among <5 Children New Visits
97
113
131
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
ACUTE RESPIRATORY INFECTION
DIARRHOEAL DISEASES
Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003 2003/2004
Antenatal First Visits as % of
Expected Pregnancies
43 %
53 %
66 %
ANC Four Visits among 1st Visit
37.8 %
36.8 %
43.6 %
Average No. of ANC Visits per
Pregnant Woman
1.9
1.8
2.1
Deliveries Conducted by Health Workers
as % of Expected Pregnancies
7.9 %
16.1 %
18.3 %
Deliveries Conducted by TBAs as % 7.1 %
of Expected Pregnancies
8.4 %
11.3 %
PNC First Visits as % of Expected
Pregnancies
18.1 %
28.3 %
SAFE MOTHERHOOD
14.4 %
Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003 2003/2004
37.4 %
37.8 %
40.2 %
FAMILY PLANNING
Contraceptive Prevalence Rate
(adjusted)
MALARIA CONTROL PROGRAMME
Blood Slide Examination Rate per
100 Malarious Area Population
0.6 %
0.6 %
0.8 %
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
70 %
71 %
71 %
Treatment Success Rate on DOTS 89 %
90 %
88 %
Sputum Convertion Rate
84 %
85 %
86 %
DOTS Coverage (Population)
89 %
95 %
96 %
Case Detection Rate
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
Condition
Male
Female
HIV Positives (Including
AIDS)
4042
1522
5564
99
AIDS (out of total HIV)
671
258
929
22
Death
* In oct 2005
Total
New Cases
in
October
2005
273 (10*)
Ministry of Health
Department of Health Services
CE NT RA L
LEVEL
C ent ral H os pit als - 5
ZONAL
LEVEL (14)
DISTRICT
LEVEL (75)
Regional TB Centre (1)
Regional Medical Store (5)
REGIONAL
LEVEL (5)
Regional Laboratory (1)
Regional Hospital (1)
Regional Training Centre (5)
Regional Health Directorate - 5
Zonal Hospi tal - 11
Di stri ct Publ i c
Heal th Offi ce - 14
ELECTORAL
CONSTITUENCY
(205)
Di stri ct Hospi tal
62
Di stri ct Heal th Offi ce
61
Pri mary Heal th Care Centre/
Heal th Centre - 188
Heal th Post - 698
Sub Heal th Post - 3,129
VDC LEVEL (3,995)
COMMUNITY
LEVEL
FCHV
48,307
T BA
15,553
PHC ORC Clinic
14,769
EPI Outreach Clinic
15,833
NPHL
NCASC
NTC
NHEICC
LCD
NHTC
C E N T R E S
LMD
EDCD
CHD
FHD
MD
D I V I S I O N S
Health Problems
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Major health concerns
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Maternal Health
Malnutrition / anemia
New and re-emerging conditions
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Sexually Transmitted Infections
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HIV
Vector-borne diseases
 Malaria
 Kala-azar
 Japanese Encephalitis
Infectious diseases
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Acute respiratory Infection
Tuberculosis
Diarrhea
Why is Health Delivery System Failing?
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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
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WHO target is US$12 (NRs.850) public spending per
person
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Development Budget
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Nepal official spending only US$3.10 (NRs.220) per person
7.28% earmarked for health (9th Plan); only 3.8% received
Escalation of conflict reducing budget for military spending
Donors
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Provide for majority of current health budget
Consider health a ‘safe’ and necessary sector
Will continue to pursue even in conflict
Public Health Challenges
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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