Family Health Division Presentation
Dr. Kiran Regmi
Director, Family Health Division
Feb 2011
regmikiran@gmail.com
 Millennium Development Goals (MDG) 4 & 5
 Targets set by Nepal and achievements
Key interventions to achieve MDG 4 and 5
 Direction beyond MDG for Nepal

 Goal 4.A: Reduce by two-thirds, between 1990
and 2015, the under-five mortality rate
 Goal 5.A. Reduce by three quarters, between
1990 and 2015, the maternal mortality ratio
 Goal 5.B. Achieve, by 2015, universal access to
reproductive health
MDG Impact
indicator
Achievement
1991 1996
Under 5 mortality
rate
158
Target
200 200 200 201 2015
1
6
9
0-11
118.3 91
61
50
55
38
Infant mortality rate 106
78.5
64
48
41
44
32
Neonatal mortality
rate
49.9
43
33
20
30
16
Millennium Development targets and achievements of Nepal
Target Set by Nepal and Achievements
Goal 5A
MDG Impact indicator
Maternal
mortality ratio
Total fertility ratio
Achievement
Target
1991 1996 2001 2006 2009 2010 2015
-11
539 539 415 281 229
134
5.3
4.6
4.1
3.1
Adolescent fertility
rate(15-19 years)
CPR (Modern
24
method)
127
110
98
26
35
44
2.9
3.0
2.5
70
45.1
48
67
Target Set by Nepal and Achievements
Goal 5B
MDG Impact
indicator
Achievement
1999 2004
No of women
2
delivering in
health facility
Childbirth by SBA 4.8
C/S rate
2.8
11
Target
2006 2008 2009 2010 2015
-11
4.1
26
41.3
18
30
60
Target Set by Nepal and Achievements
Goal 5B
FY
2007/08
2008/09
2009/10
Target 2012
CEOC*
51 in 33 district
76 in 35 district 94 in 45 district
**
BEOC hosp
31
45
47
BEOC PHC
37
45
22%
58
BEOC total
68
90
105
24 hr del in PHC
168
78%
167
79%
148
71%
406
60%
24 hr del at HP
219
301
45%
406
60%
30% of HP
24 hr del at SHP
35
64
2%
137
4%
Total birth center
422
532
695
Total CAC sites
39
39
86
47 district
60% of PHCC
Key interventions
1. Ama Surachha program
2. Family Planning
ANC
Promotion of SBA conducted childbirth
Promotion of institutional childbirth and
initiation of delivery incentives
PNC
As Ama Surachha program ANC component focused
on targeted ANC there is increase in 1st and 4th visits
 ANC motivational incentive package
 Transportation allowance and free childbirth
 This shows that Ama program is heading towards in
right direction
 This is a good indication towards meeting MDG 5A
 There is marked increase in ANC 1st and 4th in 2066
because of initiation of free childbirth policy

80%
60%
40%
20%
0%
EDR
Source: HMIS/MD, DOHS
CDR
WDR
MWDR
70%
75.10%
68.10%
65.60%
89.90%
78%
82.20%
77.40%
74.20%
97.93%
71.30%
72.80%
72.50%
65%
80.74%
89.11%
Nepal
70.50%
66.20%
62.10%
68.30%
75.30%
71.20%
66.70%
65.30%
85.90%
100%
73.10%
71.80%
67.90%
67.50%
87.96%
120%
FWDR
2062/63
2063/64
2064/65
2065/66
2066/67
30%
20%
10%
0%
EDR
CDR
WDR
Source: HMIS/MD, DOHS
48%
50.40%
51.70%
52.70%
44.12%
Nepal
43%
45.30%
44.60%
48.10%
46.51%
48.80%
53.60%
50.50%
57%
49.24%
40%
47.90%
49.20%
55.40%
59.10%
57.36%
50%
49.10%
50.00%
53.30%
56.30%
48.50%
60%
47.70%
49.80%
51.80%
55.90%
50.94%
70%
MWDR
FWDR
2062/63
2063/64
2064/65
2065/66
2066/67
 There is increase in SBA conducted delivery
indicating achievement of MDG 5B
Nepal
EDR
2065/66
CDR
WDR
2066/67
MWDR
13.7%
14.7%
16.6%
24.7%
31.8%
27.0%
31.2%
29.4%
22.4%
20.7%
29.4%
24.8%
35%
30%
25%
20%
15%
10%
5%
0%
FWDR
60%
Proportion of deliveries in which women gives birth in health
facility
54%
50%
44%
(Aama average)
48%
42%
39% 39% 38%
40%
33%
35% 34%
30%
20%
20%
17%
12% 13%
10%
7% 7%
6% 7% 6%
0%
Higher HDI districts
Apr-05
Jan-06
Jul-06
Low HDI districts
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
16
 After the initiation of free childbirth policy
there is a marked increase in PNC
40%
30%
20%
10%
0%
EDR
Source: HMIS/MD, DOHS
CDR
WDR
34%
33.50%
31.10%
30.50%
46.35%
39%
43.30%
35.50%
36.00%
54.57%
39.40%
42.00%
41.10%
35%
45.88%
50.91%
Nepal
35.70%
37.20%
37.40%
39.30%
38.70%
41.00%
39.70%
41.10%
49.85%
50%
37.80%
39.50%
37.80%
37.40%
49.72%
60%
MWDR FWDR
2062/63
2063/64
2064/65
2065/66
2066/67
40%
30%
20%
10%
0%
EDR
Source: HMIS/MD, DOHS
CDR
WDR
34%
33.50%
31.10%
30.50%
46.35%
39%
43.30%
35.50%
36.00%
54.57%
39.40%
42.00%
41.10%
35%
45.88%
50.91%
Nepal
35.70%
37.20%
37.40%
39.30%
38.70%
41.00%
39.70%
41.10%
49.85%
50%
37.80%
39.50%
37.80%
37.40%
49.72%
60%
MWDR FWDR
2062/63
2063/64
2064/65
2065/66
2066/67
Key Intervention II: Family Planning
Gap
57
 New satellite concept introduced to increase
access of LTFP
 IUCD training integrated into SBA training
 Sr. AHW training in implant insertion
Current Users
New Acceptors
New Acceptors
Current Users
 Continue reduction of MNMR
 Sustainability of Ama program
 Quality of care
 Coverage of unreached and underserved
population
 Bringing childbirth institution at home
 Develop a concept of tertiary referral centers
and satellite birthing centers
 Finding alternate ways to replace the adhoc
human resources and interventions adopted to
achieve MDG
 Train and involve under used midlevel health
worker (HA) in various reproductive health
programs
 Selective verses universal free childbirth services
 Think of the interventions beyond aid
 Develop a strong Reporting, Monitoring and
Evaluation mechanism
Thank You