1. Public Health Status and challenges of Nepal
Prepared by
Sagar Prasad Ghimire
MPH, Institute of Medicine, Nepal

2. China

3. Nepal’s Population Pyramid 2003

4. Basic Information AREA: 1,47,181 Sq.Km HIGHEST MOUNTAIN: Mount Everest
POPULATION: million
REGION:
ZONE:
DISTRICT:

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 live birth)
539*
PGR
2.24
Literacy Rate
54.1
Urban Population
14.2 %
(Source: Census, 2001* NDHS 1996)

6. Diseases status 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
Top Reasons for Hospitalization, 2003/04
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

7. 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)

8. 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
84 %
Measles Coverage
76 %
85 %
Nutrition
Growth Monitoring Coverage as % of <3 Children New Visits
41 %
51 %
55 %
Proportion of Malnourished Children (Weight/Age)
16 %
14 %
12 %

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

10. Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003
2003/2004
SAFE MOTHERHOOD
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 % of Expected Pregnancies
7.1 %
8.4 %
11.3 %
PNC First Visits as % of Expected Pregnancies
14.4 %
18.1 %
28.3 %

11. Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003
2003/2004
FAMILY PLANNING
Contraceptive Prevalence Rate (adjusted)
37.4 %
37.8 %
40.2 %
MALARIA CONTROL PROGRAMME
Blood Slide Examination Rate per 100 Malarious Area Population
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

12. Health Service Coverage Fact Sheet contd.
2001/2002
2002/2003
2003/2004
TUBERCULOSIS CONTROL PROGRAMME
Case Detection Rate
70 %
71 %
Treatment Success Rate on DOTS
89 %
90 %
88 %
Sputum Convertion Rate
84 %
85 %
86 %
DOTS Coverage (Population)
95 %
96 %
Health Services Coverage Fact Sheet:
Source: Annual Report, Department of Health Services (2003/2004)

13. Cumulative HIV/AIDS Situation of Nepal
As of October 31, 2005
Condition
Male
Female
Total
New Cases in 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

14. Structural Health Organogram of Nepal

15. Health Problems Major health concerns New and re-emerging conditions
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

16. 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

17. 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

18. 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

19. Thank you