1. Health Status in Madhesh, Nepal Ram K Shah Professor Nepal Medical College, Kathmandu

2. Wecome to Madhesh, Nepal 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 2

3. Land of Budha & Sita 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 3

4. Colourful Atmosphere 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 4

5. Environment Friendly People 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 5

6. Madhesh Poor Ignorant Iliterate Underprevileged Underfinamced Marginalised Discreminated 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 6

7. Health Status of Common People in Madhesh

8. Objectives Health Problems Health Facilities Peoples’ Expectations Solution of the Problems Conclusions 10/17/20158 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011

9. People of Nepal Population (2009 estimate): 29.3 million. Annual population growth rate (2007 estimate): 2.132%. Population breakdown/distribution (from 2001 census): Rural (86%); female (50%); in the southern Terai region (49%); in the hills (44%); in the mountains (7%). Religions (from 2001 census): Hinduism (81%), Buddhism (11%), Islam (4%), and others (4%). Education: Years compulsory--none, although education is free through Grade 8. Attendance- -primary 84% (86% male, 82% female), secondary 43.5% (46% male, 41% female). Literacy-- 57% (among youth age 15-24: 85% male, 73% female). Health: Infant mortality rate (2008 estimate)--41 deaths/1,000 live births. Life expectancy--67 years. Work force: Agriculture 73.9%; non-agriculture 26.1%. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 9

10. Top Ten Diseases 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 10

11. Top Ten Diseases 0.93 0.96 1.06 1.4 1.95 2.02 2.82 3.13 3.35 5.51 Sore Eye 7 Complaints Abdominal Pain Chronic Bronchitis Ear Infection Gastritis Pyrexia Itestinal Worms ARI Diarrhoeal Diseases STD / HIV & Skin Diseases

12. Ten Reasons to Attend Hospital 12

13. Road Traffic Accidents 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 13

14. RTA Young Healthy People. Poor : Female & Children 10-20 % Death on the Road 80 % People Die in the Hospital 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 14 No Special Care Service for the Victims

15. Health Sevices Promotive : Hygiene & Food Preventive : Vaccination Curative : Hospital Care 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 15

16. Economy & Expenditure In Health Gross Domestic Product (GDP) at producer’s price, in 2000/2001 : Rs.376,433 millions which is higher by 10.9% of the previous year. Total expenditure in health by government: 1996/97 is Rs.885.4 million 1997/98 is Rs.1049.0 million 1998/99 is Rs.1137.4 million 1999/2000 Rs.1324.8 million The public expenditure on health is 1.2% of GDP. Note: ($1 = Nrs.78.00)

17. Health Budget 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 17

18. Health Status 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 18

19. Lack of Money for Health Care 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 19

20. Health Resource 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 20

21. Human Resources in Health Description 1999/2000 2000/01 2001/02 Doctors*125936005415 Nurses290736213921 ANM174832423942 Kaviraj292302313 Vaidya322337354 Health Assistants529552958966 Health Workers319033213321 Village Health Workers401539853980 Health Volunteers625466254662546

22. Human Resource 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 22

23. Health Services Description 1999/2000 2000/01 2001/02 Hospitals839389 Health Centres101010 Health Posts711700700 Ayurvedic Services275285285 Sub – Health Posts317931713161 Primary Health Centres160180205 Hospital Beds Government Sector519052505310 Private Sector200300300 Total OPD Visits as % Total Population 35.8 2001/2

24. Network of Health Institutions & Community Health Workers 10/17/201524 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011

25. Literate 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 25

26. Iliterate 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 26

27. Antenatal Care 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 27

28. Hospital Delivery 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 28

29. Child Care 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 29

30. Vaccination 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 30

31. Malnutrition 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 31

32. Woman Health 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 32

33. Envoronment 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 33

34. Health Status 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 34

35. Right to Health 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 35

36. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 36

37. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 37

38. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 38

39. Per Capita Govt. Expenditure 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 39 Region2058/592063/64increment rate(2058/59/, 2063/64 NepalRs 3382Rs 505049.3 per cent Madhesh regionRs 1228Rs 173040.9 per cent other regionRs 5420Rs 830653.2 per cent

40. Human Development Index 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 40 Human Development Index: 2001 Human Development Index: 2009 Upper hills- 0.386 Upper hills- 0.436 Hill regions- 0.512 Hill regions- 0.543 Madhesh- 0.478 Madhesh- 0.494 According to a 2000/2001 government statistics, only 17.3 per cent of the total budget was allocated for 18 districts of Madhesh (two inner Madhesh districts are not included) but in hill districts, 72.4 per cent budget was allocated. Allocation for upper hill districts was 12.6 per cent.

41. Curative Health Most of Affluent Madheshi Go to India. Poor People Receive Poor Treatment. Lack of Suitable Health Facilities in Madhesh. Kathmandu is still Inaccessible for Madheshi. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 41

42. Solution Poverty Alleviation Increase Literacy Rate Social Justice Equal Right to Health Increase Health Spending Equity & Access Targeted Approach 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 42

43. Conclusions Madhesh is deprived, disadvantaged, underfinanced and discriminated. Health Status is Poor in Madhesh as compared to other parts. Needs Integration & Inclusion for a fair Deal. Proper Share & Distribution of Resources. Need Based Supply System. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 43

44. Conclusions Satisfactory : Promotive & Preventive Services. Poor : Curative Service 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 44

45. 10/17/2015 Role of NGO & INGO in Developing Madhesh, 14-15 Nov. 2011 45 Thank you Let us Hope For Health & Wealth Of Madhesh