Public Health Status and

challenges of Nepal
Prepared by
Sagar Prasad Ghimire
MPH, Institute of Medicine,
Nepal

China

Nepals Population
Pyramid 2003

Basic Information

AREA:

1,47,181 Sq.Km

HIGHEST MOUNTAIN:

Mount Everest

POPULATION:

REGION:

ZONE:

14

DISTRICT:

75

24.6 million

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

14.22001*
% NDHS 1996)
(Source: Census,

Diseases status
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

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)

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 2002/200
3

2003/200
4

EXPANDED PROGRAMME ON IMMUNIZATION

BCG Coverage

94 %

97 %

DPT-3 Coverage

80 %

86 %

Polio-3 Coverage

80 %

84 %

Measles Coverage

76 %

80 %

%
90 %
90 %
85 %

Growth Monitoring Coverage as

% of <3 Children New Visits

41 %

51 %

55 %

Proportion of Malnourished
Children (Weight/Age)

16 %

14 %

12 %

96

Nutrition

Health Service Coverage Fact Sheet contd.

2001/200
2

2002/200
3

2003/200
4

289

344

113

131

ACUTE RESPIRATORY INFECTION

Reported Incidence of
ARI/1,000 <5 Children New
Visits

229

Annual Reported Incidence of

97
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

Health Service Coverage Fact Sheet contd.

2001/200
2

2002/200 2003/20
3
04

43 %

53 %

66 %

36.8 %

43.6 %

SAFE MOTHERHOOD
Antenatal First Visits as % of
Expected Pregnancies

ANC Four Visits among 1st Visit 37.8 %

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

14.4 %

18.1 %

28.3 %

Health Service Coverage Fact Sheet contd.

2001/200
2

2002/200 2003/200
3
4

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 %

3.24

2.84

LEPROSY CONTROL PROGRAMME

New Case Detection
Rate/10,000

5.73

Health Service Coverage Fact Sheet contd.

2001/200 2002/200 2003/200
2
3
4

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

Condition

Male

Female

Total

New Cases
in
October
2005

HIVPositives(Including
AIDS)

4042

1522

5564

99

AIDS(outoftotalHIV)

671

258

929

22

Death

* In oct 2005

273 (10*)

Ministry of Health
Department of Health Services
D I V I S I O N S

CENTRAL
LEVEL

C E N T R E S

Central Hospitals - 5

Regional Health Directorate - 5

Zonal Hospital - 11
District Public
Health Office - 14

District Hospital
62

District Health Office

61

Primary Health Care Centre/

Health Centre - 188
Health Post - 698
Sub Health Post - 3,129
FCHV
48,307

TBA
15,553

PHC ORC Clinic

14,769

EPI Outreach Clinic

15,833

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

Development Budget

Nepal official spending only US$3.10 (NRs.220) per person

7.28% earmarked for health (9 th 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 Noncommunicable 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 users fee in public health facilities: Affordability for poor
people