Health in Nepal

Health care services in Nepal are provided by both the public and private sector and fare poorly by international standards. Disease prevalence is higher in Nepal than it is in other South Asian countries, especially in rural areas. Some improvements in health care have been made, most notably significant progress in maternal-child health. For example, Nepal’s Human Development Index (HDI) was 0.504 in 2002, ranking Nepal 140 out of 177 countries, up from 0.291 in 1975.[1] Other improvements include:[2]

Health Indicators[4][5][6]
Population growth 1.28
Life expectancy 67
Infant mortality 39
Fertility 2.64
Total expenditure on health per capita (Intl $, 2009) 69
Total expenditure on health as % of GDP (2009) 5.8

Health care expenditure

In 2002, the government funding for health matters was approximately US$2.30 per person. Approximately 70% of health expenditures came from out-of-pocket contributions. Government allocation for health care was around 5.8% of the budget for 2009.[7] In 2012, the Nepalese government decided to launch a pilot program on universal health insurance in five districts of the country.[8]

Health care infrastructure

Health care facilities, hygiene, nutrition and sanitation in Nepal are of poor quality, particularly in the rural areas. Despite that, it is still beyond the means of most Nepalese. Provision of health care services are constrained by inadequate government funding. The poor and excluded have limited access to basic health care due to its high costs and low availability. The demand for health services is further lowered by the lack of health education. Reproductive health care is neglected, putting women at a disadvantage. In its 2009 human development report, UN highlighted a growing social problem in Nepal. Individuals who lack a citizenship are marginalized and are denied access to government welfare benefits.[9] Traditional beliefs have also been shown to play a significant role in the spread of disease in Nepal.[10][11]

These problems have led many governmental and nongovernmental organizations (NGOs) to implement communication programs encouraging people to engage in healthy behavior such as family planning, contraceptive use, and spousal communication, safe motherhood practices, and use of skilled birth attendants during delivery and practice of immediate breastfeeding.[12]

Nutritional status of Nepalese children under 5 years of age[13]
Urban areas Rural areas Overall
Stunted 37% 52% 51%
Wasted 8% 10% 10%
Underweight 33% 49% 48%

Geographical contraints

Much of rural Nepal is located on hilly or mountainous regions. The rugged terrain and the lack of proper infrastructure makes it highly inaccessible, limiting the availability of basic health care.[14] In many villages, the only mode of transportation is by foot. This results in a delay of treatment, which can be detrimental to patients in need of immediate medical attention.[15] Most of Nepal’s health care facilities are concentrated in urban areas. Rural health facilities often lack adequate funding.[16]

In 2003, Nepal had ten health centers, 83 hospitals, 700 health posts, and 3,158 "sub-health posts", which serve villages. In addition, there were 1,259 physicians, one for every 18,400 persons.[7] In 2000, government funding for health matters was approximately US$2.30 per person, and approximately 70 percent of health expenditures came from out-of-pocket contributions. Government allocations for health were around 5.1 percent of the budget for fiscal year 2004, and foreign donors provided around 30 percent of the total budget for health expenditures.[1]

Political influences

Nepal’s health care issues are largely attributed to its political power and resources being mostly centered in its capital, Kathmandu, resulting in the social exclusion of other parts of Nepal. The restoration of democracy in 1990 has allowed the strengthening of local institutions. The 1999 Local Self Governance Act aimed to include devolution of basic services such as health, drinking water and rural infrastructure but the program has not provided notable public health improvements. Due to a lack of political will, Nepal has failed to achieve complete decentralization, thus limiting its political, social, and physical potential.[9]

Health status

Life expectancy

In 2010 with the average Nepalese lived to 65.8 years.[7]

Diseases

Leading diseases and illnesses include diarrhea, gastrointestinal disorders, goiter, intestinal parasites, leprosy, visceral leishmaniasis and tuberculosis.[1]

HIV/AIDS

Main article: HIV/AIDS in Nepal

As of December 2007, the Government of Nepal reported 1,610 cases of AIDS and 10,546 HIV infections, which has grown to 13,000 infections by World AIDS Day 2008.[17] UNAIDS estimates from 2007 indicate that approximately 75,000 people in Nepal are HIV-positive, including all age groups. The Government of Nepal's National Center for AIDS & STD Control (NCASC) estimated that number to be closer to 70,000 in December 2007.[18] NCASC (2010) reports that estimated number of HIV infections by risk groups is 59,984 [19]

The epidemic in Nepal is driven by injecting drug users, migrants, sex workers and their clients, and MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in Kathmandu, Pokhara, and East and West Terai indicate that the highest prevalence rates have been found among urban IDUs, 6.8 percent to 34.7 percent of whom are HIV-positive, depending on location. In terms of absolute numbers, Nepal's 1.5 million to 2 million labor migrants account for the majority of Nepal’s HIV-positive population. In one subgroup, 2.8 percent of migrants returning from Mumbai, India, were infected with HIV, according to the 2006 IBBS among migrants.[18]

As of 2007, HIV prevalence among female sex workers and their clients was less than 2 percent and 1 percent, respectively, and 3.3 percent among urban-based MSM. HIV infections are more common among men than women, as well as in urban areas and the far western region of Nepal, where migrant labor is more common. Labor migrants make up 41 percent of the total known HIV infections in Nepal, followed by clients of sex workers (15.5 percent) and IDUs (10.2 percent).[18]

Maternal and child health care

The 2010 maternal mortality rate per 100,000 births for Nepal is 380. This is compared with 240.2 in 2008 and 471.3 in 1990. The under-5 mortality rate per 1,000 births is 51 and the neonatal mortality as a percentage of under 5's mortality is 55. In Nepal, the number of midwives per 1,000 live births is 4 and the lifetime risk of death for pregnant women 1 in 80.[20]

References

  1. 1 2 3 Nepal country profile. Library of Congress Federal Research Division (November 2005). This article incorporates text from this source, which is in the public domain.
  2. ↑ Nepali Times Issue #561 (8 July 2011 – 14 July 2011)
  3. ↑ HDI 2010 index from article Let's Talk Human Development - Data challenges in estimating the HDI: The cases of Cuba, Palau and the Occupied Palestinian Territory
  4. ↑ UNICEF Nepal statistics
  5. ↑ Health Organisation Data from the Global Health Observatory
  6. ↑ Health Profile World Health Organisation data (2010)
  7. 1 2 3 Nepal Health Profile World Health Organisation data (2010)
  8. ↑ "Health for all". My Republica. Retrieved 14 Nov 2012.
  9. 1 2 Nepal human development report 2009-State transformation and human development by United Nations Development programme
  10. ↑ Beine, David. 2001. "Saano Dumre Revisited: Changing Models of Illness in a Village of Central Nepal." Contributions to Nepalese Studies 28(2): 155-185.
  11. ↑ Beine, David. 2003. Ensnared by AIDS: Cultural Contexts of HIV/AIDS in Nepal. Kathmandu, Nepal: Mandala Book Point.
  12. ↑ Karki, Yagya B.; Agrawal, Gajanand (May 2008). "Effects of Communication Campaigns on the Health Behavior of Women of Reproductive Age in Nepal, Further Analysis of the 2006 Nepal Demographic and Health Survey" (pdf). Macro International Inc. Retrieved 14 November 2012.
  13. ↑ NDHS Fact Sheet, 2001
  14. ↑ International Fund for Agricultural Development (IFAD) retrieved 20 September 2011
  15. ↑ United Methodist Committee on relief; retrieved on 20 September 2011
  16. ↑ Shiba Kumar Rai, Kazuko Hirai, Ayako Abe,Yoshimi Ohno 2002 "Infectious Diseases and Malnutrition Status in Nepal: an Overview"
  17. ↑ Nearly 13,000, The Hindu, "Nearly 13,000 HIV/AIDS cases recorded in Nepal", December 8, 2008, retrieved April 28, 2011.
  18. 1 2 3 "Health Profile: Nepal". United States Agency for International Development (March 2008). Accessed August 25, 2008.  This article incorporates text from this source, which is in the public domain.
  19. ↑ http://www.ncasc.gov.np/
  20. ↑ "The State Of The World's Midwifery". United Nations Population Fund. Retrieved August 2011.

External links

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