Health Needs of Nepal

Nepal's Health Situation

Nepal is a country of 28 million people located between China and India. Its remoteness, mountains, lack of infrastructure, and land-locked status pose extreme barriers to development. Its per capita income is USD $218 and the vast majority of people are subsistence farmers. From 1996-2006, Maoist rebels fought a civil war against the Nepal government, a democracy with a House of Representatives. Nepal's maternal mortality ratio (MMR) of 539/100,000 births ranks among the highest in the world. (In comparison, Sri Lanka's MMR is 94, while the United States' is just 8). Life expectancy is 55 years. Diseases of pregnant women, children, infections, and malnutrition account for two thirds of Nepal's illnesses. The government manages a system of curative and public health institutions that span a vast country, where travel must often be on foot. The Ministry of Health and Population (MoHP) is the central body responsible for health planning, implementation, and evaluation. The Ministry is also responsible for zonal and regional hospitals. The Department of Health Services under the Ministry is responsible for providing health services at district levels and below. Local village committees handle delivery of health services at the district levels and below through local health facilities, which are District Hospitals, Primary Health Care Centres, Health Posts and Sub-Health Posts.

Health Service Facilities (public and private)   Type of Facility Number Total Beds Government Sector   Long Stay Specialty Hospitals 5 275   Regional/Central/Teaching Hospitals 10 1860   Zonal Hospitals 10 720   District Hospitals 67 1030   Health Centres with beds 191 573   Health Posts 701 -   Sub-Health Posts 3159 -   PHC Outreach Clinics 13700 -   Total 17776 4458 Private Sector   Mission / Private / INGO 123 3804 TOTALS 17899 8262 Source: Nepal Strategic Plan for Human Resources for Health, 2003

The Nepal Government's National Health Policy (1991), Second Long-term Plan (1997-2017), and the Tenth 5-Year Health Plan (2002-7) all give highest priority to extending the health care system to the poor, rural, marginalized and most vulnerable in the population. Special attention is to be focused on maternal-child health, infectious diseases and outpatient care. In approaching these problems, the Health Sector Reform Strategy of 2004 also emphasized the concepts of "decentralization" and "public-private partnerships". Of the total Nepal government budget, only 6.4% is spent on health. Of the total Health Ministry Budget, 45% comes from external development partners like DFID, USAID, and WHO.

Nepal 's Health Ministry Strategic Plan for Human Reources (2003-17 ) Key Conclusions : The current public sector health workforce of 34,912 needs to more than double over this 15-year period. The most pressing needs are for middle level technical staff and managers. Human Resource Management is to be given a higher status within the Ministry. As a result of the proliferation of private medical schools, recruitment policies need to be in place to ensure that the Ministry is not overloaded with doctors.

1978 saw the establishment of Nepal's Institute of Medicine (IoM) whose mission was to create a cadre of health care workers for the whole country. The IoM sought to recruit students from all over Nepal and train them in a way that would encourage their return to rural facilities. This met with modest, though not sustained, success. IoM's Tribuvan University Teaching Hospital (TUTH) remained Nepal's only medical college until the 1990's, when local medical education underwent a virtual explosion. Now in 2006, Nepal has 13 medical colleges, 40 nursing campuses, and 125 campuses for mid-level health care workers. This proliferation, however, has not trickled down to rural areas where the need is greatest. A large proportion of high level health care workers (doctors and nurses) leave Nepal to study and then work overseas. Today, well over 50% of IoM's doctor graduates head for the U.S. There is still a gaping disparity in the quality of health care access offered in urban and rural areas. While Kathmandu has 98 doctors for every 100,000 people, rural Nepal averages just 2.5 per 100,000 – and in many of its 75 districts, there is no doctor. Many approved government posts of all levels of health care worker are unfilled. One indication of unmet need: For the whole of Nepal, 13% of all deliveries are conducted by trained personnel; and for the poorest fifth of the population (mainly rural) the number is just 3%.