Public Health Status and challenges of Nepal

1
Public Health Status and challenges of Nepal
Prepared by Sagar Prasad Ghimire MPH, Institute
of Medicine, Nepal
2
China
3
Nepals Population Pyramid 2003
4
Basic Information

• AREA 1,47,181 Sq.Km
• HIGHEST MOUNTAIN Mount Everest
• POPULATION 24.6 million
• REGION 5
• ZONE 14
• DISTRICT 75

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 100000 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 water79.9 (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 EXPANDED PROGRAMME ON IMMUNIZATION EXPANDED PROGRAMME ON IMMUNIZATION EXPANDED PROGRAMME ON IMMUNIZATION
BCG Coverage 94 97 96
DPT-3 Coverage 80 86 90
Polio-3 Coverage 80 84 90
Measles Coverage 76 80 85
Nutrition Nutrition Nutrition Nutrition
Growth Monitoring Coverage as of lt3 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 ACUTE RESPIRATORY INFECTION ACUTE RESPIRATORY INFECTION ACUTE RESPIRATORY INFECTION
Reported Incidence of ARI/1,000 lt5 Children New Visits 229 289 344
Annual Reported Incidence of Pneumonia (MildSevere)/1,000 among lt5 Children New Visits 97 113 131
DIARRHOEAL DISEASES DIARRHOEAL DISEASES DIARRHOEAL DISEASES DIARRHOEAL DISEASES
Diarrhoeal Deaths/1,000 117 200 222
Diarrhoeal Deaths/1,000 0.04 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 SAFE MOTHERHOOD SAFE MOTHERHOOD 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 FAMILY PLANNING FAMILY PLANNING FAMILY PLANNING
Contraceptive Prevalence Rate (adjusted) 37.4 37.8 40.2
MALARIA CONTROL PROGRAMME MALARIA CONTROL PROGRAMME MALARIA CONTROL PROGRAMME 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
LEPROSY CONTROL PROGRAMME LEPROSY CONTROL PROGRAMME LEPROSY CONTROL PROGRAMME 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 TUBERCULOSIS CONTROL PROGRAMME TUBERCULOSIS CONTROL PROGRAMME 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)
13
Cumulative HIV/AIDS Situation of Nepal Cumulative HIV/AIDS Situation of Nepal Cumulative HIV/AIDS Situation of Nepal Cumulative HIV/AIDS Situation of Nepal Cumulative HIV/AIDS Situation of Nepal Cumulative HIV/AIDS Situation of Nepal
As of October 31, 2005 As of October 31, 2005 As of October 31, 2005 As of October 31, 2005 As of October 31, 2005 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
(No Transcript)
15
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

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 US12 (NRs.850) public spending per
  person
• Nepal official spending only US3.10 (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 users fee in public health
  facilities Affordability for poor people

19

• Thank you