| Like majority of the countries in the Region Nepal is striving to
improve its health situation.The overall health status of the Nepalese
people has improved in the nineties (see Table1) but the improvement has
not benefited all as expected despite the concentric efforts jointly put
by all stakeholders including Government Organizations (GOs),
Non-government Organizations (NGOs), International Non-governmental
Organizations (INGOs), private and external development partners. There
is a wide disparity along the urban and rural areas, gender, ethnicity
and socio-economic lines (see Table 2). |
| The table suggests that the overall health status of the Nepalese
population improved in the nineties. The infant mortality rate declined
by 40% (from 108 to 64.4/1000 live births) and the fertility rate fell
from 5.1 to 4.1. The changes contributed by other sectors are
improvement in living standards, education, agriculture, housing, water
supply and sanitation, transportation, forestry and women development. |
Women’s health is not satisfactory although the life expectancy of
women has improved in recent years. However, gender disparity is
striking, particularly during childhood and reproductive years. Over 90%
of maternal deaths occur in rural areas with only 9.8 %
occurring in urban areas. 75% of pregnant women in Nepal are anemic,
which not only contributes to maternal deaths but also adversely affects
the entire growth and development of children.Health services utilization by marginalized groups within the population
is low. Evidence also shows health disparity among various groups.
Like in other countries in the Region the health status in Nepal is
affected by the double burden of diseases and lack of infrastructure.
The communicable diseases such as malaria, tuberculosis, sexually
transmitted infections including HIV/AIDS and diseases caused by poor
environment are still major killers and cause of high morbidity. The
non-communicable diseases such as diabetes, cancer and heart diseases
are rapidly increasing. These are aggravated by the changing lifestyle
of people, which include sedentary lifestyle, intake of refined
carbohydrate and high cholesterol, fatty food and smoking. It is
reported that in Nepal the average use of cigarette is 620 per
inhabitants per year compared to 540 in Pakistan, which is high in South
Asia. Almost three quarters (72%) of the human excreta is disposed off
in unsafe way (British Medical Journal, April, 2004). One in every 11
children born in Nepal die before reaching age five; slightly more than
two in three under-five deaths occur in the first year of life.
Under-nutrition is significant problem in Nepal with half of the
children five years of age stunted and almost half (48%) underweight
(Nepal Demographic and Health Survey, 2001). The maternal mortality is
estimated to be 539 per 100 000 live births (Nepal Family Survey, 1996,
Ministry of Health, Kathmandu).
The difficult terrain of the country, where a substantial proportion of
the population is scattered, has made the delivery of health care
services a challenge. The challenge of providing quality health care
services to the entire population of Nepal with a special focus on the
most vulnerable group is a real problem. The health needs of the special
groups are often not met, particularly in the case of women and
children, the poor, the underprivileged and the marginalized population.
The health care services have a challenge to address the factors that
contribute to the emerging and re-emerging infectious disease problems.
These factors include unplanned and under-planned urbanization;
overcrowding and rapid population growth; poor sanitation; inadequate
public health infrastructure; resistance to antibiotics; increased
exposure of humans to disease vectors and reservoirs of infection in
nature; and rapid and intense international travels. |
