Health care services in Nepal are provided by both the public and private sector and fares poorly by international standards. Based on WHO data, Nepal ranked 139 in life expectancy in 2010 with the average Nepalese living to 65.8 years.[1] Disease prevalence is higher in Nepal than it is in other South Asian countries, especially in rural areas. Leading diseases and illnesses include diarrhea, gastrointestinal disorders, goiter, intestinal parasites, leprosy, and tuberculosis, visceral leishmaniasis and tuberculosis. According to United Nations data for 2003, approximately 60,000 persons aged 15 to 49 had human immunodeficiency virus (HIV), and the HIV prevalence rate was 0.5%. In spite of these figures, some improvements in health care have been made, most notably its 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.[2] Other improvements include:[3]
| Health Indicators[5][6][7] | |
|---|---|
| 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 |
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In 2000, government funding for health matters was approximately US$2.30 per person. Approximately 70% of health expenditures came from out-of-pocket contributions. Government allocations for health care was around 5.8% of the budget for year 2009.[8]
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]
Nutritional status of Nepalese[12]
| Parameters | Overall | Urban areas | Rural areas |
|---|---|---|---|
| Children under 5 years: | |||
| Stunned | 51% | 37% | 52% |
| Wasted | 10% | 8% | 10% |
| Underweight | 48% | 33% | 49% |
In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. 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. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Nepal the number of midwives per 1,000 live births is 4 and 1 in 80 shows us the lifetime risk of death for pregnant women.[13]
Much of rural Nepal is located on hilly or mountainous regions. The rugged terrian 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 10 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.[17] 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.[2]
Nepal’s health care issues are largely attributed by the fact that its political power and resources are 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.[18]
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The State of the World's Midwifery - Nepal Country Profile