Healthcare services in Nepal are provided by the public and private sectors and generally do not meet international standards. The prevalence of the disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. In addition, the country's topographic and sociological diversification results in periodic epidemics of infectious diseases, epizootics and natural hazards such as floods, forest fires, landslides, and earthquakes. Most of the population is at risk of infection and death from infectious diseases, malnutrition and other health-related events that specifically affect the poor living in rural areas. Nevertheless, several improvements in health care have been made, the most significant advances in maternal-child health. The Human Development Index of Nepal (HDI) in 2011 rose to 0.458 from 0.291 in 1975. Other improvements included:
- Maternal mortality: From 850 in 100,00 mothers in 1990-190 in 2013.
- Infant mortality: From 136.9 per 1,000 live births in 1990 to 39.5 by 2015.
- Infant Death: From 97.70 to 29.40 by 2015.
- Malnutrition of children: Stunting 37%, wasting 11%, and underweight 30% among children under the age of five.
- Life Expectancy: From 58.5 in 1990 to 68 years in 2012.
Video Health in Nepal
Health care spending
In 2002, government funding for health issues was around USD $ 2.30 per person. About 70% of health expenditures come from contributions outside the pockets. The government's allocation for health care is around 5.8% of the budget for 2009. In 2012, the Nepalese government launched a pilot program on universal health insurance in three districts of the country.
By 2014, Nepal's total expenditure on health per capita is $ 127.
Maps Health in Nepal
Healthcare infrastructure
Health care, hygiene, nutrition and sanitation services in Nepal have poor quality, and fail to reach the majority of the population, especially in rural areas. The poor have limited access to basic health care because of high costs, low availability, lack of health education and conflicting traditional beliefs. Reproductive health care is ignored, putting women at a disadvantage. The 2009 UN human development report highlighted the growing social concerns in Nepal in the form of under-privileged individuals getting marginalized, and being denied access to the benefits of government welfare.
These problems have led many government and non-governmental organizations (NGOs) to implement communication programs that encourage people to engage in healthy behaviors such as family planning, contraceptive use, husband-wife communication and safe mother practice such as the use of trained birth attendants during labor and exercise. breastfeeding immediately.
Micronutrient deficiency is widespread, with nearly half of pregnant women and toddlers, and 35 percent of reproductive-aged women with anemia. Only 24 percent of children consume iron-rich foods, 24 percent of children meeting a minimum diet is acceptable, and only half of pregnant women take recommended iron supplements during pregnancy. A factor contributing to the worsening of high nutrition diarrhea disease morbidity, exacerbated by lack of access to good sanitation and general practice of open defecation (44 percent) in Nepal.
Nutritional status of Nepalese children under 5 years
Stagnant growth and political instability have led to acute food shortages and high rates of malnutrition, largely affecting vulnerable women and children in the hills and mountains of the west and west. Although the rates of stunting and underweight cases have declined and the rate of exclusive breastfeeding has increased in the past seven years, 41 percent of children under the age of five remain stunted, rising to 60 percent in the western mountains. A report from DHS 2016, has shown that in Nepal, 36% of children experience stunting (under -2 standard deviation), 12% are highly stunted (under -3 standard deviation), 27% of all children under 5 years have less weight, and 5% weight is very thin. Variations in stunting and underweight percentages were seen among children under 5 years old in urban and rural areas. The rural areas were more affected (40% stunted and 31% underweight) than urban areas (32% stunted and 23% underweight). There is a positive relationship between household food consumption scores and lower stunting, underweight and wasting prevalence. Children in safe food households had the lowest stunting rate (33 percent), while children in unsafe food households had rates up to 49 percent. Similarly, maternal education has an inverse relationship with childhood stunting. In addition, the problem of underweight and stunting is also inversely proportional to their equity wealth. Children in the lowest wealth quintile were more stunted (49%) and underweight (33%) than children in the highest quintiles (17% stunted and 12% underweight).
Nutritional status has increased over the past two decades among children in Nepal. Child stunting and weight loss trends have been observed since 2001. The declination of dwarfed children was 14% between 2001 and 2006 and an additional 16% between 2006 and 2011, and down by 12% between 2011 and 2016. Trends similar happened. observed for lean children. This trend is moving towards achieving the Millennium Development Goal (MDG) target. However, there is still a long way to reach the target of SDG to reduce stunting to 31% and less weight up to 25% among children under 5 years 2017 (National Planning Commission 2015).
Micronutrient deficiency is widespread, with nearly half of pregnant women and toddlers, and 35 percent of reproductive-aged women with anemia. Only 24 percent of children consume iron-rich foods, 24 percent of children meeting a minimum diet is acceptable, and only half of pregnant women take recommended iron supplements during pregnancy. A factor contributing to the worsening of high nutrition diarrhea disease morbidity, exacerbated by lack of access to good sanitation and general practice of open defecation (44 percent) in Nepal.
Geographic restrictions
Many rural Nepal are located in hilly or mountainous areas. The rugged terrain in Nepal and the lack of infrastructure that makes it highly inaccessible, limits the availability of basic health care for mountain populations. In many villages, the only mode of transportation is on foot. This causes delays in treatment, which can harm patients who need immediate medical care. Most of Nepal's health care facilities are concentrated in urban areas. Rural health facilities are often underfunded.
In 2003, Nepal had 10 health centers, 83 hospitals, 700 health posts, and 3,158 "sub-health posts," serving the villages. In addition, there are 1,259 doctors, one for every 18,400. In 2000, government funding for health problems was around USD $ 2.30 per person, and about 70 percent of health expenditures came from out-of-pocket contributions. The government's allocation of health to about 5.1 percent of the budget for fiscal year 2004, and foreign donors provide about 30 percent of the total budget for health spending.
Political influence
Nepal's health care problem has been largely attributed to its political power and resources largely centered on its capital, Kathmandu, resulting in social exclusion in other parts of Nepal. The restoration of democracy in 1990 has enabled the strengthening of local institutions. The Local Private Government Act 1999 aims to include the devolution of basic services such as health, drinking water and rural infrastructure but the program has not provided significant public health improvements. Due to a lack of political will, Nepal has failed to achieve complete decentralization, limiting its political, social and physical potential.
Health status
Life expectancy
In 2010, the average Nepali population lives up to 65.8 years. According to the latest WHO data published in 2012 life expectancy in Nepal is 68. Life expectancy at birth for both sexes increases 6 years during 2010 and 2012. In 2012, healthy expectations in both sexes are 9 years lower than life expectancy overall at birth. This lost healthy life expectancy represents the equivalent 9 years (s) of full health lost over the years living with morbidity and disability
Disease
According to WHO data, nine of the top ten causes of morbidity (illness) and death (death) in Nepal are:
1. COPD (9.2%) 2. Ischemic Heart Disease (9.2%) 3. Lower respiratory infection (7%) 4. Diarrheal disease (3.3%) 5. Self harm (3%) 6. Tuberculosis (3%) 7. Diabetes (2.8) 8. Road injury (2.7%) 9. Premature birth (2.5%)
HIV/AIDS
Generating up to 8% of the total population estimate of 40,723, there are approximately 3,282 children aged up to 14 years living with HIV in Nepal in 2013, while adults aged 15 and older accounted for 92%. There were 3855 infections estimated among the population aged 50 years and over (8.3%). By sex, men account for two-thirds (66%) of the infection and the rest, more than a third (34%) of infections occur in women, of which 92.2% are in the reproductive age group of 15- 49 years. The male and female sex ratios of total infections dropped from 2.15 in 2006 to 1.95 for 2013 and are projected to 1.86 by 2020. The epidemic in Nepal is driven by injecting drug users, migrants, sex workers & clients and their MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in Kathmandu, Pokhara, and East and West Terai show 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 population of 1.5 million to 2 million workers are responsible for the majority of HIV-positive population in Nepal. In one subgroup, 2.8 percent of returning migrants from Mumbai, India, were infected with HIV, according to IBBS 2006 among migrants.
In 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 infection is more common in men than women, as well as in urban and far-west areas of Nepal, where migrant workers are more common. The migrant workforce constitutes 41 percent of the total known HIV infection in Nepal, followed by sex worker clients (15.5 percent) and IDU (10.2 percent).
Mother's Health
Nepal has made significant progress in improving the health of women and children, and is on track in 2013 to achieve the Millennium Development Goals (MDGs) # 4 (to reduce child mortality) and # 5A (to reduce maternal mortality). This review provides an opportunity for Kemenkes and other stakeholders in Nepal to synthesize and document how these improvements are made, focusing on program management best practices and policies.
Nepal has made significant progress in improving maternal health. The maternal mortality rate was reduced from 748 per 100,000 live births in 1990 to 190 per 100,000 live births by 2014. Nepal has also made some progress in reducing total fertility (TFR), from 5.3 in 1991 to 2.3 in year 2014.
Despite other indicators related to maternal health, health indicators of contraceptive prevalence rates have declined: 2006 (44.2%) and 2011 (43.2%), and have been associated with higher rates of separation by migration to other countries for work (3/4 youth in rural areas). The use of maternal health services has increased (increasing) since 1996, with increased coverage and number of ANC visits (60% for at least four antenatal visits) by 2014, institutional delivery rates and delivery followed by skilled birth attendant (56%).
Children's Health
Nepal is also on track to achieve MDG 4, after reaching a level of 35.8 under 5 child deaths per 1000 live births by 2015, down from 162 in 1991 according to national data. Global estimates indicate that the figure has been reduced by 65% ​​from 128 to 48 per 1000 live births between 1991 and 2013. Nepal has successfully increased the range of effective interventions to prevent or treat the most important causes of child mortality through various communities- based and national campaign approaches. This includes high coverage of vitamin A supplementation and half-yearly worms; CB-IMCI; high rates of child immunization; and moderate coverage of exclusive breastfeeding for children under 6 months. However, in recent years, NMR has remained stagnant at around 22.2 deaths per 1000 live births by 2015. This compares to the 27.7 rate in India (2015) and 45.5 in Pakistan (2015).
NMR is a serious problem in Nepal, accounting for 76% of infant mortality (IMR) and 58% under 5 years mortality (U5MR) by 2015 and is one of the challenges ahead. Typically, conflict histories have a negative impact on health indicators. However, Nepal is making progress in most health indicators despite armed conflict for a decade. Efforts to understand this have provided a number of possible explanations including the fact that in many instances former rebels inadvertently disrupted the delivery of health services; pressure applied to health workers to attend clinics and provide services in rebel base areas; conflict creates an environment to improve coordination among key actors; and the Nepalese public health system adopt an approach that targets disadvantaged and remote groups, especially the community-based approach to basic services delivery with functional community support systems through women's health community volunteers (FCHVs), women's groups and the Committee on Health Facilities Operations Management (HFOMCs).
Children's Health program in Nepal
The Children's Health Division of the Ministry of Health and Population (MOHP), Nepal has launched several child survival interventions, including various operational initiatives, to improve children's health in Nepal. These include the Immunization Enhancement Program (EPI), the Community-Based Integrated Management Program (CB-IMCI), the Community-Based Childcare Program (CB-NCP), the Infant and Younger Feeding Program, the micronutrient supplementation program, the vitamin A campaign and the eradication of worms , and the Community-Based Acute Malnutrition Management program.
Immunization
The national immunization program is a priority 1 (P1) program. Since the start of the immunization program to date, it has become an established and successful public health intervention. Immunization services can be obtained free of cost from EPI clinics in hospitals, other health centers, mobile clinics and outreach, non-governmental organizations and private clinics. The government has provided all vaccines and logistics related to immunization at no cost to hospitals, private institutions, nursing homes. Nepal is one of the recognized countries for a well functioning immunization system with 97% equal population coverage, working for the poor and rich on a child gender basis. Although immunization coverage handles equity gaps, there is still injustice in Nepal. Nevertheless, the trend in the past 15 years has shown promising positive changes that indicate the likelihood of reaching immunization coverage. Two more vaccines are introduced between 2014 and 2015 - inactive poliomyelitis vaccines (IPV) and pneumococcal conjugate vaccines (PCV). Six districts in Nepal were declared with 99.9% immunization coverage. Nepal achieved polio-free status on March 27, 2014. Neonatal and maternal tetanus had been eliminated in 2005 and Japanese encephalitis was in control status. Measles-based measles surveillance is in the process of meeting the elimination target of measles by 2019. One percent of children in Nepal have not received any vaccine coverage.
Community-Based_Integrated_Management_of_Childhood_Illnesses_.28CB-IMCI.29 "> Integrated Community Based Management Management (CB-IMCI))
The Integrated Community Based Management Program (CB-IMCI) is an integrated package dealing with the management of diseases such as pneumonia, diarrhea, malaria and measles, and malnutrition, among children 2 months to 5 years. It also includes infection management, Jaundice, Hyperthermia and counseling about breastfeeding for young infants for less than 2 months. The CB-IMCI program has been implemented to the community level in all districts of Nepal and has shown positive results in the management of childhood diseases. Over the past decade, Nepal has succeeded in reducing under-five mortality, largely due to the implementation of the CB-IMCI program. Initially, the Diarrhea Disease Control Program (CDD) began in 1982; and the Acute Respiratory Infections Control Program (ISPA) started in 1987. The CDD and ARI programs were incorporated into the CB-IMCI program in 1998.
Community-Based_Newborn_Care_Program_.28CB-NCP.29 "> Community-Based Childcare Program (CB-NCP)
The 1996 Nepal Family Health Survey, Nepal's Demographic and Health Survey, and World Health Organization estimates from time to time have shown that neonatal mortality in Nepal has declined to a slower rate than infant and child mortality. The 2011 Demographic and Health Survey of Nepal has shown 33 neonatal deaths per 1,000 live births, which accounts for 61 percent of deaths under 5 years. The main causes of neonatal death in Nepal are infection, birth asphyxia, premature birth, and hypothermia. With the existing healthcare indicator in Nepal, it became clear that strategies to address neonatal mortality in Nepal should take account of the fact that 72 percent of births occur at home (NDHS 2011).
Therefore, as an urgent step to reduce neonatal mortality, the Ministry of Health and Population (Kemkes) initiated a new program called 'Community-Based New Care Package (CB-NCP) based on the 2004 National Neonatal Health Strategy.
Nutrition Program
The National Nutrition Program under the Ministry of Health Services has set the vision of "all Nepali people living with adequate nutrition, food security and food security for adequate physical, mental and social growth and equitable human development and survival" with a mission to improve the overall nutritional status of children, women of childbearing age, pregnant women, and all ages through control of generalized malnutrition and the prevention and control of micronutrient deficiency disorders that have greater inter-sectoral and intra-sectoral cooperation and coordination, partnerships among stakeholders different and high levels of awareness and cooperation of the population in general.
Malnutrition remains a serious obstacle to the survival, growth and development of children in Nepal. The most common form of malnutrition is protein energy malnutrition (PEM). Other forms of malnutrition are deficiency of iodine, iron and vitamin A. Each type of malnutrition damages its own damage to the human body and worsens the condition, they often appear in combination. Even children with acute and acute malnutrition are more likely to die of childhood illness than those who are well-nourished. In addition, malnutrition is a serious threat especially to the survival of young people and is associated with about one third of child deaths. The main causes of PEM in Nepal are low birth weight below 2.5 kg, due to poor maternal nutrition, inadequate food intake, frequent infections, household food insecurity, poor eating and maintenance behaviors & practices that lead to a cycle of malnutrition across generations.
Analysis of the causes of stunting in Nepal revealed that about half were rooted in poor maternal nutrition and half in malnutrition in infants and young children. About a quarter of babies are born with low birth weight. As per the results of the Nepali Demographic and Health Survey (NDHS, 2011), 41 percent of children under the age of 5 have stunting. A survey by NDHS and NMICS also showed that 30 percent of children weigh less and 11 percent of children under 5 years are wasted.
To overcome malnutrition in children, the Government of Nepal (GoN) has implemented:
- a) Eating Baby and Young (IYCF)
- b) Control of Protein Energy Malnutrition (PEM)
- c) Iodine Deficiency Disorder (IDD) Control
- d) Vitamin A Deficiency Control (VAD)
- e) Control of Iron Deficiency Anemia (IDA)
- f) Extermination of child worms aged 1 to 5 years and distribution of vitamin A capsules
- g) Community Management of Acute Malnutrition (CMAM)
- h) Hospital-based nutrition management and rehabilitation
The hospital-based nutrition management and rehabilitation program takes care of the severely malnourished children in the Outpatient Therapy Program Center (OTP) at the Health Facility. As needed, the package is linked to other nutritional programs such as Child Nutrition, micronutrient powder distribution (MNP) to children (6 to 23 months) and food distribution in food insecure areas .
Baby and Young Eating Program
UNICEF and WHO recommend that children exclusively breastfed (no other fluids, solids, or plain water) during the first six months of life (WHO/UNICEF, 2002). The nutrition program under the 2004 National Nutrition Policy and Strategy promotes exclusive breastfeeding through the age of 6 months and, subsequently, the introduction of solid or solid foods along with continued breastmilk until the child is at least age 2. Introducing breast milk substitutes before 6 months of age can contribute to failure of breast milk. Substitutes, like formula milk, other types of milk and porridge are often squeezed and provide too few calories. Furthermore, contamination that may occur in this substitution makes the baby sick. Breast-Replacement Act in Nepal (2049) of 1992 promotes and protects breastfeeding and regulates the sale and distribution of invalid or unsolicited breast milk.
After six months, a child needs a complementary diet that is adequate for normal growth. Lack of appropriate complementary feeding can lead to malnutrition and frequent illness, which in turn can lead to death. However, even with complementary feeding, the child should continue to be breastfed for two or more years.
See also
- Gender inequalities in Nepal
References
External links
- World Resurrection Country - Nepal Country Profile
Source of the article : Wikipedia
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