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2. TRENDS
IN SOCIO-ECONOMIC DEVELOPMENT
2.1Economic trends
In more than a decade, the GNP increased only by US $
16. It was reported to be US $ 250 in
2000 but it declined to US $ 249 in 2002 due to socio-political instability
and insecurity in the country. It has again gone up to US$300 in 2004/05 (as
per Nepal Millennium Development Goals: Progress Report 2005)
The GDP per capita has increased from US $ 227 in 1998/99
to US $ 237 in 2002/03. The average
annual growth during 1990-2000 was 2.4 percent (Statistical Yearbook, 2003).
Nepal
is a less indebted country, as the present value of debt is 193 percent of
export of goods, services and income (The World Bank, World Development
Indicators, 2005).
In Nepal,
the foreign aid increased from Rs. 16,188 million in 1998-99 to Rs. 16,974
million in 2002-03.
The share of annual health expenditure as percentage of
the national budget was 5.1 in 2001-03.
Nepal’s
rank in terms of the UNDP human development index (HDI) is 138 among 177
countries. The index increased from
0.291 in 1975 to 0.527 in 2004 (Nepal Annual Report DOHS, 2002-03, Human
Development Report, 2006).
Nepal’s
labour force increased from 8.8 million in 1990 to
11.7 million in 2003. The average
annual growth rate for the period is 2.2 percent. The unemployed population aged 10+ is
reported to be 5.1 percent while unemployment rate is 3.8 percent
(Statistical Yearbook, 2003 and Nepal Living Standard Survey 2003/04). However, the proportion of females in labour force has not increased much. It was 38.5 percent in 1990 and 39.5
percent in 2003 (World Development Indicators, 2005).
In Nepal, 24.1 percent of the population earn less than an
American dollar per day and 31 percent of the population is living below
poverty line (Nepal Millennium Development Goals: Progress Report 2005).
 World Bank Nepal
Ministry of Finance
HDI
UNESCAP
2.2 Demographic
trends
The population of the country increased from 11.6 million
people in 1971 to 25.8 million in 2006. However, the annual growth rate during the
period did not decline; rather it increased from 2.1 percent in 1971 to 2.6
percent in 1981, and again decreased to 2.1 in 1991, but again increased to
2.25 in 2001. The CBR decreased from
35.4 per 1,000 population in 1996-97 to 33.5 population in 2001 to 28.4 per
1,000 population in 2006 (Nepal Demographic and Health Survey, 2006) while
CDR decreased from 11.5 per 1,000 population in 1996-97 to 9.96 per 1,000
population in 2001. The average
fertility estimate for 2006 is 3.1 (Nepal Demographic and Health Survey,
2006) and 2001 was 4.1 as against 5.1 during 1984-86. There is significant difference in TFR for
urban and rural areas i.e. 2.1 and 3.3 ,
respectively (Nepal Demographic and Health Survey, 2006).
As per the census 2001, 39.3 percent of population was
below 15 years and 6.5 percent was 60 years and above. About 54.2 percent of population was
between 15-59 years (Computed from Population Census 2001, National Report).
The life expectancy at birth increased from 42.0 years for
males and 40.0 years for females in 1971 to 55.0 years and 53.5 years for
males and females, respectively, in 1991.
However, it has shown slight increase in female life expectancy over
the males since then. It was 61 years
for females and 60 years for males as per 2001 report (Demographic and Health
Survey, 2001).
Trends in infant mortality rate (IMR) show that it
declined from 140 per 1,000 live births in 1976 to 103 in 1986, to 64 in 2001
(Demographic and Health Survey, 2001) and is estimated to be 61 in 2005
(Nepal Millennium Development Goals: Progress Report 2005) and according to
NDHS survey, it is 51 per 1,000 live births (Nepal Demographic and Health
Survey, 2006).
Government
of Nepal
Central Bureau of Statistics
UNDP or National
Planning Commission
WHR
2.3 Social trends
The literacy rate is showing a steep upward trend. It was
54 percent in 2001. The Ministry of Education pegs the latest rate at 57
percent. Enrolment ratio in the primary and secondary schools are 0.79 and
0.69, respectively. Gender inequality
in the rate of literacy is, however, glaring. It was 42 percent for females
and 65 percent for males (National Population Census, 2001). The Net
Enrolment Rate in primary education in 2005 is 84 (Nepal Millennium
Development Goals: Progress Report 2005)
UNDP or NPC
Central Bureau of Statistics
UNESCO
WB
2.4 Food supply and nutritional status
The proportion of newborns weighing less than 2,500 grams
at birth was 23 percent in 1996/97 and 14.3 percent in 2006. The government has set a target to reduce
it to 12 percent by 2017 (Health Information Bulletin 2001).
The demographic and health survey of 2001 reported that
about 50.5 and Nepal Demographic and Health Survey, 2006 reported that about
49.3 percent children below 5 years were affected by stunting (short of their
age), which can be a sign for early chromic under nutrition. The survey also found that 48.3 percent in
2001 and 38.6 in 2006 of the children were under weight. Also, in the year
2000, 55 percent of children below 5 years were stunted (Nepal Millennium
Development Goals: Progress Report 2005), an indicator of acute malnutrition.
The Nepal Micronutrient Status Survey (NMSS) report 1998
revealed that the median urinary iodine level among women was 114.0 mg/I and
among school-aged children it was 143.8 mg/I.
According to the ‘between census household information monitoring
evaluation survey 2000’, only 63 percent households were adequately covered
with iodised salt.
These reports show that the median urinary iodine level is higher than
the WHO cut-off point but household coverage of adequately iodised salt is still lower than the WHO cut-off
point. Therefore, IDD is still a
public health problem in Nepal.
Iron deficiency anaemia is the most common nutritional
problem in Nepal
affecting approximately three-quarters of women. Anaemia is one of the
underlying risk factors in pregnancy. Anaemia reduces work capacity of adults
by 10-30 percent. Among women, there is distinct variation in the prevalence
of anaemia according to the ecological zone with highest levels in the Terai followed by the mountainous regions.
The most common cause of anaemia in Nepal is
considered to be inadequate intake of iron from food followed by parasitic
infection, as 71 percent pregnant women are not consuming adequate amount of
iron from their daily diets. This is despite fact that antenatal iron
supplementation is in place in Nepal since more than two
decades. However, the coverage and
compliance of antenatal iron supplementation is beyond satisfaction. There is a big gap between supply and
demand of iron tablets.
A baseline study was carried out in the districts where
Intensified Antenatal Iron Supplementation Programme (IAISP) was
implemented. The findings in the
programme areas revealed that 27 percent and 47 percent of pregnant women
took iron tables in the second and third trimester, respectively. Similarly, drop-out rate was 19 percent
during the second trimester and 25 percent in the third trimester. Lack of knowledge about the importance of
iron tablets is stated to be the main reason for not taking iron
supplementation. However, due to
continuous effort by health workers to improve the coverage of iron tablets
during pregnancy and postpartum, the coverage of iron tablets reached to 68
percent in the fiscal year 2002-03.
Breastfeeding is nearly universal in Nepal and the
median duration of breastfeeding is long (34 months). Nearly one in three children is breastfed
within one hour of birth, while two out of three babies are breastfed within
one day of birth. This is an
improvement over the last five years.
However, contrary to the WHO recommendation, only two-thirds of
children less than six months of age are exclusively breastfed. Only 53
percent of children under six months of age are
exclusively breastfed. Bottle-feeding is not common in Nepal (Nepal
Demographic and Health Survey, 2006)
It also reported that 40.9 percent of newborn receive
pre-lacteal feed which needs to be reduced (Demographic and Health Survey,
2001).
Nutrition
Nutrition – WHO/HQ
2.5 Lifestyle and Risk Factors
Smoking is associated with increased risk of lung and
heart diseases and is also closely related to other behaviours
risky to health, such as alcohol and drug use.
Nearly three-fourths of men smoke cigarettes, bidis or other tobacco, two-thirds consume alcohol; more
than one in two both smoke and consume alcohol. Smoking and alcohol consumption is much
less common among men in the age group of 15-19. Smoking and alcohol consumption is also
less common among divorced, separated, or widowed men and women living in the
Terai ecological zone, western development region,
and central Terai sub-region than in other regions.
The present priority in health programmes is more on group
I and II diseases. However, heart disease, diabetes and cancer are on the
increase. That is why the government has taken several steps to create
awareness among the public about the harmful effects of tobacco, alcohol and
narcotic drugs. Besides, other measures such as increase in excise duty on tobacco
and alcohol products, health tax on tobacco products, compulsory health
warning on every cigarette package, ban on smoking in public places, ban on
advertising and promotion of tobacco products, and import and export tax on
tobacco products have been enforced to discourage use of tobacco and alcohol.
The Smoking (Prohibition and Control Act, 2058) is awaiting the parliamentary
approval. Under the national anti-tobacco programme, anti-tobacco
communication campaign, a five-year action plan (2004-08) has been prepared
by the health ministry (Update on the National Health System Profile Nepal, 2004).
Substance Abuse
Tobacco WHO/HQ
Alcohol
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