Nepal

6. HEALTH SERVICES

6.1 Health education and promotion

The National Health Information, Education and Communication  Centre (NHIEC) was established as a health education section of the DHS during early 1950s particularly to promote personal and community hygiene, food and nutrition and educate people on the utilisation of health services. It was converted into an autonomous centre during the 1993 re-organisation of the Ministry of Health in 1993. Since 2002, the centre has been shifted from the DHS to the Ministry. 

The early activities of the centre have been were gradually shifted to other relevant ministries such as the Ministry of Housing & Physical Planning. Today the centre carries out the following activities:

1.      Provides technical backstopping to other ministries, NGOs, INGOs and private organisations

2.      Provides reproductive health education, hygiene, nutrition promotion and disease prevention education to 8th to 10th grade students

3.      Encouragement of public and private partnerships

4.      Training to health workers in collaboration with the National Health Training Centre, and

5.      Conducts research to determine gap in KAP among target population and service providers, impact assessment and evaluation of different IEC (Information Education Communication) interventions.

More than 90 percent of the Nepalese people can be reached through radio. Mass media are used against tobacco and alcohol on a regular basis.

Related Links

Health Promotion, NCD- WHO/SEARO

Health Education-WHO/HQ

Health Promotion-WHO/HQ

6.2 Maternal and child health/family planning/adolescent health

The first Plan of Action on Safe Motherhood was prepared for 1994-1997. The programme now covers 19 districts. The basic principle of this programme is to create awareness at all levels, building up the local capacity in dealing with three delays – delay in seeking care, delay in reaching care and delay in receiving care. The present programme has been enunciated under a 15-year plan of action (2002-2017). The ultimate aim of the plan is to scale up the intervention to all 75 districts. The 10th five -year plan (2003-2008) also proposed to establish a Comprehensive Emergency Obstetric Care (CEOC) in 10 hospitals and Basic Emergency Obstetric Care (BEOC) in 50 hospitals across in the country.

A Reproductive Health Steering Committee, at the central level and a Reproductive Health Coordination Committee in 33 districts have also been formed. That apart, district level Safe Motherhood Sub-committees have been formed in three districts for an effective coordination.

Building up of local capabilities and adoption of two major strategies have been the mainstay for addressing the programme thrust. These strategies are (i) Providing the CEOC or BEOC round the clock, and (ii) Ensuring the presence of skilled attendants during delivery, especially at home. The programme also envisages an increased access to emergency funds and transportation services. The CEOC model includes improved physical facility, provision of appropriate and adequate equipment and capacity- building. Initiative has also been taken to accommodate delivery corners in major hospitals and low cost special care baby unit at the Maternity Hospital in the nation’s capital city of Kathmandu.

According to the record of the Maternity Hospital, Kathmandu (1993), about 20-27 percent of maternal deaths in the hospital occurred due to complications of abortion. The maternal mortality and morbidity study in 1998 revealed that five percent of the deaths in the community were due to abortions.

Starting in 1995 from the Maternal Hospital in Kathmandu, a post-abortion care programme has now been expanded to 29 cities in the country. The Nepal Government (NG) has recently approved the Safe Abortion Service Procedures, 2060 (2004) and accordingly, this Maternal Hospital at Thapathali, Kathmandu has started providing abortion related services since March 2004.

The 11th amendment to the civil code has legalised abortion services under certain conditions. Under safe abortion service procedures, a consultative committee had been formed under the chairmanship of the Director General of Health entrusted with the responsibility to advise and recommend to the government in the formulation of policy, plan and programmes for safe abortion services and play the role of facilitator and coordinate the services among the Government, NGOs and private agencies. Professional organisations and NGOs are the active partners which are complementing the family planning and safe motherhood services. Together they contribute to about eight percent of the total services in Nepal (BASICS II-2004).

Trends in ANC Visits and Delivery Services (DoHM, HMIS, Health Service Coverage Fact Sheet-2004)

In Nepal, 44 percent pregnant women were attended by trained personnel during pregnancy in 2005-06 (Demographic Health Survey, 2006). Around 18.3 percent of deliveries were attended by trained personnel in 2005-2006 (expressed as a percentage of expected pregnancies). Further, around 40.2 percent women of childbearing age were using family planning methods during this period (Demographic Health Survey, 2006).

Related Links

Adolescent Health- WHO/SEARO

Child Health- WHO/SEARO

Child Adolescent Health- WHO/HQ

Gender, Women and Health- WHO/SEARO

Maternal Health-WHO/HQ

Reproductive Health- WHO/SEARO

Reproductive Health-WHO/HQ

Making Pregnancy Safer- WHO/SEARO

Making Pregnancy Safer- WHO/HQ

RH Nepal

UNICEF Nepal

6.3. Immunisation

Universal immunisation of children under one year of age against the six vaccine-preventable diseases (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles) is one of the most cost-effective programmes in reducing infant and child morbidity and mortality.  The expanded programme of immunisation is a priority programme for the Government of Nepal.  Among the immediate objectives of the programme are (i) to reduce measles cases by 90 percent and deaths due to measles by 95 percent from previous levels by the year 2000, and (ii) to eradicate polio by the year 2000 (Ministry of Health, 2001).  Since 1988, the EPI under the Ministry of Health has covered all 75 districts of the country. The programme in Nepal follows the guidelines set by the World Health Organisation (Ministry of Health, Nepal Demographic and Health Survey, 2001).

Vaccine Coverage among Infants in Nepal.

Source: DHS, HMIS, Health Service Coverage and * EPI Fact Sheet, WHO/SEARO

The National Immunisation Day is observed annually every year with broader participation of local communities, NGOs and volunteers. A high level inter-agency coordination committee has been formed for coordination of immunisation programmes with representatives of the World Health Organisation (WHO), the UNICEF, the JICA and NGOs and private philanthropic organizations.

Hepatitis B vaccination has been added to the arsenal of EPI in 2003 with the help of GAVI. The whole country is expected to be covered by 2006-2007. Vaccine coverage has been improving during the last three years mainly due to strengthening of programme management and monitoring measures at various levels.

Related Links

WHO Nepal- Programme for Immunization Preventable Diseases

Immunization- WHO/SEARO

Immunization- WHO/HQ

6.4. Prevention and control of locally endemic diseases

An inter-country agreement among Bangladesh, Bhutan, India and Nepal has been reached to develop cross-border collaboration and networking by sharing information and standardisation of surveillance and laboratory diagnosis for priority vector- borne diseases.

Spraying, early detection and treatment, IEC, distribution of insecticide treated bed-nets, outbreak response etc., are some of the important strategies adopted by the royal government in this regard. In addition to these measures, an Early Warning Reporting System (EWARS) has also been established in 24 zonal and district hospitals throughout Nepal. The EWARS mainly focuses on weekly reporting of cases and deaths of six priority diseases (malaria, kala-azar, encephalitis, polio, measles and rabies).

Malaria, kala-azar, Japanese encephalitis and filariasis are some of the major endemic diseases prevalent in the Himalayan country. Malaria is endemic in 65 districts and approximately 74 percent of the total population is at risk. Out of 1, 13,403 slides examined, 10,446 (9.2 percent) were found to be positive in 2001-2002. As compared to 2002, there was rise in slides collection by 6.75 percent and decrease in number of positives by 25.64 percent. The slide positivity came down from 9.2 percent in 2001-02 to 4.3 percent in 2003-04.

Kala-azar is endemic in 12 districts of the Eastern Terai region and approximately 5.5 million people are at risk. The reported cases of kala-azar decreased from 1,290 in 2000-2001 to 829 in 2001-2002 but in 2003, altogether 2229 cases were recorded in the country. There were 32 deaths due to Kala-azar in 2003.

Japanese encephalitis has been reported from 14 Terai districts, including some from Kathmandu. So far, total of 26,667 cases and 5,381 deaths have been reported during 1978 to 2003.The Case Fatality Rates (CFR) are ranging from 9.8 percent to 46.3 percent during 1978 to 2003. But in the recent years, CFR has declined and contained below 20 percent.

HIV/AIDS is assuming an unprecedented proportion in its prevalence particularly among the injecting drug users. It is estimated that there are 60,000 HIV positive and about 5,000 AIDS cases in Nepal. Among injecting drug users, over 68 percent were from the Kathmandu valley and 44 percent of them in the country have been found to be HIV positive during 2002.

Iodine deficiency disorder was the most endemic problem in Nepal.  The Ministry of Health has introduced a policy to fortify all edible common salt with iodine to overcome this public health problem.

In Nepal, the prevalence of leprosy has dropped to 2.41 per 10,000 populations in 2003-04 from 5.9 at the end of the eighth plan.  The Nepal Leprosy Elimination Campaign is working towards eliminating leprosy from the country by detecting hidden cases in the community. The improvement in reduction of leprosy prevalence was possible due to partial progress in transferring of patient retained earlier at referral centres to the health institution nearest to the patients’ house.  It can be improved further if referral centres fully comply with the national guidelines for transferring of retained patients to the respective health centres (Ministry of Health, Annual Report 2003/2004).

Related Links

CDS- WHO/SEARO

Infectious Disease-WHO/HQ

HIV- WHO/SEARO

Malaria- WHO/SEARO

TB- WHO/SEARO

TB-WHO/HQ

Leprosy- WHO/SEARO

LF- WHO/SEARO

Kalazar- WHO/SEARO

Dengue- WHO/SEARO

AI- WHO/SEARO

Cholera- WHO/SEARO

JE- WHO/SEARO

6.5. Prevention, control and management of common diseases and injuries

The Acute Respiratory Tract Infection Control Programme has been given a major emphasis in Nepal in view of the fact that more than one-third of deaths among the children in Nepal, have been reportedly caused by respiratory diseases.  This programme aims at reducing the complication caused by respiratory tract.  To achieve this objective, there is a regular ARI control programme in place which has been implemented in 61 districts as a special programme.  The incidence of diarrhoea and ARI cases are given below in the table:.

Diarrhoea and ARI Situation in Nepal (DHS, HMIS, Health Service Coverage Sheet – 2004

In Nepal, the Diarrhoeal Disease Control programme was launched in 1984 to reduce the infant and child mortality by promoting Oral Rehydration Therapy.  As per the given table, the percentage of children with severe dehydration has decreased from four percent in 2000-01 to three 3 percent age in 2003-04.  This improvement is assumed to be due to increased public awareness created by health education programmes.

Cases of heart diseases and cancer are increasing due to extended longevity and changing of life style and dietary patterns. To address the situation, the government has established a specialised hospital in Kathmandu and a cancer hospital in Bhratpur. In addition, the government is also providing services of radio therapy and chemotherapy from Bir and Bhaktapur hospitals.

Related Links

NCD- WHO/SEARO

Mental Health- WHO/SEARO

Mental Health-WHO/HQ

Cancer-WHO/HQ