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Nepal counts down to 2015
Dr. Pradhan Y.V
Director, Child Health Division
Department of Health Services,
Ministry of Health & Population
Nepal
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Welcome to Nepal...
South Asia
India
Pakistan
Afghanistan
Bangladesh
Sri Lanka
Maldives
Bhutan
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Nepal Facts
2005
Population (million) 25.2
Children under 5 (million) 3.7
GNI per capita (US$) 240
Population below 1 US$ per day (%) 24
Health expenditure/capita/year (US$) 6.5
Including private sector (US$) 26
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Trend in Under-Five Mortality1986-2016
201
155
120
4356
7291
0
50
100
150
200
1981-86 1986-91 1991-96 1996-01 2001-06 2006-11 2011-16
Dea
ths
per
100
0 li
ve b
irth
s Estimates
Based on DHS 1996
Based on DHS 2001
MDG = 54 deaths per 1000 live births by 2015
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• Vitamin A supplementation
• Community based pneumonia treatment
• Newer interventions to reduce neonatal mortality
Three Major Programmes
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1997
19981993199419951996
199920002001
2002
Nepal Vitamin A Programme
• High dose Vitamin A post-partum supplementation within six weeks of delivery
• High dose Vitamin A supplementation to 6-59 months children twice a year
• Treatment of measles, prolonged diarrhea, xerophthalmia, severe malnutrition with Vitamin A
• Promotion of vitamin A rich foods
National Role-out
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Impressive coverage: > 3.5 million children reached each round (> 90 %)
0
10
20
30
40
50
60
70
80
90
100
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Pe
rce
nta
ge
Vitamin A Coverage by Year (1993-2005)
12,000 child deaths averted each year12,000 child deaths averted each year
Nepal Vitamin A Programme
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Female Community Health Volunteers
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Female Community Health Volunteers
48,000 FCHVs75 districts
4,000 VDCs
35,217 wards
80 households each
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FCHVs assess and treat with Cotrim
Community Based Treatment of Pneumonia
Timer
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DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
NAWALPARASI
KAPIL-BASTU RUPAN-
DEHI
DANG
BANKE
ACHHAMKALIKOT
JHAPAMORANG
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI
DADEL-DHURA
KANCHAN-PUR
BAJURA
PARSABARA
RAUT-AHAT
DHANUSA
MAHO-TARI
SUNSARI
SARLAHI
DHADING
MAKAWAN-PUR
CHITWAN
KASKIBAGLUNG
TANAH U
PALPA
SYANGJA
PARBAT
ARGHAKHACHI
GULMI
UDAYAPUR
SINDHULI
ILAM
BHOJ-PUR PACHETHAR
DHAN-KUTA
TAPLEJUNG
RAMECHHAP
OKHAL-DHUNGA
TERHA-THUM
KHOTAN G
LALIT
BHAKKATHM SULUK-
HUMBU
DOLAKHA
SANKHUWA-SABA
NUWAKOTSINDHU-PALCHOK
KAVRE
RASUWALAMJUNG
GORKHA
PYUT-HAN
ROLPASALYANMYAGDI
DAILEKHJAJARKOT
RUKUM
MUSTANG
MANANG
25 districts covered in 2005
Community Based Treatment of Pneumonia
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0
10
20
30
40
50
60
70
1996 1997 1998 1999 2000 2001 2002 2003
Programme Districts Non-programme Districts
Community Based Treatment of Pneumonia
Proportion of Expected Pneumonia Cases Treated (%)
8,500 deaths averted each year8,500 deaths averted each year
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Interventions to reduce neonatal mortality
• MIRA
Reducing maternal and neonatal mortality using participatory women’s groups
• MINI
Reducing neonatal mortality with management of
neonatal infections by FCHVs
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Keys to Success
• Openness to research findings and new ideas
• Development, testing and refinement of local implementation model
• Gradual expansion with quality control
• Willingness to delegate preventive and designated curative services to non-health professionals (FCHVs)
• Continued dedication of the FCHVs and other health workers
• Good government-partner collaboration and coordination