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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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

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

• Vitamin A supplementation

• Community based pneumonia treatment

• Newer interventions to reduce neonatal mortality

Three Major Programmes

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

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

Female Community Health Volunteers

Female Community Health Volunteers

48,000 FCHVs75 districts

4,000 VDCs

35,217 wards

80 households each

FCHVs assess and treat with Cotrim

Community Based Treatment of Pneumonia

Timer

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

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

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

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