Nepal

OVERVIEW OF THE HEALTH SYSTEM IN NEPAL 1
1.1 HEALTH STATUS IN NEPAL
A
review of the health situation in Nepal shows that the country has made encouraging progress on
improving the overall health outcomes of its citizens. In particular, Nepal has made impressive
progress toward the Millennium Development Goal (MDG) targets for child survival (target 4) and
maternal health (target 5) (NPC, 2013). A clear indicator of this progress is the increase in life expectancy
at birth, which rose to around 67 years in 2011 compared with 50 years in 1981, when maternal and child
mortality were high (CBS, 2014). The substantial improvement is the result of effective community-based
health interventions such as the birth preparedness package, the Aama Surakshya Program, family planning
programs, basic and comprehensive emergency obstetric and neonatal care, safe abortion services, nutrition
initiatives (vitamin A, breastfeeding, complementary feeding), integrated management of newborn and
childhood illness, the National Immunization Program, and other promotive, preventive, and curative
measures.
Tables 1.1 and 1.2 provide further evidence of the scope of the changes in population and health
indicators over the past several decades in Nepal. Population growth has slowed, literacy levels have
improved, and there has been continuing improvement in the gross domestic product (GDP).
Table 1.1 Trends in key population indicators, Nepal 1991-2011
Indicators 1991 2001 2011
Population (millions) 18.4 23.2 26.5
GDP per capita (NPR) 8,084 19,410 56,880
Literacy rate (percentage of 6 years and above) 39.6 54.1 65.9
Life expectancy at birth (years) 54.3 60.4 66.6
Source: Population censuses 1991, 2001, and 2011 (CBS, 2012)
Mortality rates among young children have declined as utilization of maternal health services,
including family planning, has increased. The nutritional status of children also has been improving.
Table 1.2 Trends in key health indicators, Nepal 2001-2011
Indicators 2001 2006 2011
Total fertility rate 4.1 3.1 2.6
Infant mortality rate (per 1,000 live births) 64 48 46
Under-5 mortality rate (per 1,000 live births) 91 61 54
Contraceptive prevalence rate 39 48 50
Antenatal care (by skilled provider; percentage) 28 44 58
Delivery care (by skilled provider; percentage) 11 19 36
Stunting rate (percentage of children under age 5) 57 49 41
Wasting rate (percentage of children under age 5) 11 13 11
Underweight rate (percentage of children under age 5) 43 39 29
Use of improved water supply (percentage) - - 89
Source: NDHS 2001, 2006, and 2011
The maternal mortality ratio (MMR) has decreased as well, from 790 per 100,000 live births in 1996
to 258 in 2015, a decline of 67 percent (WHO, 2014).
Despite these improvements, Nepal faces a triple health care burden. Communicable diseases still
account for a large proportion of deaths and disability. The prevalence of non-communicable diseases
(NCDs) is growing, emerging as a major public health problem. These problems are further compounded by
threats from natural disasters, the adverse effects of climate change, and accidents and injuries.
Overview of the Health System in Nepal • 1