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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
Welcome to Nepal...
South Asia
India
Pakistan
Afghanistan
Bangladesh
Sri Lanka
Maldives
Bhutan
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