Latest Health Care Service and Sociological Statistical Data of Nepal

Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards. The prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas.

Population, particularly those are living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition, and other health-related events. Now some improvements are seen in maternal health as follows:-

1. Human Development Index (HDI) increased to 0.458 in 2011 from 0.291 in 1975. 
2. The mortality rate during childbirth decreased from 850 out of 100,000 mothers in 1990 to 190 out of 100,000 mothers in 2013 
3. Mortality under the age of five decreased from 61.5 per 1,000 live births in 2005 to 31.4 per 1,000 live births in 2018. 
4. Infant Mortality decreased from 97.70 in 1990 to 29.40 in 2015.
5. Child malnutrition: Stunting 37%, wasting 11%, and underweight 30% among children under the age of five.
6. Life expectancy rose from 66 years in 2005 to 71.5 years in 2018.

Health care expenditure

• In 2002, government funding for healthcare was approximately US$2.30 per person. Approximately 70% of health expenditure came from out-of-pocket contributions. Government allocation for health care was approximately 5.8% of the budget in 2009.
• In 2012, the Nepalese government launched a pilot program for universal health insurance in five districts of the country. 
• As of 2014, Nepal’s total expenditure on health per capita was US$137.

Health care infrastructures in Nepal

• The United Nation’s 2009 human development report highlighted a growing social concern in Nepal in the form of individuals without citizenship being marginalized and denied access to government welfare benefits.
• Nepal became a member of WHO in September 1953 by becoming a party to the Constitution, joining the South East Asia Region. WHO country office was established in Kathmandu in 1954.
• 3. Non-governmental organizations (NGOs) to implement communication programs encouraging people to engage in healthy behavior such as family planning, contraceptive use, spousal communication, and safe motherhood practices, such as the use of skilled birth attendants during delivery and immediate breastfeeding.
• There are 9 zonal hospitals and the government has made a policy to establish 1 zonal in each zone.   
• The number of beds in the zonal hospital is 50-150. There are 9 hospitals in this category.
• The Government’s dedication to PHC and to improve rural health care services has been instrumental: 50,007 Female Community Health Volunteers work across Nepal to provide basic health services; 205 PHC Centers, 1,311 Health Posts and 2,511 Sub Health Posts are present across the country.

Health Insurance scheme in Nepal 

• Nepal government launched its public health insurance plan in the 2016/17.  Payment   premium of USD 113 per year to get the services worth up to USD 348. 
• This scheme provide coverage of services such as nutrition, psychological counseling, vaccination, family planning, safe motherhood, OPD,  emergencies services, medications and preventive services consisting ambulance.

Nutrients of children under 5 years 

       Urban area

•  Stunted:- 27%
• Wasted:- 8%
• Underweight:- 17%

       Rural areas 

•  Stunted:- 42%
• Wasted:- 11%
• Underweight:- 30%

      Overall

• Stunted:- 17%
• Wasted:- 30%
• Underweight:- 29%

Life expectancy in Nepal according to 2017

Distribution of oral hygiene practices among different age groups in Nepal.

Age Groups (years): – 15-29                                    

Clean teeth at once a day       clean teeth twice a day    

97.9 %                                    13.1 %

Fluoridated toothpaste    Dental visit (within 6 months)

79.3%                              2.8%

Age Groups (years): – 33-44

Clean teeth at once a day       clean teeth twice a day    

94.8%                                     8.2 %

Fluoridated toothpaste    Dental visit (within 6 months)

69.1%                              4.0 %

Age Groups (years): – 45-69

Clean teeth at once a day       clean teeth twice a day    

89.6 %                                    6.2 %

Fluoridated toothpaste    Dental visit (within 6 months)

57.6 %                              6.1 %

In order to address under-nutrition problems in young children, the Government of Nepal has implemented:-

• Infant and Young Child Feeding (IYCF)

• Control of Protein Energy Malnutrition (PEM)

• Control of Iodine Deficiency Disorder (IDD)

• Control of Vitamin A Deficiency (VAD)

• Control of Iron Deficiency Anemia (IDA)

• Deworming of children aged 1 to 5 years and vitamin A capsule distribution

• Community Management of Acute Malnutrition (CMAM)

• Hospital-based nutrition management and rehabilitation

Distribution of Medical colleges in Nepal according to Province:

• Province 1: BPKIHS (UG-PG-SS- Med-Dental), Nobel (UG-PG-Med-Dent), Birat (UG-Med) 
• Province 2: Janaki (UG-Med), National (UG-PG-Med), MD Kedia (UG-Dental) 
• Province 3: MMC (UG-PG-SS- Med-Dent), KUMS (UG-PG-Med-Dent), PAHS(UG-PG-Med), NAMS (PG-SS- Med-Dent), NMC (UG-PG- Med-Dent), KMC (UG-PG- Med-Dent), NAIHS (UGMED), Kist (UG-PG- Med-Dent), Kantipur (UG-PG-Den), Peoples (UG-PG-Den), CMC (UGMed-Den), COMS (UG-PG- SS- Med-Dent)
• Province 4: PAHS (Not started), MCOMS (UG-PG-SS- Med), Gandaki (UG-Med-Den)
• Province 4: PAHS (Not started), MCOMS (UG-PG-SS- Med), Gandaki (UG-Med-Den)
• Province 5: UCMS (UG-PG-Med-Dent), Nepalgunj (UG-PG- Med), Lumbini (UG-PG- Med), Debdaha (UG-Med)
• Province 6: KAHS (No UG/PG Program)
•  Province 7: Nil

Medical Education in Nepal 

• Currently, there are 20 medical colleges among which 5 belong to the public, and 15 are privates.
• According to the latest data 11,000 students are studying in all medical colleges and approximately 5,000 have gone abroad to obtain a higher medical degree.
• According to recent data ministry of educations, nearly 15,000 students appeared for the MBBS entrance exam in 2019/2020 session but the total number of seats available only 1,900 most of them are in payments either partial or full.
• Recently data states the patient-doctor ratio is 1: 1,721 and one nurses for every 500 people.
• Nepal needs more medical colleges because more than 1,000 students used to go abroad to study.

Total number of registered doctors in Nepal

Total Registration status up-to 31st December 2019

	Male	Female	Total
MBBS	15485	7661	23146
BDS	1118	2082	3200
Total	16603	9743	26344

Specialist Registration status up-to 31st December 2019

	Male	Female	Total
MD/MS	5213	1972	7185
MDS	317	256	573
Total	5530	2228	7758

Covid-19 in Nepal 

Current health systems capacity

• The country has 26,930 hospital beds in public and private hospitals. Likewise, 1595 ICU beds and 840 ventilators are available in 194 hospitals. 
• Recently, MoHP has designated 111 hospitals to run COVID clinics and 28 hospitals to treat COVID-19 cases. 
• As these facilities, particularly inpatient beds and ventilators, are being used for other conditions or inpatient care services, we assume only one-third of it could be available for COVID-19 cases.

Some facts of Pandemic COVID-19 till May 25^th

• COVID -19 first case appeared in Nepal at 2020-01-23 in a 31-year-old student who had returned to Kathmandu capital city of Nepal from Wuhan, china on 9 Jan 2020. this is the first recorded case of COVID-19 in south Asia.
• The first case of local transmission was confirmed on 4th April 2020 in the Kailali district.
• First death occurs on 14th May 2020, which is a 29-year-old woman.
• Total death confirmed till May 25, 2020, are 4.
• Total cases till May 25^th 2020 are 682.
• The total recover case till May 25, 2020, is 112.
• Total active cases till May 25^th 2020 are 566.
• Approximately 47 districts are affected with COVID-19

RT-PCR,   RDT

Till date 25^th may 2020.

Total RT-PCR done 51,682. 

Total RDT done 95,192.

• Nepal started quarantine from 2020-03-24 to June 2, 2020.
• Till now no critical cases of   COVID-19.
• Nepal has approximately one ventilator for 114, 000 People. Approximately the population of Nepal is 29 million and the poorest country with per capita income of only US $642.
• Ministry of Health and Population claimed that there are 600 ventilators in the country, 400 only in Kathmandu valley, and the remaining 200 in other places but According to several workers in the health sector claim, it’s not true what Ministry had told. 
• Just approximately 360 as total in Nepal.
• 260 ventilators in Kathmandu valley and remaining other places.
• According to health workers, approximately 25% are not in the working process.

Treating COVID-19 cases in Nepal

• As we know according to WHO, out of 100 reported cases of COVID-19, 80 can be treated at home, 15 need hospitalization, and the remaining 5 need serious treatment on a ventilator. This means Nepal can handle only a little more than 5,000 cases of COVID-19.
• Symptomatic, Vitamin C, and natural home remedies which help in boosting immunity.
• The home remedy used in Nepal for COVID-19.

Surgical challenges which are being faced during COVI-19 in Nepal

• It is only logical that Nepal prepares the best with the limited medical facilities that have. 
• There are numerous challenges that impact the surgical department and the hospital administration in general. New guidelines are being formulated and updated frequently.
• The challenge to provide sufficient personal protective equipment, limited finances, and need to train staffs are pertinent challenges.
• A change in the method of treatment and execution has exerted pressure on the surgeons with a need to keep abreast of new developments.
• As mostly Nepal is a mountainous area so there is a lack of transport facilities and where there are few roads to go hospitals and because of this pandemic COVID-19 surgeons were unable to handle surgery because of lack of proper skilled manpower, proper equipment.
• Recently 25th May 2020, Orthopedic Surgery Department of Patan Hospital got first chance to do the surgical repair of fracture of both leg in a COVID-19 positive patient under the command Professor, Dr. Suman Shrestha ( orthopedic department) of the Patan hospital and finally, the operation was successfully done although there are lots of challenges during this pandemic.

Ecological and environmental changes during pandemic COVID-19 

• Due to the coronavirus outbreak’s impact on travel and industry, as a whole region of Nepal experienced a drop in air pollution. Reducing air pollution can reduce both climate change and COVID-19 risks as well, but it is not yet clear which types of air pollution (if any) are common risks to both climate change and COVID-19.
• Water quality is being improved as due to lockdown effect many migrants, as well as locals, were not able to throw their garbage near water resources and also industrial wastes not being mixed to water resources.
• The increase in water clarity was due to the settling of sediment that is disturbed by boat traffic and mentioned the decrease in air pollution along the waterways.
• As people stayed at home due to lockdown and travel restrictions, some animals have been spotted in cities due to the lowered levels of human interference and light pollution.
• As according medical exports decided to ban the human consumption of bats and pangolins, to stem the spread of zoonotic diseases, as the novel coronavirus is thought to have transmitted itself to humans through these animals.
• Farming increases as due to lockdown people are free and utilizing their time.

Socioeconomical changes

• Nepal was rebuilding its economy since 2016 and aimed to achieve target growth of 9.6 percent up to 2021 but it’s won” happen anymore because of pandemic COVID-19. Nepal achieved economic growth of 7 percent for the last three years, with an official target of 8 percent in 2020, but the global pandemic shock looks to derail Kathmandu’s plans.
• Almost industries are not functioning fully due to a lack of raw materials as well as man powers.
• As per the analysis by the Asian Development Bank, the outbreak of this deadly disease will hit almost every sector of the Nepali economy, shaving up to 0.13 percent off the gross domestic product and rendering up to 15,880 people jobless.
• The impact has already started to affect the number of sectors like tourism, trade and production linkages, supply and health especially the entire service industries: tourism, aviation, and hospitality sector have been hit hardly by the outbreak.
• With the launch of visit Nepal 2020 campaign in January, the country was in hope to attract two million visitors, but due to the corona pandemic the campaign got canceled which has shattered the hospitality and tourism-related business sector. 
• With this, the tourist arrival rate has declined to below 10 percent, from 70 percent before the Covid-19 outbreak. The tourism sector, being one of the largest industry has been contributing 8 percent to Nepal’s economy. Likewise, cancellation of all spring mountaineering expeditions, including Everest ascents, has resulted in job loss of around 13,000 tours, trekking, and mountain guides.
•  The outbreak has affected people’s lives as well as the private and public sectors. Banks are suffering in loss of their investments in hospitality and aviation due to the coronavirus tourist slump.
• The wholesale and retail sector is the second-largest contributor to the economy, after agriculture.
•  The sector contributes 14.37 percent to the economy, which is already being affected by the drastic downfall in imports from China and India following the outbreak of the disease.
• Pandemic COVID-19 makes a chance to gather all family members together who are far distant.

Sources:

• Ministry of health of  Nepal.
• Worldometer
• Wikipedia 
• WHO official site
• Nepal medical council official site
• And other electronic journals.