Statistics, as we all know, don’t always reflect the full picture. Questions of provenance, accuracy and purpose sometimes need to be considered when reading any document. Reading the latest Nepal Health Sector Plan (2010-2015), published by the Ministry Of Health & Population there’s little doubt that despite a good deal of progress, there are significant shortcomings in health care provision within Nepal. None of this comes as a surprise, but it is a stark reminder of the uphill struggle which still exists.
As a VSO volunteer, I have access to good medical services in Kathmandu should they be required, and the costs are borne by VSO. Picking up a repeat prescription for medication is therefore a relatively straightforward process for me. Something of a contrast between my experience and that of many parts of Nepali society.
“The Government alone cannot reach the remote rural communities and deliver more basic health services, especially to the poor and excluded, without partnering with the NGO community. …Failing to deploy and retain health care providers, particularly doctors and nurses in remote areas, persists and will continue to damage quality of care at Primary Health Care Centres and District Hospitals.
… Access to health care facilities continues to be a problem in rural areas, especially for the most disadvantaged. They are too few in number and often not built at a location likely to provide access to those who need care the most.” (NHSP-IP II (2010-2015)
A few facts extracted from the document illustrate the distance still to be travelled…
- The improvement in the relative health status of the poor and marginalised is notable because it has taken place in a context in which the incidence of poverty decreased markedly from 41% to 31% between 1996 & 2004, but the overall disparity between rich and poor has increased. The wealthiest consume eight times more than the poorest, and 3 of 10 Nepali citizens remain below the poverty line.
- Although deaths of children under five years of age have decreased by 48 % in the past 15 years, in 2010 six of 100 children are likely to die before their fifth birthday. Deaths of infants have declined by 41 %, but 5 of 100 babies still die before their first birthday.
- Maternal mortality has declined by 48 % in the last decade, but 42 women are dying each week due to child bearing related problems. …Nepal remains one of the most malnourished countries in the world, with nearly half of under five year olds stunted, indicating early chronic malnutrition. This reduces survival chances, causes permanent impairment of physical and cognitive development, and perpetuates poverty by reducing their achievement in school and their future earnings.
- In 2008, UNDP ranked Nepal 142 of 177 countries on the Human Development Index. Life expectancy was 63 years in 2006…
- Political instability, exacerbated by the economic crisis, rising food prices, constant power outages, street demonstrations and general lack of law and order, constitutes the health sector’s backdrop of the recent past and, most likely, for the foreseeable future. There have been major accomplishments in a short time but there is much to be done if Nepal is to achieve its health sector goals and the Millennium Development Goals.
Food for thought indeed….