Health Equity and System in Nepal: Gloomy Achievements behind Bright Commitment

Transcription

1 Health Equity and System in Nepal: Gloomy Achievements behind Bright Commitment

2 General Background Information of Nepal Population = 22,736,934 Male : 11,359,378 Female : 11,377,556 Largest Area District : 7,889 sq. km. Lowest Area District : 119 sq. km. Highest Populated District : KTM : 1,081,845 Least Populated District : Manag : 8,587

3 General Health Situation of Nepal Life expectancy at birth 61.9 (Second lowest in south Asia) Maternal Mortality Rate (per 100,000) Crude Death Rate (per 1000) 416 (third highest in south Asia) 10 (highest in south Asia) <5 Mortality Rate (per 1000) 83 (Second highest in south Asia) CBR (per 1000) Total Fertility Rate (per-women) 33.3 (highest in south Asia) 4.1 (Second highest in south Asia) CPR 39.3 (Second lowest in south Asia)

4 Conceptual Framework : Nexus between Health Outcomes and Other Sectors of Development Policy Level Commitment towards equity and human rights Policy development approach Budgetary management Prioritized sectors of development Equity/human rights monitoring mechanism Societal level DEVELOPMENT OUTCOMES Gaps Among Social groups Economic groups Gender Racial/ethnic groups Geographical groups Age groups HEALTH DIFFERENTIALS Differentials in Knowledge/information Income/opportunities Specific exposure Vulnerability to illness Coping capabilities Participation Decision-making power HEALTH OUTCOMES Gaps Among Social groups Economic groups Gender Racial/ethnic groups Geographical groups Age groups Social justice system Social stratification Customary regulations Cultural taboos/ privileges Power dynamics

5 Policy Response to Health Equity in Nepal Health Services System Nati RH Strategy State commitment towards human and reproductive rights

6 Health Services System Ministry of Health & Population Department Department of of Health of Health Services Services PFA AD D FH D D I V I S I O N S D I V I S I O N S D I V I S I O N S D I V I S I O N S CH D ED ED CD CD LM LM DD HIM HIM DD DD LCLCD D NHNHT TC C NH NH EIC EIC C C C E N T R E S C E N T R E S C E N T R E S C E N T R E S NTNTC C NC NC ASASC C NP HL NP HL CENTRAL LEVEL REGIONAL LEVEL (5) Central Hospitals - 5 Central Central Hospitals Hospitals - 5 Central Hospitals - 5 Regi Health Services - 5 Regi Regi Health Health Services Directorate - 5 Regi Health Services Directorate - 5 Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Regi Hosp Trai Train Lab Labo Med Medi pital Hosp ning Trai ing Train orat Lab rator Labo ical Med cal Medi pital Cen ning Cent ing ory orat rator y Stor ical Store cal ter Cen er Cent ory y e Stor Store er ter e Regi Regi Regi Regi TB TB Cen TB Cent TB ter Cener Cent ter er ZONAL LEVEL (14) Z Hospital - 11 Z Hospital - 11 DISTRICT LEVEL (75) ELECTORAL CONSTITUENCY (205) VDC LEVEL (3,995) District Public Health Office District Public -14Health Office -14 District Hospital District 62Hospital 62 Primary Health Center Primary Health Center Health Post Health Post Sub-Health Post 3,129 Sub-Health Post 3,129 District Health Office District Health Office COMMUNITY LEVEL FCHV 47,673 FCHV 47,673 TBA 15,433 TBA 15,433 PHC Outreach PHC Outreach 15,248 15,248 EPIOC 15,532 EPIOC 15,532

7 Nati Reproductive Health Strategy of Nepal Government s Integrated Reproductive Health Package, Nepal Family planning; Safe motherhood Child health and new born care Abortion related problems and management HIV/AIDS and STDs Infertility management and treatment Reproductive health of Adolescence Problems of elderly women (uterine, cervical and breast cancer treatment)

8 State Commitments towards Human and Reproductive Rights Full commitment towards Equity in Development Sectors and Health Sector. Accession and/or ratification of Several commitments e.g. CEDAW, ICPD, conventions of ILO and UNESCO. But also high level of inequity in health sector.

9 Health Disparities at Population Level

10 Disparity in Access to Health Facility Proportion of Households within 30 Minute s Distance from the Nearest Health Facility, Nepal Household Characteristics Percent Place of Residence Urban 89 Rural 57 Ecological Zone 37 Mountain 37 Plain 76 Consumption Quintile Poorest 59 Richest 79

11 Age Disparity in HIV Infection Percentage of Reported Cases of HIV Infection by Age Group, Nepal Age Group Male Female Total 0-14 years years years Total 3,545 1,316 4,861 (100%) (100%) (100%)

12 Disparities in Life Expectancy at Birth & < 5 Mortality Disparities in health outcome indicators by ethnicity group, Nepal Caste/Ethnicity Life Expectancy Under-five Group at Birth Mortality Rate Occupati caste Muslim Others Brahmin Newar 63 75

13 Disparity in Contraceptive Use Proportion of Current Contraception Accepters by Types of Methods Used, Nepal Traditi Methods 24% Male Methods 10% Female Methods 66%

14 Types of MCH Care Services Received by Women in the Last Five Years, Nepal Use of MCH Care Services (%) Background Characteristics Place of residence ANC Check-up from HW/TBA Delivery at Health Facility Urban Rural 47 7 Mother's education No education 39 4 SLC and above 95 55

15 CONCLUSION

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