Kathmandu Post

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Primary Health Care and Health MDGs

KATHMANDU, SEP 11 -
According to the Alma Ata Declaration in 1978, Primary Health Care (PHC) refers to essential health care, based on practical, scientifically sound and socially acceptable methods and technology. It is the kind that is made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

The status of PHC is reflected in the basic health indicators and according to the government’s Nepal Health Sector Program Implementation Plan-II, the Neonatal Mortality Rate /1000 live births is 20 at present, Infant Mortality Rate /1000 live births is 41, Under Five Mortality Rate (U5MR)/1000 live births is 50, Maternal Mortality Ratio (MMR)/100,000 live births is 229, Total Fertility Rate /Woman is 2.9, and Contrace-ptive Prevalence Rate is 45.1 %.

However, there are big disparities in the status of basic health indicators between urban and rural areas, between the rich and the poor, between men and women, between the educated and uneducated and between the privileged and under privileged. For example, the total fertility rate in the urban areas and rural areas are 2.1 and 3.3/woman respectively. Skilled attendance at birth in urban and rural areas are 50.6% and 14.3% respectively. Contraceptive Prevalence Rate in urban and rural areas are 54% and 43% respectively. Antenatal first visit in urban and rural areas are 85% and 38% respectively. Skilled attendance at birth in mothers with SLC or higher level education and in mothers with no education are 75% and 8% respectively. And all vaccination coverage under two  years of age in mothers with SLC or higher level education and uneducated mothers are 90% and 74.3% respectively. Life expectancy is 74.4 years in Kathmandu and 37 years in Mugu District.

Narrowing down these geographical, socio-economic, rural-urban and gender gaps is a big challenge. Even if we take the national average , there’s a long way to go before we meet the Millennium Development Goals (MDG) by 2015. We have to bring down the MMR from the current 229/100,000 live births to 134, and we have to halt the spread of HIV/AIDS, Malaria, Tuberculosis and other communicable diseases. To reach the MMR goal, we need to speed up and mobilise the whole community in a well coordinated manner.

The health sector budget in terms of percentage of the total national budget in the fiscal years 2008-09, 2009-10, 2010-11 and 2011-12 was only 6.33, 6.24, 7.12 and 6.5  respectively. This is not adequate and it should be increased to at least 10%. The lion’s share of the budget should be spent on PHC and for special programs that help to address the above mentioned disparities.

The Nepal Health Sector Program Implementation Plan can be described as the product of the combined efforts of the government of Nepal and External Development Partners (EDPs). The second phase of the plan takes into considerations the importance of primary health care, health MDGs, various disparities in the basic health indicators, the principles of International Health Partnership (IHP) and the lessons learnt in the implementation of the first phase,

International Health Partnership (IHP) is an integral part of Global Campaign for health MDGs. Nepal was one of the first 7 countries to sign the IHP in 2007. Therefore, the Ministry of Health and Population should co-ordinate with all the External Development Partners and move ahead in line with the Rome Declaration on Harmonization (2003), Paris Declaration on AID Effectiveness (2005) and the principles of IHP. Also, since commercialisation of medical, nursing and paramedical education is a growing problem in the country, the government should take necessary steps to alleviate it.

Additonally, at the moment, many hospitals in the country, including the district hospitals, have hospital development boards. These boards have unnecessarily employed many medical, nursing, paramedical and administrative staff in the hospitals. To pay salary and other benefits to the staff, the hospitals have done away with free services for patients. And because of this, it has become difficult for the poor and lower-middle class people to receive treatment even at the government health institutions. Therefore, the government also needs to review these development boards all over the country and bring about some positive change.



Dr Shrestha is a Senior Consultant Psychiatrist and Former Health Secretary of the Government of Nepal

Posted on: 2011-09-12 09:16

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