Introduction as context of NepalDr. Resha Khanal

Dr. Jeetendra Bhandari

(presented on Role of Medical doctor in Achieving SDG 3)

Organized by UNYSAN

Kathmandu

How did we get up to this?

Alma-Ata Declaration

(1978)

Millennium Development

Goal(2000)

Sustained Development

Goal(2015)

Alma Ata Declaration“Health For all by 2000”

Bring health service to door step

Primary health Care as a Part of national Health

systemCommunity Participation

Alma Ata Declaration

Social acceptability of services

Evidence based

approach

Affordability of services

What we aimed at to be achieved by 2000….Topics Goals by 2000 What we

achieved

IMR per 1000 live births reduce from 107 to 45 64

Population growth rate reduce from 2.66 to less than 2 percent 2.11%

Life expectancy at birth increase from 51 to 65 years both for men and women

62.33

Health Worker to Population ratio

One health worker for every 3000 of the populationOne trained nurse for every 600 populationOne health volunteer for every 500 population

1 doctor: 18,439 people1 nurse : 4987 people(2003)

Then came “ Millennium Development Goal”

Millennium Development Goal

8 Goals with 3 Health

Goals

September 2000

189 member

states

To be Achieved by

2015

Goal 4: Reduce child mortality

Goals Base year 1990

Status 2000

Target for 2015

In 2015

Reduce under five mortality by two third, between 1990 and 2015

IMR(per 100 live birth) 108 64 36 33

Under 5 mortality rate(per 1000 live birth)

162 91 54 38

Proportion of one year old children immunized against measles (%)

42 71 >90 92.6

We achieved Goal

Goal 5: Improve maternal mortalityGoals Base year 1990 Status in 2000 Target for 2015 Status in 2015

5A. Reduce maternal mortality ratio by three quarters between 1990-2015

Maternal Mortality ratio(per 1 lakh live birth)

850 415 213 258

Proportion of births attended by skilled birth attendants (%)

7 11 60 55.6

5B. Achieve universal access to reproductive health by 2015

Contraceptive prevalence rate(modern method)

24 35.4 70 49.6

ANC care coverage Not available 48.5%(at least one visit)14%(At least four visit)

100%(at least one visit)80%(At least four visit)

68.3%(at least one visit)59.5%(At least four visit)

We partially achieved

Goal 6: Combat HIV/AIDS, malaria and tuberculosis

Goals Base year 1990

Status 2000 Target for 2015

In 2015

6A. Have halted by 2015 and began to reverse the spread of HIV/AIDS

6B. Achieve universal access to treatment for HIV/AIDS for all those who need it by 2015

HIV prevalence among men and women aged 15-24 years (percent)

NA 0.15 Halt and reverse trend

0.03

Condom use at last high-risk sexual encounter (15-24 year old)

NA 71.2 NA 65.8

Percentage of population aged 15-24 years with comprehensive knowledge of HIV/AIDS

NA 35.6 M:60, F:40 36.4

Goals Base year 1990

Status 2000

Target for 2015

In 2015

Proportion of population with advanced HIV infection receiving antiretroviral combination therapy (percent)

NA NA 80 26.5

Goals Base year 1990

Status 2000 Target for 2015

In 2015

Malaria

Clinical Malaria incidence(per 1000 People)

NA NA Halt or reverse trend

1.74

Annual parasite incidence(per 1000 people)

NA 0.55 0.06 0.11

Death rate associated with malaria(per 1000 people at risk)

Na 0.55 Halt and reverse trend

0

% of children <5 who are treated with appropriate anti malarial drug

NA 3.2 2.5 2.8

% of children under five who sleep under a long lasting insecticide nets

NA 48.2 100 96.8

Goals Base year 1990

Status 2000 Target for 2015

In 2015

Tuberculosis

Prevalence rate associated with TB(per 100000)

460 310 Halt or reverse trend

211

Death rate associated with TB (per 1 lakhs)

43 23 Halt and reverse trend

20

Proportion of TB cases detected

NA 70 85 83

Proportion of TB cases cured under DOTS

40 89 91 91

End result of Millennium Development goal on Health

Some goals yet to be achieved

Some goals remained far back of our achieving

We could complete some

goals

Yet to achieve perfection on every indicator

Sustainable Development goal

• Official Name: Transforming our world: the 2030 Agenda for Sustainable Development

• Adopted in UN Sustainable Development Summit in September 25-27 2015, in New York, USA

End Poverty

Protect Planet

Ensure Prosperity for

all

• By 2030, • Reduce global maternal mortality ratio to < 70 per 100,000 live births

• End preventable deaths of newborns and children under 5 years of age

• End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and other communicable diseases

• reduce by one third premature mortality from non-communicable diseases

• Strengthen prevention and treatment of substance abuse

• Ensure universal access to sexual and reproductive health-care services

• substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination

• By 2020, halve the number of global deaths and injuries from road traffic accidents

• Achieve universal health coverage

• Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate

• Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases

• Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries

• Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks

Nepal's focus

Coverage

Care

Quality Human Resource

• National Planning Commission (NPC) –Preparing set of targets that are to be fulfilled in year 2030.

• Relevant ministries and the Central Bureau of Statistics (CBS), created nine thematic committees, are being consulted to ensure that indicators can be successfully tracked

• Initial findings can be found in the Sustainable Development Goals 2016-2030 National (Preliminary) Report released by the NPC

• Incorporated SDGs into the 14th National Plan

How is our government working?

Difficulties and Challenges

Data collection

and Analysis

Co-operation between

government and private sectors

Political stability

References

• "Health - United Nations Sustainable Development". United Nations Sustainable Development. N.p., 2017. Web. 9 May 2017.

• Karkee R, Jha N. Primary health care development: where is Nepal after 30 years of Alma Ata Declaration?JNMA J Nepal Med Assoc. 2010 Apr-Jun;49(178):178-84.

• Jha N. Revitalizing Primary Health Care and activities in Nepal. Health Renaissance 2013;11(3):185-191.

• Central Bureau of Statistics, National Planning CommissionSecretariat, Government of Nepal, Kathmandu, Nepal,November, 2012. National Population and Housing Census2011, National Report. Volume 01, NPHC 2011.

• Iss.wisc.edu. N.p., 2017. Web. 9 May 2017.

• Costello A, Osrin D. The case for a new Global Fund for maternal, neonatal, and child survival. Lancet 2005366603–606.

• Nepal Millennium Development Goals Progress Report 2013

Thank you