The Department of Health Services (DoHS) in Nepal has released its annual report for the fiscal year 2078/79 (2021/2022), marking its twenty-eighth consecutive report. This report serves as a comprehensive analysis of Nepal's health programs, focusing on objectives, targets, strategies, achievements, and trends in service coverage over three fiscal years. Additionally, it identifies challenges, issues, and constraints while proposing actions for improvement within health institutions.
In this fiscal year, Nepal's health programs were primarily delivered through a network of healthcare institutions, including 192 public hospitals, 2,155 non-public health facilities, 188 Primary Health Care Centers (PHCCs), 3,775 Health Posts (HPs), and Primary Health Care Outreach Clinic (PHC-ORC) sites. An extensive Expanded Program of Immunization (EPI) was supported by 16,950 clinics and 50,229 Female Community Health Volunteers (FCHVs).
The report underscores the critical role played by various health-related departments under the Ministry of Health and Population (MoHP), such as the Department of Drug Administration (DDA) and the Department of Ayurveda and Alternative Medicine (DoAA). DDA's focus is on regulating the production, marketing, distribution, and use of medicines, ensuring their safety and efficacy. DoAA, on the other hand, is dedicated to traditional Ayurvedic medicine, which is widely practiced and accessible to a significant portion of Nepal's population.
Key programs highlighted in the report include:
National Immunization Program (NIP): Significant progress was made in immunization coverage, with improvements in BCG, DTP-HepB-Hib3, OPV3, fIPV2, PCV3, and MR1/MR2 coverage. However, further efforts are needed to achieve measles eradication.
Integrated Management of Neonatal and Childhood Illnesses: The report shows that chlorhexidine administration for umbilical cord care varied by province. Injectable Gentamycin was provided for infants under two months old, and pneumonia cases were reported, emphasizing the importance of continued care for children under five.
Nutrition: Growth monitoring and promotion (GMP) improved significantly at the national level, with varying provincial coverage. Additionally, the Mother Baby Friendly Hospital Initiative (MBFHI) and complementary feeding were assessed.
Safe Motherhood and Newborn Health: Improvements in maternal and newborn health indicators were noted, including ANC visits, institutional deliveries, skilled birth attendance (SBA), and emergency obstetric care (EOC). However, disparities in quality of care and interprovincial variations were observed.
Family Planning and Reproductive Health: The modern contraceptive prevalence rate increased, with variations among provinces. Depo remained the most preferred contraceptive method. The report emphasized the need for post-abortion contraception services and highlighted trends in adolescent sexual and reproductive health.
Adolescent Sexual and Reproductive Health: The National Adolescent Health and Development Strategy was expanded to all districts, but there were declines in adolescents receiving temporary contraceptive methods and abortion services. This may be attributed to a preference for private sector services.
Primary Health Care Outreach Clinics: PHC/ORC clinics continued to extend basic health services to communities, with an increase in the number of people served.
Malaria and Kala-azar: Nepal aims to eliminate malaria by 2025, with a focus on imported cases. The report indicated an increase in P. falciparum infections, mainly imported from neighboring regions. Kala-azar remains a priority public health issue.
Lymphatic Filariasis (LF): Nepal has made progress in LF elimination efforts, with the goal of achieving elimination status by 2030. Post-MDA surveillance is ongoing in 48 out of 64 endemic districts.
Dengue: Dengue cases have been reported since its emergence in Nepal in 2062. While reported cases decreased for a time, there has been an increase in recent years, with 733 cases reported in FY 2078/79.
Scrub Typhus: An outbreak of scrub typhus occurred across the country after the devastating earthquake in 2072. In FY 2078/79, a total of 2,474 scrub typhus cases were reported from 71 districts.
Leprosy: A slight increase in leprosy prevalence rates has been observed, possibly due to loosening COVID-19 restrictions. A total of 2,285 new leprosy cases were detected in FY 2078/79.
Disability Inclusion: Efforts have been made to create a disability-inclusive health system, with rehabilitation services and assistive technology being a focus. A significant number of clients received rehabilitation services in FY 2078/79.
Zoonoses: Nepal faces challenges related to zoonotic diseases. Over 60 zoonotic diseases have been identified in Nepal, with rabies and snake bites being major concerns.
Tuberculosis (TB): TB remains a public health problem in Nepal, with efforts to detect and treat cases. There are also challenges related to drug-resistant TB cases.
HIV/AIDS and STIs: Nepal continues to address HIV/AIDS, with a prevalence rate of 0.12% among adults. Efforts include providing antiretroviral treatment (ART) to those in need.
Non-Communicable Diseases (NCDs): NCDs are emerging as a leading cause of death in Nepal, with efforts to address risk factors and provide care for NCDs.
Mental Health: Mental health and substance abuse are recognized as public health priorities, with a focus on addressing these issues in line with Sustainable Development Goals.
Epidemiology and Outbreak Management: The report highlights the importance of preparedness and response to outbreaks, including the continuation of efforts related to the COVID-19 pandemic.
Surveillance and Research: Surveillance systems, including the Early Warning and Reporting System (EWARS) and drinking water quality surveillance, play a crucial role in monitoring and responding to health issues.
Health Sector Response to COVID-19 Pandemic: Nepal continues its efforts to respond to the COVID-19 pandemic, including vaccination and testing.
Curative Services: The Curative Service Division focuses on ensuring the provision of basic and emergency health services and coordinates specialized tertiary hospitals.
Nursing and Social Security: This division is responsible for capacity development of nurses and midwives, evaluation of geriatric and gender-based violence programs, and providing treatment support for selected diseases to impoverished citizens.
Female Community Health Volunteer (FCHV): FCHVs continue to play a critical role in promoting maternal and child health, family planning, and community-based health initiatives.
The annual report also highlighted the ongoing efforts to eliminate Kala-azar and reported a decreasing trend in indigenous PF malaria cases.
In conclusion, the Department of Health Services' annual report for fiscal year 2078/79 provides a comprehensive overview of Nepal's health programs, achievements, and challenges. It underscores the importance of continued efforts to improve healthcare services, reduce disparities, and work towards the ambitious goal of eliminating malaria and kala-azar while addressing the unique healthcare needs of adolescents. The report serves as a valuable resource for policymakers, healthcare professionals, and stakeholders working to enhance Nepal's healthcare system.
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