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  • Basic Health Servicesfor GII officer Training at NASCMahendra Prasad ShresthaDirectorNational Health training Centre

  • Content coveredConcept of health and public healthBasic health servicesHealth indicatorsHDI in relation to healthAccess to health servicesIssues and improvement areas

  • Definition of healthWHO 1948Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease of infirmity

  • Philosophy of healthHealth is not mainly an issue of doctors, social services and hospitals. It is an issue of social justice;Health is a Fundamental human rightHealth is the Essence of productive lifeHealth is inter-sectoralHealth is central to the concept of quality of lifeHealth is an integral part of developmentHealth and its maintenance is a major social investment, and world wide social goalHealth involves individual, state and international responsibility.

  • Public HealthC.E.A. Winslow 1920 :the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts

  • Basic health servicesThe current Interim Constitution of Nepal, for the first time in Nepals history, guarantees health as a fundamental right of every citizen.NHP-2071 sets out a forward looking agenda for improving the health and well-being of all citizens of Nepal, including the old, disabled, single women, poor, marginalized and at risk communities.

  • Changing concept

    Basic health servicesEssential health care servicesHealth for AllPrimary health care servicesHealth promotion

  • Basic health servicesUNICEF/ WHO 1965:A basic health service is understood to be a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent professional and auxiliary personnel to perform these functions.

  • Essential Health Care Services2nd long term health plan 1997-2017 identified the 20 essential health services:Appropriate treatment of common diseases and injuriesRH, EPI, IMCI, Condom distribution and promotion, TB, Leprosy, Nutrition, prevention and control of blindness, environmental sanitation, school health, vector born control, oral health, deafness, substance abuse, occupational health, Accident prevention and rehabilitation, community based rehabilitation, Emergency preparedness and management

  • Health for ALLIn May 1997, World Health Assembly decided that the main social goal of government and WHO in coming years should be the attainment by all the people of the world by the year 2000 AD of al level of health that will permit them to lead a socially and economically productive life

  • Primary Health CareAlma Ata Conference 1978Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individually and families in the communities through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination.

  • Primary Health Care ELEMENTSEducation about health and diseases.Promotion of food supply and proper nutritionSafe water and basic sanitationFP/ MCHImmunization against infectious diseasesPrevention and control of endemic diseasesTreatment of common diseases and injuriesProvision of essential drugs

  • Principles of PHCEquitable distributionCommunity participationIntersectoral coordinationAppropriate technology

  • The Jakarta Declaration on Health Promotion (July 1997)The determinants of health; new challenges in the 21st century; and the fundamental conditions and resources for health are:Peace, Shelter, education, social security, social relations, food, income, the empowerment of women, a stable ecosystem, sustainable resource use, social justice, respect for human right and equity.Above all, Poverty is the greatest threat to health.

  • Basic need indicator By ILOCalorie consumptionAccess to waterLife expectancyDeath due to diseaseLiteracyDoctor and nurses per populationRooms per personGNP per capita

  • Indicators of HealthHealth Policy IndicatorsSocial and economic indicators related to healthIndicators for the provision of health careHealth status indicators

  • 1. Health policy IndicatorsPolitical commitmentResource allocationThe degree of equity of distribution of healtth servicesCommunity involvementOrganizational framework and managerial process

  • 2. Social and economic indicators related to healthRate of population increaseGNP and GDPIncome distributionWork conditions Adult literacy rateHousingFood availability

  • 3. Indicators for the provision of health careAvailabilityAccessibilityUtilizationQuality of care

  • 4. Health status indicatorLow birth weight (percentage)Nutritional status and psychosocial development of the childrenInfant Mortality rateChild Mortality rateLife expectancy at birthMaternal mortality rateDisease specific mortalityMorbidity- Incidence and prevalenceDisability prevalence

  • Selected health and socio-economic indicators (WHO/UNICEF 2012)

    SNIndicatorLDCODCHDC1Life expectancy at birth (2010)5968802IMR (per 1000 live births) 2010714453Under 5 mortality (per 1000 live births) 20101106364MMR 2009 (per 100,000 live birhs)41053145Doctor population ration per 10,000 (2009)424286Nurse population ration per 10,000 (2009)1040817GN I per capita Us $ (2009)6693,30440,8458Per capita public expenditure on health USD (2009)253264,6929 Adult literacy rate (2005-2010)58809910Access to safe water % population (2010)659310011Access to adequate sanitation % population (2010)3773100

  • Under-five, Infant, Neonatal and Postnatal Deaths














    Deaths per 1,000 live births



    1996 (1991-95) NFHS502979118

    2001 (1996-2000) NDHS39266491

    2006 (2001-05) NDHS33154861

    2011 (2006-10) NDHS33134654

    2014 NMICS23113338

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  • We have Made Impressive Progress in Reducing MMR







    Data sources: 1996: Nepal Family Health Survey 2006: NDHS2009: MMMS- representative 2012: WHO Global Estimates2014: WHO Global Estimates

    Series 1

    Maternal deaths per thousand live births


    Series 1






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  • Quality of Care: Need Our Focus Quality of care at the point of service deliveryAvailability and readiness of quality services Maternal deaths in health facility increased from 21% in 1998 to 41% in 2009 82% institutional maternal deaths were emergency admissions (MMMS 2009)22% of health workers post is vacant/not fulfilled Lower level facilities are underutilized and referral hospitals are overcrowded 32% of public hospitals; 91% of PHCCs; and 16% of HPs meet infrastructure standard (HIIS 2013/14) Procurement and supply of commodities, drugs, equipment and services are generally delayed for some reasons Quality at point of production vs. point of service delivery

  • Suicide: A preventable killer: Alarming facts

    Suicide cases: Data from other sourcesPer 100,00 population25WHO estimate 2014Per 100,000 WRA22MMMS 1997/98Per 100,000 WRA28MMMS 2008/09% of WRA deaths 10MMS 1997/98% of WRA deaths16MMMS 2008/09







    Suicide cases reported to Nepal Police, 2066/67-2070/71

    Source: CID Magazine 2014, Nepal Police

    Series 2

    Number of suicide cases


    Series 1Series 2






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  • Road Traffic Accidents Reference : Status Paper on Road Safety in Nepal 2013

  • Human Development Index (HDI)Human Development Index (HDI) is defined as a composite index combining indicators representing three dimensions- longevity (life expectancy at birth); Knowledge (mean years of schooling and expected years of schooling) and income( GNI per capita in purchasing power parity in USD).

  • Human Development Index


    IndicatorDimension IndexLong lifeKnowledgeStandard of livingLife expectancySchooling Mean and expectedGNI per capitaLife exp indexEducation IndexGNI IndexHuman Development Index (HDI)

  • Dimension Index

    Dimension Index=Actual value-minimum valueMaximum value-minimum value

  • Nepals development priorities post-2015, including graduation of Nepal from LDC to DC by 2022

    Second half of 13th Development Plan (mid July 2013 mid July 2016) coincides with Post-2015 SD agendaThe current plan has the long term vision of graduating Nepal from it current status of least developed country to developing or middle income country by 2022The main objective of the current plan is to improve the living standard of the people of Nepal by reducing poverty ...........

  • Development prioritiesDevelopment of hydro power and other sources of energyIncrease in agricultural productivity throug