Nepal is on track to achieve and even exceed a few of the Millennium Development Goals, such as reduction of child mortality, maternal mortality, fertility, access to drinking water supply, and basic education.
In the past half century, Nepal reduced its under-5 mortality by 80 per cent, from 250 to 50 deaths per 1000 live births. Most European countries took two centuries to achieve such a reduction.
Some of the greatest public health success stories in Nepal are the eradication of smallpox, virtual eradication of polio, and significant reduction in iodine, Vitamin A and iron deficiency anemia affecting large numbers of women and children. Our national network of 50,000 female community health volunteers deserves credit.
The children of Nepal today are healthier, more educated, and more knowledgeable about the world than any previous generation. There has also been good progress in women's health, education, and their overall status in society.
But there are huge inequalities and disparities among various population groups. Some of our historically marginalised communities and population groups lag seriously behind, not least in terms of child and maternal mortality rates, and access to health facilities.
In the light of this mixed picture, a 10+2 agenda should govern public health in the coming decade in Nepal:
1. Scale up essential health care
We have to substantially increase the number and quality of trained health workers, ensure there is no stock-out of essential medicines, upgrade health facilities, and offer conditional cash grants for vulnerable populations to ensure universal access to basic health services.
2. Focus on equity
The elimination of user fees for certain basic health services has progressively reduced barriers to access by the poor, marginalised communities. But more effort must be made to implement the National Health Systems Plan (NHSP-II), which contains specific objectives to reduce cultural and economic barriers to accessing health care services by the poor, Dalits, Janjatis, Muslims and deprived Madhesi communities.
3. Tackle malnutrition
Nepal has unacceptably high maternal and child malnutrition. A key strategy to improve nutrition is to ensure household food security. But beyond food, control of infections and good caring practices are equally important. Pilot schemes initiated to improve maternal and child nutrition should be scaled-up.
4. Prioritise non-communicable diseases
Nepal is going through an 'epidemiological transition' to non-communicable diseases such as heart and kidney ailments, cancer, asthma, diabetes, obesity, and strokes, as well as accidents, injuries and mental health problems. The main response to these is behaviour change and adoption of healthy lifestyles.
5. Prevent accidents, injuries and disabilities
Besides prevention, much more needs to be done to expand treatment, rehabilitation and special education, and counter the alarming rise of traffic accidents.
6. Promote environmental health
Safe water, clean air, basic sanitation and hygiene are of critical importance with respiratory infections and diarrhoea, the leading preventable causes of mortality and morbidity in the country. Our children should be taught good environmental citizenship.
7. Harness the power of educawation for behaviour change
The more we can do to empower parents with knowledge and skills in child care, the better the health outcomes. Teachers, and children themselves, are potential health workers, and we should harness the power of radio, TV, newspapers, and mobile phones to spread public health messages.
8. Strengthen health systems
To back up the health-seeking efforts of people themselves, we have to strengthen our health systems to make them more effective, including in emergencies.
9. Foster public-private partnerships
We need to foster a more productive partnership among the public, philanthropic and for-profit private sectors. Urgent action is needed to enact and enforce clearer norms and regulations, while avoiding excessive government interference or micro-management.
10. Capitalise on international health partnerships
Nepal enjoys strong international support in health programs, but there is room to ensure greater aid effectiveness to produce even better results.
Additional +2 elements are needed to ensure a peaceful and healthy national body politic to further advance Nepal's public health:
1. Institutionalise a culture of non-violence
The 'structural violence' of poverty, inequality, exclusion and marginalisation has long existed in Nepal, but widespread physical violence in public life is a recent phenomena. We must reject this cancer of violence as an acceptable means for achieving any worthy goals, and inculcate non-violence in the minds and hearts of our children.
2. Consolidate genuine democracy
The WHO defines health as being "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Such well-being is only possible in a full-fledged democracy with a thriving economy in which people can live a long, healthy, productive and creative life.
This article summarises the keynote address at the inaugural conference of the Nepal Public Health Foundation in Kathmandu, 30 June 2010