11 - 24 October 2013 #677

Topping the health charts

Dhanvantari by Buddha Basnyat, MD

In these days of political doom and gloom, there is welcome news about Nepal’s health indicators. Although we still have large scope for improvement, the World Bank’s health assessment and more recently the glowing assessment by Oxford University’s MPI (multidimensional poverty index) give us something to cheer about.

In 1990 Nepal was behind in every development indicator. However, within two decades, we have managed to surpass India’s performance in health. This phenomenal improvement appears almost paradoxical, given that Nepal is the poorest amongst neighbouring countries being compared. What could have accounted for this?

Besides government programs and outstanding work carried out by international and national NGOs, the hard-earned money sent home by our migrant workers has had a huge role to play in improving the health of the country. This remittance may not be factored in the calculation of the abysmal gross national income for Nepal. 

Levels of poverty and health indices in general corelate. But in the case of Nepal, health indices have improved out of proportion to the decrease in poverty according to the new MPI measure invented by Sabina Alkire at the Oxford Poverty and Human Development Initiative. Although Nepal continues to be the poorest country in South Asia, since 2006 we have seen the largest falls in poverty in the region.

What is fascinating is that by doubling health spending and concentrating on the poorest areas, maternal mortality rates - where Nepal has been a traditional underperformer - have been cut in half between 1998 and 2006. These gains are clearly more than what would be obtained by poverty reduction alone. Similar findings like Nepal from Bangladesh and Vietnam show that the $ 1.25 a day poverty line, the cut-off upon which is envisioned a poverty free world, may not necessarily be accurate. An index like the MPI may tell a more comprehensive story. 

So cutting poverty may not be just about boosting incomes. Other factors that impact health like the lack of schools, clean water, family planning, vaccination campaigns, and availability of medicines all need to be taken into account. For example, although India is far ahead in terms of economic growth than its South Asian neighbours, it is clearly a ‘slacker’ in almost all measurable health indices, when it should have been a role model for better health and alleviation of poverty in the region.

But there is much left to be done in our country. Studies have shown that each week at least 40 Nepali women die unnecessarily during childbirth. Doctor Mark Zimmerman, a captivating raconteur and the executive director of the Lalitpur-based Nick Simon’s Institute articulates this tragedy vividly,“In her home high in the mountains of western Nepal, a woman goes into labour to deliver her first child. She does it the same way that her mother did and her grandmother before her: on the floor, with only a relative to help.” And surely enough, the stage is set for complications .

With newly-trained, more competent, and skilled birth attendants working in rural Nepal today, hopefully the numbers of women dying during childbirth will reduce drastically in the next decade.