situational analysis of MDGs 4,5 and 6 in Nepal

SITUATIONAL ANALYSIS OF MDGS 4,5
AND 6 GOALS IN CONTEXT OF NEPAL
Presented By:
Kamal Bdr. Budha
Kamala Paneru
Bikal Subedi
Gokarna sapkota
Khagendra Poudel

INTRODUCTION
The UN global conferences of the 1990s drew up a
number of different key global Development goals and
targets to focus equalize and harmonize the needs and
status of the people all over the world.
These goals and targets were known as the International
Development targets. Again in 2000, the representatives
of 189 nations, including 147 heads of state and
Government adopted the Millennium Declaration during
the Millennium Development Summit (September 6-8,
2000) of the United Nations.

The Millennium Declaration focused on peace, security and
development to all people. The representatives made specific
commitment seven area viz.
1. Pease, security and disarmament
2. Development and poverty eradication
3. Protection our common environment
4. Human right, democracy and good governance
5. Protecting the vulnerable
6. Meeting the special needs of Africa
7. Strengthening the United Nations

The international development targets and the
development goals were merged together and renamed as
the Millennium Development Goals (MDGs).
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development.

5

 The goal and targets to be reached by 2015 in each of
seven areas are so called the MDGs.
 MDGs place health at the heart of development.
 3 of 8 goals are directly related to health; 8 of 18
targets are directly related to health; 18 of 48
indicators of the progress are health related.

SITUATIONAL ANALYSIS OF MDGs 4,5 and 6 IN NEPAL 2/5/2013

Goal 4: Reduce Child Mortality Rate

6

Target 5:
 Reduce by two thirds, between 1990 and 2015, the

Under five mortality rate.
Indicator:
 Under-five mortality rate (UNICEF-WHO)

 Infant mortality rate (UNICEF-WHO)

 Proportion of eye year children immunized against

measles.


Goal 5: Improve Maternal Health
7

Target 6:

 Reduce by three quarters, between 1990 and 2015,
the maternal mortality ratio.

Indicator:
 Maternal mortality ratio (UNICEF-WHO)

 Proportion of births attended by skilled health
personnel (UNICEF-WHO)


Goal 6: Combat HIV/ AIDS, malaria, and other
diseases
Target 7:
8
 Have halted by 2015 and begun to reverse the
spread of HIV / AIDS.
Indicator:
 HIV prevalence among pregnant women aged 15-
24 years
 Condom use rate of contraceptive prevalence rate
 Condom use at last high- risk sex
 Percentage of population aged 15-24 years with
comprehensive correct knowledge of HIV / AIDS
 Contraceptive prevalence rate
 Ratio of school attendance of orphans to school
attendance of non orphans aged 10-14 years

Target 8:
 Have halted by 2015 and began to reverse the

9
incidence of malaria and other major diseases.

Indicator:
 Prevalence and death rates associated with malaria

 Proportion of population in malaria-risk areas using
effective malaria prevention and treatment measures
 Prevalence and death rate associated with tuberculosis

 Proportion of tuberculosis cases detected and cured

under DOTS (internationally recommended TB
control strategy)


Goal 4: Reduce Child Mortality
Rate

10 SITUATIONAL ANALYSIS OF MDGs 4,5 and 6 IN NEPAL 2/5/2013

Reduce by two- third between 1990
11
and 2015 the under five years
mortality rate
Indicators 1990 1995 2000 2005 2010 2011 2015
IMR( Per 1000 LB) 108 79 64 61 41 46 34

U5MR(Per 1,000LB) 162 118 91 82 50 54 54

Proportion of 1-year olds 42 57 71 85 85.6 88 >90
immunized against measles


12

 Infant mortality rate (per 1,000 live births) is decrease
by ½ and more: from 108 [1990] to 41[2010] or/and
46 [2011] and 34 has achieved data of MDGs in 2015.
 Similarly,Under-5 mortality rate (per 1,000 live
births) is also decrease from 162 [1990] to 50 [2010]
or/and 54[2011]; which is nearer to the target i.e. 54.
 % of 1 year-old children immunized against measles
in 1990 is 42 which is increase by the year 2009
[85.6] and/or 88 in 2011; which is nearest to the
MDGs target i.e. >90.


Measles coverage
13 120

100 9796
9193
8688 84
88 8687
78 8081 81
80 75 76
70 72
2065/66
60
2066/67
2067/68
40

20

0
NATION EDR CDR WDR MWDR FWDR

Goal 5: Improve Maternal Health


Reduce by third- quarters between 1990 and
2015 the maternal mortality rate
15

Indicators 1990 1995 2000 2005 2010 2011 2015

Maternal Mortality Rate 850 or 539 415 281 229 - 231 or
515 134
Percentage of deliveries 7 9 11 20 28.8 36 60
attended by skill health
personal
Contraceptive 24 29 39 44.2 45 49.7 67
Prevalence Rate


16

 Maternal mortality ratio (per 100,000 live
births) in 1990 is 850 which is reduced in year
2009 [229] from this indicator Nepal was
awarded.(1)
 Maternal Mortality Ratio decreased from
539/100,000 live births (DHS 1996) to 325 in
2006 and 300 in 2009.(2)
 Skilled attendance at birth increased from 13%
(DHS 2001) to 22% in 2006 and 35% by 2009.

SITUATIONAL ANALYSIS OF MDGs 4,5 and 6 IN NEPAL
1: Given in MDGs Progress report 2010
•
2/5/2013 2:Given in NHSP-PI

Goal 6: Combat HIV/ AIDS
malaria, and other diseases


Have halted by 2015 and to reverse the
18
spread of HIV/AIDS

Indicators 199 199 2000 2005 2010 2011 2015
0 5

HIV prevalence NA NA 0.29 0.25 0.49 -
among 15-49 years
olds (%)
Contraceptive 24 29 39 44.2 45 65.8 67
prevalence rate (%)


19

 Knowledge of at least one programmatic method of
preventing HIV transmission increased from 37.6%
(DHS 2001) to 75% for women and 50.8% (DHS
2001) to 85% for men.
 Given the CPR estimated from the HMIS and
NDHS, achieving NHSP‐IP goal of 67 percent by
2015 from the current level demands innovative
approaches and appropriate strategies.
 However, there has been decline in Total Fertility
Rate (TFR) from 3.1 in 2006 to 2.6 in 2011 (NDHS
2011) and is expected to meet the NHSP‐IP target of
2.5 by 2015.

The contraceptive prevalence rate (CPR) for
modern family planning method is 44 percent, it
is comparable with 2011 NDHS (43%).
Central development region reported the highest
level of CPR(51%) and western development
region reported the lowest (32%).
Contraceptive prevalence rate (%) is 24 in 1990
and 45 in 2010. this shows that just nearer to
double % CPR is increased.(1)
20
Contraceptive Prevalence Rate increased from
39% (DHS 2001) to 43% in 2006 and 47% by
2009.(2)
SITUATIONAL ANALYSIS OF MDGs 4,5 and 6 IN
1: Given in MDGs Progress report 2010
2:Given in NHSP-PI
NEPAL

Have halted by 2015 and to reverse the
spread of Malaria and Other Disease
21

Indicators 1990 1995 2000 2005 2015

Prevalence rate associated 115 NA 65 78 -
with malaria(per 100,000 at
risk)
Proportion of population in NA 9.75 6.94 11.4 -
malaria risk areas using
effective prevention measures

Slide positivity rate 5.1 9.2 4.3 NA -


22

Indicators 1990 1995 2000 2005 2010 2015

Prevalence rate associated 460 420 310 280 -
with Tuberculosis
Death rate associated with 43 35 23 NA -
Tuberculosis
Proportion of tuberculosis NA 46 69 71 75 -
cases detected
Proportion of tuberculosis NA NA 89 88 89 -
cases cured under DOTS


Case detection and treatment
23
success rate of TB

Activity 2005/06 2006/07 2007/08 2008/09

Case 65 70 71 75
detection rate
Treatment 88 89 88 89
success rate


24

 Prevalence rate associated with malaria(number of
cases per 1000 of the population) is 1.96 in 1990 and
decrease in the year 2009 [0.16].

 Prevalence associated with tuberculosis is 460 in
1990 and decrease in year 2005 [280].


Situation of HIV in Nepal (2011)
25


Important milestone in the response to
HIV/AIDS
26

 1988; Launched the first National AIDS prevention
and control Program
 1990-92; First medium term plan
 193-97; Second medium term plan
 1993; National policy on blood safety
 1995; National policy on HIV/AIDS
 1997-2001; Strategic plan for HIV/AIDS prevention
 2000; Situational analysis of HIV/AIDS
 2002-06; National HIV/AIDS strategic plan
 2003-07; National HIV/AIDS operational plan
 2006-2011; New national HIV/AIDS strategic plan
 2006-2008; National HIV/AIDS action plan

Adult (15-49) HIV Prevalence
27


DISCUSSION
28

 National Free Health Program: to increase
access to and utilization of quality essential
health services by ensuring availability of
essential drugs In both urban and rural health
facilities throughout the year.
 Social health protection – to achieve universal
coverage of essential health services by
developing a more comprehensive approach
(structure or system) with the aim of protecting
the population against the financial risks of
expensive health care.

29

 Urban and Environmental Health – To provide
quality essential health care services to the
municipality population at accessible delivery
points through urban Health clinic in partnership
with MoLD ; To promote environmental health
especially hygiene and sanitation amongst
population in conjunction with other essential
health care services for improved hygiene
practices in partnership with related agencies


Conclusion
30

 Nepal has made marked progress in some social indicators
leading to the attainment of some MDGs by 2015. But the
progress has halted in the recent years. The country faces
added difficulty in achieving MDGs in the current political
scenario- weak resource base, violence, conflict and weak
governance.
 The conflict affect towards achieving MDGs for a number
of reasons including the risk of domestic resource crowd
out, ineffectiveness of service delivery, prolonged absence
of elected representatives at the local bodies, and setbacks
in social mobilization and community participation.

31

 MDGs are reinforcing to each other and the
attainment of one goal would help the
attainment of others.
 MDGs can be achieved only through a
strategic partnership among government, local
bodies, NGOs, CBOs, and donors, strategic
partnership in project formulation, execution,
coordination of development activities, donor
harmonization, and participatory monitoring
and evaluation system are highly essential.

References
32
 1. UNDP, Gov. of Nepal. Nepal Millennium Development Goals -
Planipolis - Unesco[Internat]. sep. 2005[Cited feb. 2013]: Available from:
 www.planipolis.iiep.unesco.org/upload/Nepal/Nepal%20MDG%202005.pd
 www.npc.gov.np
 2. CIGI, KDI. Post-2015 Development Agenda: Goals, Ta rgets and
Indicators[Internet].Copyright © 2012[ cited feb 2013; p.4. Avalable from:
file:///D:/MDGs/Statement%20delivered%20by%20UN%20Resident%20and
%20Humanitarian%20Coordinator%20on%20the%20third%20Nepal%20MD
Gs%20Progress%20Report%202010%20_%20Statement%20_%20UNDP
%20in%20Nepal.htm
 www.cigionline.org
 3. UNDP, Gov. of Nepal. MDG Progress Report for Nepal 2010 - UNDP
in Nepal [Internat]. sep. 2005[Cited feb. 2013]: Available from:
 www.undp.org.np/pdf/MDG-Layout-Final.pdf


33

 7. Gov of Nepal. NHSP-IP 2004-
2009.Ministry of Health; oct. 2009: Availeble
from:
 8. Poudel s, Gurung Sa, Gurung Sb, Timilsina
S, Kumal S. MDGs in nepal[Internate]. 2012[
cited 3 feb. 2013].Pokhara: Available from:
www.slideshare.net/sagunpaudel/mdgs-in-nepal


situational analysis of MDGs 4,5 and 6 in Nepal

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