International Health - Research Paper Example

?Focus on Nepal Health and Development Nepal is a relatively small country that borders China and India. It is widely topographically diverse with climates ranging from subtropical to arctic. The people of Nepal are culturally diverse, although most are Asian, primarily located in rural areas. Their workforce is mainly agricultural at 74%. They have free and compulsory education through eighth grade. There is also significant political instability with frequent civil unrest. Natural disasters and sociological diversion promote frequent epidemics of infectious diseases and parasites. Their per capita income is approximately $427. They suffer many human rights violations, most notably that of human trafficking of women and children. They have been under Communist rule, part of a kingdom, and currently have a representative democracy. They depend highly upon hydroelectric power, though the infrastructure is still largely under development. (US Department of State, 2010) Nepal has targeted several areas for immediate improvement since they became a representative democracy in May, 2006; one of those being the strengthening and development of a quality health care delivery system. There are focused goals aimed at: cooperation and collaboration between private, community, and NGO sectors of health care; equity in health care access; decentralized health care delivery; improved health care outcomes for the indigent through fair financing, poverty reduction, and increased socio-economic inclusion; and finally global coverage of basic, high quality essential health care services. (Srestha, Introduction) The new government, in the Interim Constitution, has provided access to health care in the Free Basic Health Care Services to All. Through this mandate, the government has agreed to support and assist with making a major overhaul to every aspect of the health care delivery system. It recognizes these specific changes requiring immediate attention: 1) effective decentralization of health services; 2) starting the reform at the local health authority and facility level; 3) supporting the training of the health workforce; 4) improving the health information system; and 5) working with the private sector to ensure adequate and high quality health care delivery. The desired outcomes of this program will be: 1) to make pregnancy safer; 2) to provide access to medications; 3) to integrate disease surveillance; 4) to promote the prevention and early detection of non-communicable diseases; 5) to have a system in place for responding to crisis and natural disaster; and 6) to provide for adaptation to climatic changes. (Srestha, Table of Contents) In keeping with the commitment to progress Nepal, in July 2007, a Three-Year Interim Plan was drafted by the Government of Nepal National Planning Commission. This plan was aimed at increasing the elements surrounding peacekeeping, the economy, reconstruction of the infrastructure, and, social policies providing rehabilitation, relief, and reintegration for all classes of people, most especially the indigent, with inclusion efforts for women and the indigenous population. The vision of this plan is to create change for a modern Nepal where there is freedom for all, with equality of rights for all Nepalis to live in an environment of social and economic progress with access to quality of life in regards to basic human needs. This Plan provides a framework for meeting the Millennium Development Goals by 2015, and with the assistance of the UN Country Team has been updated to reveal the progress from 2010-2013. The MDG are the primary deciding factor in funds allocation for projects. (Government of Nepal, 2007) (UNDP, 2011) (End Poverty 2015, 2010) The strategies of this Plan are to: 1) increase employment-oriented and broad-based high economic growth, 2) improve governance and service delivery systems, 3) increase investment in physical, social, and economic infrastructural development, 4) provide for social development, 5) institute inclusive development and targeted programs, 6) initiate sustainable peacekeeping, and, 7) harness international cooperation and regional economic prosperity for national development through foreign direct investment and trade integration. (Sharma, 2009) The following Millennium Development Goals were established for implementation by 2015. Millennium Development Goals and Key Indicators Baseline 1990 1995 2000 2005 Latest Figure Target 2015 Goal 1a: Eradicate Extreme Poverty Target: decrease by half the number of people living below poverty as well as those living on less than $1/day by 2015 % of population less than $1/day 34 NA 24 NA 17 % of population below poverty 42 38 31 NA 21 Goal 1b: Eradicate Hunger Target: to decrease by half the number of people suffering from hunger by 2015 % of population below minimum dietary energy consumption 49 47 NA 40 40 24.5 % of Underweight Children (age 6-59 months) 57 NA 53 NA 49 29 % Stunted Children (age 6-59 months) 60 NA 55 NA 46 30 Millennium Development Goals and Key Indicators Baseline 1990 1995 2000 2005 Latest Figure Target 2015 Goal 2: Achieve Universal Primary Education Target: ensure potential for completion of equity based primary education by 2015 % Net enrollment primary school 64 69 81 87 89 100 % Cohort survival rate to grade 5 NA 38 63 79 81 100 % Literacy rate age 15-24 50 56 70 73 NA 100 Millennium Development Goals and Key Indicators Baseline 1990 1995 2000 2005 Latest Figure Target 2015 Goal 3: Promote Gender Equality and Empower Women Target: equal education regardless of gender in secondary education hopefully by 2005 and surely by 2015 Ratio of girls to boys in primary school 0.56 0.66 0.79 0.86 0.95 1 Ratio of girls to boys in secondary education 0.43 0.56 0.7 0.82 0.85 1 Ratio of literate women to men age 15-24 0.48 0.56 NA 0.73 NA 1 % Seats held by women in Congress 3.4 3.4 5.9 NA 33 NA The problem of disparity causes women, children, and minorities to receive minimal opportunities for changing their quality of life. Lack of education at the primary and secondary level is a primary target for improvement. One obstacle to obtaining quality education involves the use of communication and information technology. (Bhatta, 2008) Studies on child mortality found that major contributing factors in Nepal were lack of adequate nutrition, xerophthalmia, measles, and prolonged diarrhea. Prevalence of parasites and water borne illnesses were also significant factors. Another innovative approach involves stimulating agriculture to provide a wider variety of vegetables and fruits year round. Something as simple as providing prophylactic vitamin A supplements could prevent illness, death, and stunting. (Gottlieb) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figure Target 2015 Goal 4: Reduce Child Mortality Target: Children Under 5, decrease by two thirds by 2015 Infant Mortality Rate/1,000 live births 108 79 64 51 48 2113 or 134 Under 5 Mortality Rate/1,000 live births 162 118 91 65 NA 60 % 1 Yr. old Children receiving measles vaccination 42 57 71 85 81 >90 Making pregnancy safer was an outcome of this support. Data showed that only 18% of all births took place in a health facility; ecological regions had a bearing on where health care facilities were available. For this reason, maternal and neonatal mortality was higher in rural areas. Maternal mortality rates were 281 per 100,000 live births; nearly one fourth of those deaths were attributed to post abortion and postnatal complications. The total fertility rate dropped by 1%, due to urban women using contraception successfully. The poverty rate for this study was 31%, with 31% of the women experiencing pregnancy related anemia. The National health budget was nearly twice the previous level at 7.4% with approximately 80% of this group using Essential Health Care Services. The antenatal and post natal infant mortality rate was down 16% from previous studies. Successful training of midwives was an issue; therefore the MDG 2015 is that 60% of all births will be attended by an SBA (skilled birth associate). In urban areas, 52% of births are already attended by an SBA. (Hulton, et al, 2006) (Nepal Trend Report, 2007) (London, 2004) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figures Target 2015 Goal 5: Improve Maternal Health Target: decrease by 75% the maternal mortality ratio by 2015 Maternal Mortality Ratio per 100,000 live births (2006) 850 or 515 539 415 NA 281 213 or 134 % of Births attended by Skilled Birthing Associates (2006) 7 10 11 19 NA 60 % Contraceptive use in married women ages 15-49 (2006) 24 29 39 NA 48 67 The communicable and sexually transmitted diseases in Nepal stem from the human sex trafficking of women, children, ethnic minorities, and also from the prevalence of frequent natural disasters which further damage the already crumbling infrastructure. There is a high incidence of HIV/AIDS as well as syphilis and other STI .There is surveillance reporting system and a TB management program. There needs to be more public education as well as leadership initiatives for increasing the service area of these programs. (UNGASS Progress Report, 2010) (Burkhalter, 2003) (WOREC,2009) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figures Target 2015 Goal 6: Combat HIV and AIDS, Malaria and other major diseases Target: decrease spread of HIV, AIDS, Malaria and other major diseases, and reverse by 2015 %Prevalence of HIV/AIDS ages 15-49 NA NA 0.29 0.55 0.49 Reverse Laboratory confirmed malaria cases per 100,000 people at risk NA NA 52 30 NA Reverse Prevalence of tuberculosis per 100,000 people (2006) 460 420 310 257 244 Reverse Part of the overall problem Nepal faces is that they lack internal leadership. There are resources within the country to provide many services; however, the leadership, management, and accountability for these resources are corrupt and pathetically untrained. Current research into sustainability efforts to improve the crumbling infrastructure and improve relationships cooperation, collaboration with regards to the reduction of inequalities and the environment has begun. However, the highly fragmented information system across all sectors produces another major challenge to meeting the MDG 2015. They have instituted more global intervention initiatives, clarify and strengthen basic regulatory functions, and provide further infrastructure support with a focus on technical skill, research, and implementing universal health policies and procedures. Meeting the MDG 2015 will depend on educating the public to become aware and be pre-active in many areas. (Sharma, 2009) (Baland, Bardhan, Bowles, 2006) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figures Target 2015 Goal 7a: Ensure Environmental Stability Target: institute sustainable development policies to reduce loss of environmental resources and reverse damage done by 2015 % of Forest land area consumed 37 29 NA 25 29 Reverse % of Biodiversity protected land area 11 18 18 20 20 Reverse Nepal is a country widely diverse in exposure to natural disaster; it ranks 11th with respect to earthquakes, and 30th for flooding worldwide. Emergency preparedness and crisis management are new concepts for this country, yet, the impact on public health is significant. There is a huge need for funding and preparedness plans; accompanied by public education and awareness. This aspect of public health is often overshadowed by the constant civil unrest, which consumes more of the budget and attention. While there is no current program, there are initiatives being drawn up to implement a disaster management plan in the very near future. One significant factor of dealing with natural disasters is also dealing with the injuries and unavoidable illnesses that result from standing water, open sewage, and dead bodies of people and animals. (Nepal Water for Health, 2008) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figures Target 2015 Goal 7b: Ensure access to water and sanitation Target: decrease by half the population without sustainable access to drinking water % Sustainable access to improved water source 46 70 73 81 89 73 % Sustainable access to improved sanitation 6 22 30 39 41 53 The Humanitarian Action program has received financial and volunteer contributions from other countries such as Sweden and South Korea to support development. They have the capacity to respond to a crisis and send supplies to the Health Ministry in times of disaster. The U.S., as well has established ongoing assistance and disaster management there. (Sretha, 2007, pp. 58-59) (USAID, 2010) Another form of assistance comes from the United Nations Country Team; a dedicated group of professionals from around the world who have formed a team to commit to the improvement of life for all citizens in Nepal; especially women, the social outcasts, and the indigent. Their goal is to work with Government, as well as civilians and financial backers to help provide peace, human rights with inclusion of women, minorities, and the disabled, equal access to high quality basic health care, and to support the country as it moves towards successful accomplishment of its MDG 2015. The noted risk factors in Nepal are natural disasters and global epidemics, peace collapse, government and financial corruption, and unrealistic expectations of the people. (United Nations Development, 2008-2010) Millennium Development Goals and Key Indicator Baseline 1990 1995 2000 2005 Latest Figures Target 2015 Goal 8: Develop a Global Partnership for Development % of GNI Official Development Assistance 11.6 9.8 6.8 5.6 6.25 NA USD Millions Official Development Assistance 423 429 387 425 514 NA Telephone Lines per 100 Population 0.32 0.41 1.2 1.79 2.21 NA In order for Nepal to build a stronger health care system, it must take a teamwork approach involving the people, the providers, and education. Through proactive mentoring and leadership the MDG 2015 will be met and Nepal will finally be able to provide equal access to high quality of life for all. (Sarangkot, 2010) References Background note, US Department of State, Bureau of South and Central Asian Affairs, December 20, 2010, viewed March 27, 2011, http://www.state.gov/r/pa/ei/bgn/5283.htm Baland, J, Bardhan, P, Bowles, S, Inequality, cooperation and environmental sustainability, Princeton University Press: 2006, viewed 27 March, 2011. http://www.forestrynepal.org/publications/book/2492 Bhatta, SD, Tackling the problems of quality and disparity in Nepal’s school education: the OLPC model, Studies in Nepali History and Society 13(1): 17:48 June 2008 Mandela Point Book http://www.olenepal.org/SD_Bhatta_OLPC_model_2008pdf Burkhalter, H, Physicians for Human Rights: Sex trafficking and the HIV/AIDS pandemic, 2003, viewed 27 March, 2011, http://physiciansforhumanrights.org/library/2003-06-25.html Dhakal, R, Analysis of the implementation challenges of health sector decentralization policy in Nepal, 2009, viewed 27 March, 2011, http://cphs.healthrepository.org/bitstream/123456789/1462/1/PHD%20Thesis_2009_Ramji.pdf End Poverty 2015, ODI releases seven new case studies showcasing concrete MDG progress in Africa and Asia, End Poverty 2015 Millennium Campaign, December 21, 2011, viewed 27 March, 2011, http://endpoverty2015.org/en/news/region/asia Gottlieb, J, Reducing child mortality with vitamin A in Nepal, Case 4, nd, viewed 27, March, 2011. http://www.cgdev.org/doc/millions/MS_case_4.pdf Government of Nepal, Three-year interim plan approach paper, National Planning Commision, July 2007, viewed 27 March, 2011. http://ekh.unep.org/files/Nepal_ItnerimPlanApproachPaper.pdf Hulton, L, Maskey, M, Matthews, Z, Pant, P, Pradhan, A, Suvedi, B. 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