In recent decades, Nepal has achieved remarkable progress in reducing the rates of maternal and infant mortality. According to a new United Nations study released coinciding with the World Health Day, Nepal has achieved a commendable reduction in maternal deaths by over 70% since 2000. Nepal has one of the greatest public health success stories in the region, with a maternal mortality ratio of 151 per 100,000 live births. According to the UN's "Trends in Maternal Mortality" report, there was a 34% decrease in maternal deaths globally between 2000 and 2023. The neonatal death rate of Nepal is 15 per 1,000 live births, yet another major achievement which has become possible with better access to maternity and neonatal health care services. Achievements gained over years have however been threatened by some recent events. The abrupt suspension of USAID funds led to the closure of several major health programs in Nepal. One small example – 36 working nurses at 18 federal and provincial hospitals have lost their jobs as a result of the funds' withdrawal. The nurses performed major activities, including advocacy for exclusive breastfeeding, a mainstay of infant health. Efforts at improving health care, education, agriculture, and information systems have been suspended, undermining key services, including neonatal care training for health workers and studies into epidemics. These undesired happenings have badly hit the country's maternal and child health achievements. With the suspension of aids, the rate of maternal and child mortality may go up. There is widespread apprehension.
Despite the success story, Nepal's health infrastructure is challenged by long-term structural problems, especially in rural areas. Remoteness, poor or lack of health infrastructure, and unskilled health workers hinder access to good-quality services. For instance, in Lumbini Province, only 13 of 109 local units have been able to eliminate home births, which indicates that those residing in rural settings still resort to unsafe delivery methods at home. Less or no medical workers means remote communities are deprived of necessary health services. In order to overcome these difficulties, Nepal must pursue a multi-dimensional strategy. Domestic investment in the health of mothers and children needs to be increased to ensure consistent funding and service extension. Rural infrastructure such as building health centers must be improved in order to increase accessibility and the quality of health care. Building partnerships with alternative international donors and NGOs will enable the covering of budget shortfalls, while diversifying funding sources enhances sustainability and reduces dependency on certain aid sources. Partnerships and cooperation with regional and international bodies can also be a potential option.
Worth of stories
Nepal must expand community-based health programs and should train local health workers to provide basic maternal and child care, reaching out to the poor and remote area people. These programs have been effective even in low resource situations. Also, the use of technology in areas such as telemedicine can make up for healthcare worker shortages in rural areas while digital health platforms and online consultation can extend specialized services to areas without medical professionals. To sum up, better health governance is necessary to give continuity to the country’s success story. Fair resource allocation and monitoring ensure the best use of funds in the face of shortage of resources. Community involvement in planning and decision-making improves sustainability and accountability. Even though loss of USAID funding poses a challenge, Nepal can still keep maternal and child mortality in check if it moves ahead prioritizing and allocating adequate domestic resources, diversifying funding, using technology, and strengthening health governance.
