NepalUrban population

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2019 Health SDG Proﬁ le: Nepal

Out-of-pocket expenditure⁴ In most cases, high percentage of out-of-pocket

expenditure out of the total health expenditure is associated with low financial protection.

Nepal

Urban population²

20.2%

Life expectancy at birth

Life expectancy⁵ measures how long people will live and is an indication of overall mortality of a country's population. Lost healthy life expectancy (HALE) represents equivalent year(s) of full health lost through years lived with morbidity and disability. Although females live longer, lost HALE is longer as well, on average 1.2 years or 14.5% more than males.

Population (000s)¹

28 609

Poverty³

15.0%

GDP per capita³ (Current US$)

1025.8

Current health expenditure as share of GDP

⁴ 6.3%

0 20 40 60 80

Age (years) Male

Female

HALE Lost HALE

Monitoring the health SDG goal: Indicators of overall progress

(ppp < $1.90 a day)

5.7%

The goal of universal health coverage (UHC) is that all people and communities receive the health care they need, without suffering financial hardship. Monitoring UHC requires measuring health service coverage and financial protection (SDG target 3.8).

Universal health coverage: At the centre of the health goal

HEALTH SERVICES COVERAGE

The summary measure of essential health services coverage, service coverage index of 16 indicators in four main areas: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security.

FINANCIAL PROTECTION

Financial protection is measured through two indicators:

(1) impoverishment, and (2) catastrophic health expenditure.

Impoverishment: 1.7% or approximately 486 353 people are being pushed into poverty because of out-of-pocket health spending¹⁷ .

Catastrophic expenditure on health: 10.7% of people spent more than 10% of their household's total expenditure on health care¹⁷.

Family planning

coverage⁶ Pregnancy and

delivery care⁶ Child immunization

coverage⁷ (DTP3) Care seeking behaviour suspected pneumonia⁶ 0

50 100

Coverage (%)

90

56 64 85

Reproductive, maternal, newborn and child health

Latest available data (2010-2017)

Tuberculosis (effective) treatment

Coverage⁸

HIV antiretroviral

therapy coverage⁹ Insecticide-treated bednets/IRS coverage for malaria prevention¹⁰

Access to basic sanitation¹¹ (%) 0

50 100

Coverage (%) ₁₀₀

64 49 46

Infectious diseases

Prevalence of normal fasting glucose level¹²

Prevalence of normal blood pressure¹²

Cervical cancer

screening Tobacco non-use¹³ 0

50 100

Coverage (%)

83 70 69

Noncommunicable diseases

Density of hospital beds¹², expressed as % of global threshold, 18/10

000

Heath worker density¹⁴, expressed as % of

global threshold, 44.5/10 000

Access to essential

medicines¹⁵ Health security: IHR compliance¹⁶ 0

50 100

Coverage (%)

17

75 72

23

Service capacity, access and health security

UHC services coverage index of essential health services To provide a summary measure of

coverage, an index of national service coverage is computed by averaging service coverage values across the 16 tracer indicators. The UHC coverage index ranges from 0% to 100%, with 100% implying full coverage across a

range of services.

2010 2019

0 50 100

Coverage (%)

52 59

UHC services coverage index

Out-of-pocket expenditure, as % of the health expenditure (2016)

Public spending on health ⁴ is determined by the capacity of the government to raise revenues and the level of priority it attaches to the health sector.

This profile provides an overview of the current status of progress towards the 13 targets under the

Sustainable Development Goal #3 (SDG3): Ensure healthy lives and promote well-being for all at all ages.

All SDG3 indicators plus other selected health-related indicators are presented using global health estimates or country comparable reported values if available.

When nationally reported indicators from other sources are available, these are included in the references.

55.4%

68.8 71.6

5.7%

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2019 Health SDG Proﬁ le: Nepal

Variation by education

Equity status and trends: Variation by income, geographical location and education*

*There are many dimensions of equity, including but not limited to examples based on income, geographical location, and education presented here but also age, sex, race, and others. SDG 17.18 emphasizes the need for disaggregated data to facilitate better measurement of inequalities.

SDG 3: Health targets

Maternal and child mortality (SDG target 3.1, 3.2)

Births attended by skilled health personnel⁶

⋅

¹⁸

⋅

¹⁹

2001 2006 2011 2014 2016 0

50 100

Pe rc en ta ge (% )

10.8 18.7

36.0

55.6 58.0

Maternal mortality ratio²²

2000 2005 2010 2015

0 150 300 450 600

M M R (p er 1 00 0 00 li ve b irt hs )

548.0

258.0

1990 2000 2005 2010 2015 2016 2017 0

50 100 150 200

C M R (p er 1 00 0 liv e bi rth s)

140.0

33.7 59.0

20.7

Child mortality²³

Neonatal mortality rate Under-five mortality rate

Health service delivery

NCD risk factors

2000 2005 2010 2015

0 50 100

Su cc es s ra te

^84.0 ^91.0

TB treatment success rate for new cases²¹

2000 2005 2010 2015

0 50 100

Pe rc en ta ge % )

_90.074.0

Coverage of DTP3 immunization⁷

Cervical cancer screening

Female Male

2000 2005 2010 2015

0 10 20

Pe rc en ta ge (% )

0.9 2.7

2.2

5.4

Prevalence of obesity among adults²¹

(18+ years of age) 2001 2006 2011 2014 2016

0 50 100

Pe rc en ta ge (% )

48.400

75.500

11.800

61.700

Antenatal care coverage⁶

⋅¹⁸⋅¹⁹

(4+ visits)

Rural Urban

2001 2006 2011 2014 2016 0

50 100

Pe rc en ta ge (% )

39.7

26.6 50.5

36.7 61.4

45.7

Prevalence of stunting among children under-five

by mother's education level⁶

⋅¹⁸⋅¹⁹

None Primary Secondary

2001 2006 2011 2014 2016 0

50 100

Pe rc en ta ge (% )

42.5

88.7

2.6

33.9

Proportion of births attended by skilled birth

attendant⁶

⋅¹⁸⋅¹⁹

Quintile 1 (poorest) Quintile 5 (richest)

Variation by geographical location

2001 2006 2011 2014 2016 0

50 100

Pe rc en ta ge (% )

42.6

61.4

Children < 5 yrs with diarrhoea receiving ORT

and continued feeding⁶

⋅¹⁸⋅¹⁹

Bed occupancy rate (BOR)

Variation by income

2000 2005 2010 2015

0 25 50

Pe rc en ta ge (% )

27.5 29.7

27.2 29.5

Prevalence of raised blood pressure among adults²¹ (18+ years of age)

Female Male

2013 0

25 50 75 100

Pe rc en ta ge (% )

48.1

14.1

Prevalence of tobbaco use¹³

Female Male

Current data are insufficient for analysis

2011 2013 2015 2017

0 1 2

Pe r p er so n pe r y ea r

0.7 0.8

OPD utilization²⁰ (per person per year)

Current data are insufficient for analysis

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Malaria incidence rate¹⁰

2013 2014 2015 2016 2017 0.0

0.2 0.4 0.6 0.8 1.0

Incidence (per 1000 pop. at risk)

0.20

0.10 0.10 0.10 0.12

TB incidence rate²⁴

20132014 201520162017 0

150 300 450

TB incidence (per 100,000 pop.)

159 158 156 154 152

Communicable diseases (SDG target 3.3)

Indicators SDG

Target Year Nepal Regional estimate Probability of dying from any of CVD,cancer,

diabetes,CRD between age 30 and age 70²⁵ (%) 3.4.1 2016 21.8 23.1 Noncommunicable diseases and injuries

Malaria incidence is calculated for confirmed cases

Indicators Year Nepal Regional estimate Number of people

requiring interventions against neglected tropical diseases²⁵

2016 16,062,081

Hepatitis B surface antigen prevalance among children under 5 years²⁵ (%)

2015 0.31

73,300,000

0.26 2001 2006 2011 2014 2016 0

50 100 150 200

Adolescent birth rate

110.0 98.0

81.0 71.0 88.0

Adolescent birth rate⁶

⋅¹⁸⋅¹⁹

(per 1000 women aged 15 to 19 years)

Proportion of married or in-union women of reproductive age who have their need for family

planning satisfied with modern methods⁶ 3.7.1 2016 56.1 71.4 Sexual and reproductive health

Female Male

2000 2005 2010 2015

0 250 500 750 1000

Total NCD mortality rate (per 100 000 pop.)

726.9

874.9

615.8

727.0

Total NCD mortality¹³

2009- 20102010-

20112011- 20122012-

20132013- 20142014-

20152015- 2016

0 5 10 15

Deaths per 100 000 population

6.5 7.4

Reported road traffic deaths²⁶ (per 100 000 population)

Adolescent birth rate⁶ (per 1000 women aged 15

to19 years) 3.7.2 2016 88 33.0

Age-standardized mortality rate attributed to household and ambient air pollution²⁵

(per 100 000 population) 3.9.1 2016 193.8 165.8

Mortality due to environmental pollution

Note: A dash (-) implies relevant data are not available

Total net official development assistance to medical research and basic health per capita²⁵

(constant 2014 US$) 3.b.2 2017 2.09

Proportion of health facilities that have a core set of relevant essential medicines available and

affordable on a sustainable basis 3.b.3 2016 -

0.6 -

Health worker density¹⁴ (per 10 000 population) 3.c.1 2017 33.5 - Health workforce

2013 2014 2015 2016 2017 0

2 4

HIV infection (per 1000 pop.)

0.23 0.22 0.21 0.20 0.20

New HIV infections⁹

Suicide mortality rate²⁵ (per 100 000 population) 3.4.2 2016 8.8 Total alcohol per capita (age 15+ years)

consumption²⁵ 3.5.2 2016 2.0

Road traffic mortality rate²⁵ (per 100 000

population) 3.6.1 2016 15.9

13.2 4.5 20.7

DTP3 immunization coverage among 1-year-

olds 3.b.1 2017 90

MCV2 immunization coverage by the nationally

recommended age²⁵ 3.b.1 2017 59

PCV3 immunization coverage among 1-year

olds²⁵ 3.b.1 2017 80

88 77 12 Essential medicines and vaccines

International Health Regulations Core Capacity

Index¹⁶ 3.d.1 2018 23 56

National and global health risks

Mortality rate attributed to exposure to unsafe

WASH services²⁵ (per 100 000 population) 3.9.2 2016 19.8 Mortality rate attributed to unintentional

poisoning²⁵ (per 100 000 population) 3.9.3 2016 0.4

15.4 1.8

Prevalence of tobacco use among 15-64 years

old¹³- Female 3.a.1 2013 14.1

Prevalence of tobacco use among 15-64 years

old¹³- Male 3.a.1 2013 48.1

-

Tobacco use

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References

1.World population prospects: the 2019 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/wpp/, accessed 29 June 2019).

2. World urbanization prospects: 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://population.un.org/wpp/, accessed 29 June 2019).

3.World Bank. (https://data.worldbank.org/, accessed 28 May 2019)

4.Global health expenditure database. Geneva: World Health Organization; June 2019

5.Global health estimates 2016: Life expectancy, 2000–2016. Geneva: World Health Organization; 2018 (https://www.who.int/gho/mortality_burden_disease/life_tables/en/, accessed 29 June 2019).

6. Nepal Demographic and Health Survey (DHS) 2016.

7. WHO/UNICEF estimates of national immunization coverage. (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=BGD, accessed 29 June 2019) 8. Global tuberculosis report 2018. Geneva: World Health Organization; 2018 (https://www.who.int/tb/publications/global_report/en/, accessed 15 March 2019).

9. UNAIDS/AIDSINFO [Online database]. (http://aidsinfo.unaids.org/, accessed 29 June 2019)

10. Calculated. World Malaria Report 2018. Geneva: World Health Organization; 2018 (https://www.who.int/malaria/publications/world-malaria-report-2018/en/ , accessed 15 March 2019).

11. WHO/UNICEF Joint Monitoring Programme estimate 2015.

12. Tracking universal health coverage: 2017 global monitoring report

13. Nepal (2013) Tobacco Factsheet 2018. New Delhi: World Health Organization/SEARO; 2018 14. HRH profiles 2018

15. Nepal Service Provision Assessment (SPA) Survey 2014. (, accessed 29 June 2018)

16. International Health Regulations (2005) Monitoring Framework, GHO data. Geneva: World Health Organization (https://www.who.int/gho/ihr/en/, accessed 21 March 2019).

17. Hui Wang, Lluis Vinals Torresa & Phyllida Travis. Financial protection analysis of eight countries in the South-East Asia Region: current status and policy responses. Bulletin of the World Health Organization, 2018; 96:610–620.

18. Nepal Demographic and Health Survey (DHS) 2001, Nepal Demographic and Health Survey (DHS) 2006, Nepal Demographic and Health Survey (DHS) 2011 19. Nepal Multiple Indicator Cluster Survey (MICS) 2014

20. Calculated. Nepal Annual Health Statistics 2072-2073

21. WHO Global Health Observatory (GHO) (https://www.who.int/gho/en/ - accessed 29 June 2019)

22.Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva; 2015 (https://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf;jsessionid=56B6C12830EA6EA8CD0F30A8433E8FC3?sequence=1, accessed 28 May 2019).

23. Levels & trends in child mortality: report 2017: estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC): UNICEF, World Health Organization, World Bank, United Nation; 2017 (http://www.childinfo.org/, accessed 28 May 2019).

24. WHO Global Tuberculosis database [online].

(https://www.who.int/tb/country/data/download/en/, accessed 29 June 2019).

25. World Health Statistics 2019.

(https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf?ua=1, accessed 28 May 2019) 26. Country reported

Other health-related SDGs

Annual mean concentrations of fine particulate

matter (PM2.5) in urban areas²⁵ (µg/m3) 11.6.2 2016 94.3 57.3 Ambient air pollution

Mortality rate due to homicide²⁵ (per 100 000

population) 16.1.1 2016 3.3 4.1

Homicide and conflicts

Birth registration coverage⁶ 16.9.1 2016 56.2 -

Birth registration

Note: A dash (-) implies relevant data are not available

Completeness of cause-of-death data (%) 17.19.2 2007 - 10 Cause-of-death data

Indicators SDG

target Year Nepal Regional estimate Domestic general government health expenditure

as percentage of general government

expenditure⁴ (%) 1.a 2016 5.3 6.7

General government health expenditure

2000 2005 2010 2015 2016 2017 0

50 100

Percentage (%)

15.0 18.0 22.0 27.0 28.0 29.0

Population with primary reliance on

clean fuels and technologies¹² (%)

2006 2011 2014 2016 0

50 100

Coverage (%)

35.0 42.3

58.1 56.2

Birth registration coverage⁶

⋅¹⁸⋅¹⁹ (%)

Proportion of ever-partnered women and girls aged 15 yrs and older subjected to physical, sexual or psychological violence by a current or former intimate partner in previous 12 months²⁵

5.2 2009-2017 11 -

Intimate Partner Violence

Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan²⁵

(constant 2016 US$ millions) 6.3 2017 172.21 1484.41

Proportion of population using safely managed

drinking-water services²⁵ (%) 6.1 2015 27

Proportion of population using safely managed

sanitation services (%) 6.2 2015 -

- - Drinking water services and sanitation

Children under 5 years who are stunted⁶ 2.2.1 2016 35.8 Children under 5 years who are wasted⁶ 2.2.2 2016 9.7 Children under 5 years who are overweight⁶ 2.2.3 2016 1.2

15.2 33 3.4 Child nutrition

Proportion of population with primary reliance on

clean fuels²⁵ (%) 7.1 2017 29 45

Clean household energy

Prevalence of stunting among children under-five⁶

⋅

¹⁸

⋅

¹⁹ (%)

2001 2006 2011 2014 2016 0

50 100

Percentage (%)

57.2 49.3

40.5 37.4 35.8