With the government of Nepal investing around Rs 3 billion annually on maternal and child health, the country has made a tremendous stride to achieving the MDGs, especially the MDG 4 and 5 which talks on the maternal and child health issues. Significant improvements were also made in the fight against HIV/Aids, malaria and other diseases, the targets set by the MDG 6.

The three indicators on child health have already been achieved. The under-five child mortality has been reduced to 38 per 1,000 live births and the number of infants dying in the first year after the birth has decreased to 33. Similarly, the coverage of vaccination against measles stands at about 92.6 percent among the children.

However, the issue of maternal mortality has become controversial as a recent census data showed that there are 418 per 100,000 women dying during pregnancy. The data from many health agencies, including the Ministry of Health and Population, has been claiming that the death is limited to 213.

Some experts in the field say that the discrepancy was caused due to error in the survey process and analysis during the census. While analysing the maternal mortality, the death of women after six weeks of delivery or death by pregnancy related causes is taken into account, said one expert. “However, if you consider a death of a pregnant women dying during a bus accident as maternal mortality then the situation becomes different,” she said. “Many countries like Philippines and Indonesia have recoiled from publishing its maternal mortality rates  based on census, as the set of questionnaire did not meet the actual definition of maternal mortality.”   

While the debate over the issue continues, if the government data is anything to go by, the maternal mortality rate too has been achieved, while the number of women delivering their babies with skilled birth attendants have also been encouraging.

Dr Baburam Marasini, chief of Epidemiology and Disease Control Division, said their target on malaria as set by MDG 6 has been already achieved. He said no people are dying of the disease and the incidence of malaria is also decreasing.

In case of HIV/Aids, the prevalence rate is already too low, while people using condoms are also high.  

“Most of the current programmes are supported by external funds, which may not be forthcoming in the future. Providing HIV-prevention services to hard-to-reach populations, especially females is a challenge, as is devising appropriate strategic behavioural change communication interventions targeted at high-risk groups, including migrant workers,” a 2013 MDG progress report published by UNDP reads. “Despite the efforts of the government, it has been difficult to provide equitable access to services; in particular, curative services are not unevenly distributed across Nepal’s five development regions.”

Dr Yasobardhan Pradhan, public health expert, said that the main challenge lies in sustaining the achievements that the country has made so far. He said the country should now focus more on increasing hospital-based facilities for newborns and women. “The focus should now also be shifted to non-communicable disease that is gripping the country in the post-MDG agenda,” Dr Pradhan said.