Over the years, Nepal has made significant progress in improving the health status of its citizens, particularly in life expectancy, child survival, maternal health, and control of infectious diseases. The contributing factors for this progress are mainly the increased public awareness on health issues, enhanced capacity of the health services, and a strong government commitment for health.

Download the Country Position Paper on Universal Health Coverage Nepal (2023) here.

The Global Burden of Disease (GBD) study 2019 reports that the life expectancy of the Nepalese population is 71.1 years, which has increased by 12.7 years since 19903. However, healthy life expectancy stands at 61.5 years.

There has been a steady decline in the total fertility rate (TFR) from 4.8 births per woman in the 1996 to 2.1 births per woman in the 2022, with the decline most prominent in rural areas4. Teenage pregnancy remains an issue with highest rates in Karnali Province (21%), followed by Madhesh Province (20%), and lowest in Bagmati Province (8%). The percentage of women who received antenatal care from skilled provider is high with 94% in 2022 with 81% making four or more antenatal care (ANC) visits.

Access to essential medicines and medical products

Ensuring access to medical products is another national priority that aims to balance the availability of quality assured medical products (supply side) with meeting priority public health needs with products that are acceptable and affordable (demand side). Experiences show that local production is growing and diversifying over the years. To ensure a strong linkage between what is produced locally and what improves access, a comprehensive and system-wide approach is needed to bring coherence between industrial, trade and health policies.

So far, there are 62 pharmaceutical industries manufacturing human related medicines, 8 pharmaceutical industries manufacturing medicines for animals and 73 Ayurvedic medicine manufacturing industries in Nepal. There are 390 foreign pharmaceutical industries which are supplying medicines through importers in Nepal. While analysing data of domestic production and import of pharmaceutical products; it has been observed that market share of domestic production is 46%, medicine from India is 52% and other countries medicine is 2%. Specifically, vaccines, biotechnological products, and modern technology related medicines; used for anti-cancer, antiretroviral therapy (ART), critical care are imported5. Further strengthening of local productions of medicines as well as importation require robust regulatory frameworks for registration, licensing, and quality assurance.

Gaps and challenges

Key gaps in the health sector are basically limited capacity of provincial and local governments in implementation of national health policies, strategies and guidelines, wider inequities in health service utilization – especially by poor and vulnerable populations, unequaldistribution of human resources for health, high of out-of-pocket expenditure for health care, monitoring and managing quality and price of medicines and medical products.

The lack of adequate human resources for health in rural areas is a critical barrier to provide basic health services in the remote communities. There are needs to advance equity-based planning by use of data that highlights the need of a targeted approach such as by coverage areas, disease prevalence level, age category and affordability status of the population. This will help consider the specific needs of the gender, disability, and left-behind groups. To facilitate this process, more support is needed to promote health systems research in the high priority areas of health sector.

Therefore, one of the critical challenges is to transform the health system into an efficient and responsive one to people’s needs in the federal context. A more proactive approach is needed to improve human resource management, strengthen the evidence and equity-based planning, safe and people-friendly health infrastructures, ensuring uninterrupted availability of quality medicines and supplies, improving governance, leadership, and accountability, and effectively managing public health emergencies.

More importantly, there is a clear need to reduce a range of persistent health inequalities – based on social, cultural, economic, gender, political, geographical and psychological dimensions, so forth. In this context, people’s voices for health and civil society stance on UHC and commitments need to be further strengthened and institutionalized to address the local context of social inclusion, leave no one behind, and localization of health-related SDGs. Other important considerations include an increased role of civil society in promoting right to health, and reaching the unreached, socially excluded and marginalized groups during health emergencies, disasters or conflicts, as well as health on humanitarian context.

Way forward

In this context, some specific actions that are an urgent need are as follows:

  1. Enhance the implementation capacity at province and local
  2. Address lack of trained human resources for
  3. Strengthen inclusive health systems resilience and community
  4. Ensure meaningful engagement of civil society in reaching the unreached strategy for health care to those who are poor and socially marginalized.
  5. Strengthen localization of UHC and health related
  6. Strategic focus on social protection for poor and socially marginalized
  7. Further build the local capacity to manage the pandemics and
  8. Uphold people’s voices for health and civil society role in the UHC
  9. Scale up whole-of- society and whole- of- government