Nepal Millennium Development Goals 4, 5 & 6: Countdown to 2015

[Editorial] PHP Volume 3 Issue 9 Sep 2013 -

The countdown to Millennium Development Goals (MDGs) 2015 is approaching closer. The Government of Nepal and the United Nations country team Nepal has thus recently released a 'Nepal Millennium Development Goals Progress Report 2013' to assess progress and identify remaining gaps. On the basis of this progress report, considering the three health related goals (Goals 4, 5 & 6), a glimpse of what has been achieved, what is achievable and what is unlikely to be achieved by 2015 is presented in this editorial.

The majority of the health-related MDGs have already been achieved, or are on track to being achieved, with the exception of two indicators in MDG 5, the contraceptive prevalence rate and the unmet need for family planning; and one indicator in MDG 6, the proportion of the population with advanced HIV receiving Antiretrovial Combination Therapy (ART).

The MDG 5 target 'reduce maternal mortality by three quarter' and the MDG 6 target 'have halted and begun to reverse the incidence of malaria and other diseases' have already been achieved.

The MDG 4 (reduce child mortality), MDG 5 (improve maternal health) target 'achieve universal access to reproductive health' and MDG 6 targets viz. 'have halted and begun to reverse the spread of HIV/AIDS' and 'achieve universal access to treatment for HIV/AIDS' are likely to be achieved.

The childhood mortality declined markedly over the past 20 years, between 1990 and 2011. The Infant Mortality Rate (IMR) declined from 108 to 46 and the Under-Five Child Mortality Rate (U5MR) from 162 to 54 per 1,000 live births. However, still one in 22 Nepali children dies before the age of one year and one in 19 before he or she turns five years of age. While Neonatal Mortality Rate (NMR) did drop considerably between 2001 and 2006, from 43 to 33 per 1,000, it did not decline and further between 2006 and 2011. 

In fact, the target for the U5MR, 54 per 1,000 live births, was achieved in 2011 and a new target, 38, set. The IMR target was also lowered, to 32, although just reaching the original target of 36 will require increasing the rate of decline. Besides, the present rates of decline of Nepal's IMR and U5MR cannot be sustained unless the rate of decline of the NMR is increased.

The proportion of one year-old children immunized against measles through routine immunization has more than doubled in the last two decades, from 42 % in 1990 to 88 % in 2011, and is on track to meet the 2015 target of more than 90 %. However, its progress is not uniform. The disparities in access to measles vaccinations in terms of gender, consumption quintiles, rural-urban settings, and ecological and development regions continue to persist.



At the national level, the Contraceptive Prevalence Rate (CPR) did not increase between 2005 and 2010. Actually, it dropped slightly from 44.2 to 43.2 % after increasing significantly from 35.4 % in 2000. The unmet need for family planning among married women of reproductive age increased from 24.6 % in 2005 to 27 % in 2011. Given that the current CPR is less than 50 %, achieving the MDG of 67 % by 2015 will be a major challenge requiring great innovation. It is also unlikely that the rate of unmet need, which is currently about one-quarter.

The proportion of pregnant women who made a first Antenatal Care (ANC) visit increased from 48.5 % in 2000 to 73.7 % in 2005 to 85 % in 20111. While rates increased drastically from 14 % in 2000 to 29.4 % in 2005, still in 2011 only about half of the mothers who made a first ANC visit made a fourth.

The MDG for HIV prevalence among adults aged 15-49 years was achieved in 2011. The drop of HIV prevalence among men and women aged 15-24 years from 0.15 to 0.12 % between 2006 to 2011 signaled achievements of the goal. Nearly 66 % of youths aged 15-24 used a condom during their last high-risk sexual encounter while only 30 % of this population has comprehensive knowledge of HIV/AIDS. 

As of 2012, the estimated number of adult and children with advanced HIV infections was 26,876, of whom only 7,719 (28.7 %) were receiving ART. It will be very difficult to achieve the MDG goal for ART, 80 %, by 2015 since most of the current programs are supported by external funds, which may not be forthcoming in the future.