Introduction
The chosen country for this assignment in Nepal. Nepal has been selected for this study because of its healthcare model that is offered by both the government and private sectors, ranked poorly on the international understanding, as well as the influence of Asian culture on treatment and modern medicine. These factors would help in exploring poor health provisions and outcomes shown through high mortality rates in both adults and children in Nepal.
Location/Geography
Nepal is a relatively young country following its emancipation from a constitutional monarchy to a democratic state in the year 2008. It is found within the rugged widespread parts of the Himalayas. The Tibet part of China borders the country on the north while India borders Nepal on the west, east and south. In addition, Bhutan is located on the east of Nepal while the Independent Tibet region is located in the northeast of the country (CIA, 2015).
Nepal is to some extent bigger than the Arkansas State in the US, and it measures about 800 km (497 mi) (CIA, 2015). The country has several entry points, but the transport network is generally poor and, therefore, affects the delivery of services. It can be accessed through Chinese entry points, including Renjo La, Kongma La and Cho La while the Indian access points include Bir Gunj, Gunj and Mahendra Nagar. The country has only a single entry point, Lungu La pass that serves both Tibet and Bhutan.
The poor transportation network and the landlocked nature of Nepal have negatively affected service delivery as witnessed during the recent earthquake of 2015.
For several decades, Nepal was isolated from the rest of the world until the early periods of the 1950s. It was only after a major revolt that led to the overthrow of the dictator Rana Dynasty that Nepal emancipated itself and entered into global relations. The country’s capital city is Kathmandu.
Population
According to data obtained from the CIA for the 2011 census, Nepal has approximately 26.5 million people. Currently, the country’s population growth is estimated to be 1.6 percent, which is estimated to be 31 million people with an average age of 21.6 years (CIA, 2015).
Nepal consists of young people with a female average age of 23.6 years while the male average age is 22.2 years. It is estimated that only 4.6 percent of the population are senior citizens (65 years and over), which is about 781,563 women and 668,760 men. Majorities (61 percent) are aged between 15 and 64 years old while the rest (30.72 percent) are aged below 14 years old (CIA, 2015).
The country’s birth rate is about 20.64 births per 1,000 people. The child mortality rate is “39.14 deaths for every 1,000 live births” (CIA, 2015, p. 1). Life expectancy in Nepal is approximate, “67.52 years for the general population, for female is 68.92 years while men’s life expectancy is about 66.18 years” (CIA, 2015). The death rate for Nepal is approximate “6.56 deaths in every 1,000 persons” (CIA, 2015, p. 1). The CIA estimates the net migration rate at “3.86 migrants in every 1,000 persons with about 66 percent of literate people” (CIA, 2015).
Several ethnic groups make up the Nepal population.
Government
The type of government in Nepal is a federal democratic republic with the executive arm and the central government of the country. Before the revolt that ended the monarchy, the Government of Nepal was referred to as Hid Majesty’s Government.
Today, the president is the head of the state with ceremonial functions. The Prime Minister of Nepal is responsible for several functions of the country.
Other arms of the Government of Nepal are the Head of Legislative, Head of Judiciary, Heads of Constitutional Bodies, and Head of Security Services.
Nepal has 14 administrative divisions.
Economy
The Heritage Foundation has noted that Nepal’s economic freedom score has continued to rise because of reforms to curb corruption and enhance business freedom. The country’s monetary freedom has declined. It is ranked 34th among 42 Asia-Pacific countries. This economic score of Nepal is below the global and regional averages.
Majorities of the population have lived in abject poverty for several decades because of the government’s failure to introduce sound economic reforms. Consequently, the country’s economy is merely above the repressed group based on economic freedom indicators.
Nepal has performed poorly in enforcing the rule of the law. Therefore, many potential investors have shunned the country. In addition, the energy supply is poor in Nepal. Nepal has excessive and inhibitive regulations that have deterred even small businesses from joining the main formal market (Heritage Foundation, 2015).
The Heritage Foundation has estimated that the country’s GDP is $42.1 billion with an annual growth rate of 3.6 percent and $1,508 per capita (Heritage Foundation, 2015). The current rate of unemployment stands at 2.7 percent with an inflation rate of 9.9 percent. The foreign direct investment inflow is about $73.6 million.
State of Health (Diseases/Violence/Accidents)
As previously mentioned, the general health condition for Nepal is low. The adult and child mortality rates are high. Common infectious diseases include tuberculosis, Japanese encephalitis, dysentery, typhoid, HIV/AIDS, kala-azar and hepatitis A among others. The World Health Organization had previously predicted a gloomy health status in the country.
There are also nutritional disorders in Nepal.
The recent earthquake showed how Nepal is vulnerable to natural calamities and their subsequent effects, including deaths and severe injuries.
In addition, the WHO has attributed about 2,455 deaths (1.65 percent of all deaths) in Nepal to violence in 2011. It is also imperative to recognize that these deaths do not include deaths associated with acts of terrorism.
Culture/Traditional Medicine
Nepal has adopted oriental traditional medicine. However, in the recent past, Nepal, like other developing nations, has embraced modern medicine. Nevertheless, contradictions between modern medicine and traditional medicine still exist. One major challenge has been integrating the two forms of healthcare practices. Specifically, modern medicine has encountered challenges in Nepal due to three critical reasons. First, it is argued that the modern healthcare system has failed to appreciate the relevance of traditional medicine. Modern health focuses on health education whereas natives prefer curative care and not new knowledge. Second, in some instances, many healthcare providers believe that traditional culture and medicine are barriers to modern healthcare and education. Local practices and beliefs have failed to facilitate the adoption of modern medicine. Finally, Nepal’s traditional medicines and cultural practices continue to dominate rural villages because of deeply rooted healing traditional practices (Shankar, Paudel, & Giri, 2006).
Traditional medicines and healers have been recognized for their therapeutic roles. An effective strategy to enhance healthcare provision in Nepal should embrace traditional medicine and cultures.
Healthcare System and Delivery
Majorities in Nepal lack access to modern care. In addition, socio-economic challenges and geographical features have contributed to healthcare disparities. The Government of Nepal provides more than two-thirds of healthcare services in the country.
Governmental Health-Related Agencies
The Nepal healthcare model consists of the Department of Health Services (DoHS) and the Ministry of Health (MoH). The primary purpose of DoHS is to enhance care delivery, preventive care, curative and promote healthcare services throughout the country. The Department and related agencies have several health-related roles.
Healthcare Personnel
Nepal’s healthcare system is poor because of few nurses and doctors. In 2012, the OECD estimated that there were 0.2 doctors for every 1,000 people in Nepal (OECD, 2012). This estimate was obtained in 2004. Clearly, the size of doctors and nurses in Nepal has negative effects on healthcare outcomes.
Nursing Education System and Accrediting Organizations
Nurses in Nepal are referred to as Associate Nurse Midwife or equivalent of licensed nurses in the US. Nursing students take two years to complete training to become ANM. Today, Nepal has fewer programs for ANM.
Nepal hospitals normally take their nurses through a three-year program referred to as Proficiency Certificate Level (PLC).
PLC nurses may acquire further education and become nurses with bachelor, which takes two years. Bachelor of Science in Nursing is relatively new in Nepal, but nurses must have at least some years to be considered for the program.
Nursing Associations
Nepali Nursing Council is the accreditation and governing body of nursing in Nepal. In addition, nurses belong to a body known as the Nursing Association of Nepal, which is a member of the International Council of Nurses.
Health Priorities
The Government of Nepal has expressed its commitment to serve all healthcare needs of the public through annual reports (Government of Nepal, 2015). However, some specific areas of concern for the government have been “family health, family planning, child health, infectious disease control, eradication of malnutrition, control of AIDS and STDs” (Government of Nepal, 2015). In addition, other infectious diseases and communicable diseases, including kala-azar and malaria have been significant areas of concern.
The Government has recognized high rates of poverty, illiteracy, doctor and nurse numbers and physical geographical barriers. Consequently, it has developed a referral hierarchy to facilitate access to healthcare services. Hence, majorities can get affordable care and minor services. These referral hierarchies offer support mechanisms at the grassroots levels (Government of Nepal, 2015).
Conclusion: Nursing Implications
For a country that has poor healthcare services and inadequate resources like Nepal, nurses face daunting tasks. Nurses, however, have opportunities to improve care provision in Nepal by addressing priority areas.
Nurse education is imperative for the healthcare system in the country. The OECD shows that Nepal has an unacceptable number of nurses. Thus, further education will help nurses acquire the right competencies and skills for their jobs.
Nurses can change the nursing profession through advocacy and strong leadership. Resources are inadequate in Nepal. In addition, the geographical barrier has negatively affected healthcare services in the country. Only adequate resources can help nurses address priority areas in healthcare in Nepal.
Nurses should be innovative, use limited resources for maximum positive outcomes and develop models that meet the unique challenges of the Nepal healthcare system.
The need to inculcate traditional medicine and cultural practices in modern healthcare is important for nurse practitioners. Rural folks have continued to ignore modern medicine because of ignorance and cultural beliefs. Therefore, nurses should provide patient education and work with community leaders to overcome barriers to modern healthcare in rural Nepal regions.
References
CIA. (2015). The World Factbook: Nepal. Web.
Government of Nepal. (2015). Department of Health Services: Annual Report 2070/71 (2013/2014). Web.
Heritage Foundation. 2015 Index of Economic Freedom: Nepal. Web.
OECD. Health at a Glance: Asia/Pacific 2012 . Web.
Shankar, R. P., Paudel, R., & Giri, B. R. (2006). Healing traditions in Nepal. Web.