Family Planning in Asia and the Pacific - International Council on ...

year development plans <strong>and</strong> one three-year developmentplan. The Third Five-year Development Plan (1965-1970)was <strong>the</strong> first to clearly state <strong>the</strong> need for a populationpolicy <strong>in</strong> Nepal. <strong>Family</strong> plann<strong>in</strong>g was considered a crucial<strong>in</strong>strument <strong>in</strong> address<strong>in</strong>g high fertility. At this time, familyplann<strong>in</strong>g was <strong>in</strong>tegrated with maternal <strong>and</strong> child health(MCH). <strong>Family</strong> plann<strong>in</strong>g has always been a part of Nepal’sdevelopment plans <strong>and</strong> has had specific fertility reductionobjectives. (See Box 1 below.)Past achievements <strong>in</strong> familyplann<strong>in</strong>g <strong>and</strong> reproductivehealthThis section conta<strong>in</strong>s a review of key past achievements<strong>and</strong> lessons learned from Nepal’s national family plann<strong>in</strong>g(FP)/reproductive health (RH) programme.The follow<strong>in</strong>g are <strong>the</strong> major achievements s<strong>in</strong>ce 1970:TFR dropped from 6.3 <strong>in</strong> 1976 to 3.1 <strong>in</strong> 2006CPR rose from 2.9 per cent <strong>in</strong> 1976 to 48 per cent<strong>in</strong> 2006, with consistent <strong>in</strong>creases <strong>in</strong> every five-yearperiodMaternal mortality ratio dramatically decreased<strong>and</strong> much of this is attributed to FP, as well as safemo<strong>the</strong>rhood <strong>in</strong>itiativesNeonatal <strong>and</strong> <strong>in</strong>fant mortality decreasedEffective IEC programme encouraged smaller familysize <strong>and</strong> normalized FPKnowledge of FP methods has become nearlyuniversalSecrets of success/lessons learned are as follows:Governmental policies <strong>and</strong> programmes had specificfertility objectivesGovernment was able to establish health delivery<strong>in</strong>frastructure, <strong>in</strong>clud<strong>in</strong>g human resources, but <strong>the</strong>re isa lack of strong management <strong>and</strong> support to supervise<strong>and</strong> fur<strong>the</strong>r <strong>the</strong> programmesIntegration of services at facilities is more efficientCommunity-based distribution programmes, <strong>in</strong>clud<strong>in</strong>gFemale Community Health Volunteers, reachhouseholds <strong>in</strong> rural areasMobile camps for sterilization reach rural areasWide-reach<strong>in</strong>g public IEC campaigns on radio <strong>and</strong>television, as well as posters <strong>and</strong> billboardsSocial market<strong>in</strong>g of contraceptionEfforts to <strong>in</strong>crease education <strong>and</strong> literacy rates forwomen have led to more use of FP; importance given to<strong>in</strong>vest<strong>in</strong>g <strong>in</strong> social <strong>and</strong> economic development, as well asFP/RHCurrent issues <strong>in</strong> <strong>the</strong> nationalprogrammeService delivery<strong>Family</strong> plann<strong>in</strong>g <strong>in</strong>formation <strong>and</strong> services are providedby both <strong>the</strong> public <strong>and</strong> private sectors. The public sectordelivers family plann<strong>in</strong>g through different layers of healthfacilities <strong>in</strong> <strong>the</strong> country. At <strong>the</strong> community level, <strong>the</strong>reare 48,549 Female Community Health Volunteers <strong>in</strong> all75 districts of <strong>the</strong> country. They act as a bridge betweengovernment health services <strong>and</strong> <strong>the</strong> community, <strong>and</strong> <strong>the</strong>yare <strong>the</strong> frontl<strong>in</strong>e local health resource persons who providefamily plann<strong>in</strong>g <strong>and</strong> maternal health <strong>in</strong>formation <strong>and</strong>services. At <strong>the</strong> Village Development Committee level,<strong>the</strong>re are sub-health posts <strong>and</strong> health posts; at <strong>the</strong> area level,<strong>the</strong>re are primary health care centres <strong>and</strong> ilaka (roughlyequivalent to a sub-district) health posts; at <strong>the</strong> districtlevel, <strong>the</strong>re are district public health offices <strong>and</strong> at <strong>the</strong>central level, <strong>the</strong>re is <strong>the</strong> Department of Health Services <strong>in</strong>Kathm<strong>and</strong>u. In addition to public health services, <strong>the</strong>re arehospitals at <strong>the</strong> district, zonal, regional <strong>and</strong> central levels.Long-term methods are available only at hospitals <strong>and</strong> alimited number of health centres <strong>and</strong> selected health postswhere tra<strong>in</strong>ed personnel are available. Sterilization servicesare provided at hospitals, public health-care facilities <strong>and</strong>static sites through scheduled seasonal or mobile outreachservices. In 2005, <strong>the</strong> share of MoHP <strong>in</strong> <strong>the</strong> provisionof contraceptives was 59 per cent, while <strong>the</strong> comparablefigures for social market<strong>in</strong>g <strong>and</strong> FPAN were 25 <strong>and</strong> 16 percent, respectively (see Box 2 below for details).In addition to <strong>the</strong> public sector, several NGOs providefamily plann<strong>in</strong>g services. The largest <strong>and</strong> oldest NGOprovid<strong>in</strong>g family plann<strong>in</strong>g <strong>in</strong> Nepal is FPAN. A majorNGO provid<strong>in</strong>g family plann<strong>in</strong>g services is Marie Stopes<strong>International</strong> (MSI). In addition, <strong>the</strong> Nepal ContraceptiveRetail Store Company, supported by <strong>the</strong> United StatesAgency for <strong>International</strong> Development (USAID), <strong>and</strong>Population Services <strong>International</strong> (PSI) do social mark<strong>in</strong>g<strong>and</strong> distribute contraceptive commodities to <strong>the</strong> public <strong>and</strong>private sectors. Ow<strong>in</strong>g to social market<strong>in</strong>g services, oralcontraceptive pills, condoms <strong>and</strong> <strong>in</strong>jectables are availablefor purchase over <strong>the</strong> counter <strong>in</strong> pharmacy shops.The follow<strong>in</strong>g <strong>in</strong>ternational organizations are <strong>in</strong>volvedwith family plann<strong>in</strong>g <strong>in</strong> Nepal:Adventist Development Relief Agency NepalSave <strong>the</strong> ChildrenUSAID173